MRI abdomen and pelvis without and with IV contrast is defined as any protocol not specifically tailored for evaluation of the upper and lower urinary tracts, without both the precontrast and excretory phases and without heavily T2-weighted images of the urinary tract, as is the case for MRU. US Abdomen with IV Contrast Prior studies show promise regarding the potential role of contrast-enhanced ultrasound (US) for the initial diagnosis and follow-up of patients with complicated acute pyelonephritis [20-22]. Using CT as a reference standard, Mitterberger et al [22] demonstrated a sensitivity of 98% and a specificity of 100% for contrast-enhanced US in the diagnosis of acute pyelonephritis in 100 patients. Its use in current mainstream practice remains limited, however, with only recent FDA approval for abdominal imaging applications. Recurrent Lower Urinary Tract Infections in Females Discussion of Procedures by Variant Variant 1: Recurrent lower urinary tract infections in a female. Uncomplicated with no underlying risk factors. In women with recurrent uncomplicated UTIs, cystoscopy and imaging are not routinely used [1]. Lawrentschuk et al [23] showed that women with no risk factors for UTI had a negative predictive value of 93% for normal cystoscopy. Prior series have demonstrated a low yield of nonincidental findings in those patients with a low pretest probability of complicated UTI [1,24]. CT Abdomen and Pelvis There are no specific guidelines recommending imaging studies in women who have recurrent UTIs but no known underlying medical or anatomic conditions [6,25]. As such, CT is not generally performed for evaluation of uncomplicated UTI. CT Pelvis with Bladder Contrast (CT Cystography) There are no specific guidelines recommending imaging studies in women who have recurrent UTIs but no known underlying medical or anatomic conditions [6,20]. As such, CT cystography is not generally performed for evaluation of uncomplicated UTI.
Recurrent Lower Urinary Tract Infections in Females. MRI abdomen and pelvis without and with IV contrast is defined as any protocol not specifically tailored for evaluation of the upper and lower urinary tracts, without both the precontrast and excretory phases and without heavily T2-weighted images of the urinary tract, as is the case for MRU. US Abdomen with IV Contrast Prior studies show promise regarding the potential role of contrast-enhanced ultrasound (US) for the initial diagnosis and follow-up of patients with complicated acute pyelonephritis [20-22]. Using CT as a reference standard, Mitterberger et al [22] demonstrated a sensitivity of 98% and a specificity of 100% for contrast-enhanced US in the diagnosis of acute pyelonephritis in 100 patients. Its use in current mainstream practice remains limited, however, with only recent FDA approval for abdominal imaging applications. Recurrent Lower Urinary Tract Infections in Females Discussion of Procedures by Variant Variant 1: Recurrent lower urinary tract infections in a female. Uncomplicated with no underlying risk factors. In women with recurrent uncomplicated UTIs, cystoscopy and imaging are not routinely used [1]. Lawrentschuk et al [23] showed that women with no risk factors for UTI had a negative predictive value of 93% for normal cystoscopy. Prior series have demonstrated a low yield of nonincidental findings in those patients with a low pretest probability of complicated UTI [1,24]. CT Abdomen and Pelvis There are no specific guidelines recommending imaging studies in women who have recurrent UTIs but no known underlying medical or anatomic conditions [6,25]. As such, CT is not generally performed for evaluation of uncomplicated UTI. CT Pelvis with Bladder Contrast (CT Cystography) There are no specific guidelines recommending imaging studies in women who have recurrent UTIs but no known underlying medical or anatomic conditions [6,20]. As such, CT cystography is not generally performed for evaluation of uncomplicated UTI.