The added benefit of an excretory phase from any CTU image acquisition protocol is likely negligible with respect to detection and characterization of APN in this patient cohort. DMSA Renal Scan DMSA renal scintigraphy is not beneficial in the imaging evaluation for suspected APN in a patient with a pelvic renal transplant and native kidneys in situ [15]. Fluoroscopy Antegrade Pyelography Antegrade pyelography is not beneficial in the imaging evaluation for suspected APN in a patient with a pelvic renal transplant and native kidneys in situ [15]. Fluoroscopy Voiding Cystourethrography VCUG is not beneficial in the imaging evaluation for suspected APN in a patient with a pelvic renal transplant and native kidneys in situ [15]. Acute Pyelonephritis MRI Abdomen and Pelvis There is limited literature on the use of MRI of the abdomen and pelvis in the evaluation of suspected APN in a patient with a pelvic renal transplant and native kidneys in situ. APN is rare in native kidneys. However, APN of a renal allograft is more common, and renal transplant recipients are at high risk for complications from a variety of factors, including immunosuppression [52]. In a p rospective study of renal transplant recipients with suspected APN (n = 5 6), contrast-enhanced MRI was positive in 66% (37/56) of patients [53] . In a small retrospective study of 24 kidney transplant recipients who underwent MRI without IV contrast and had clinical suspicion of APN, 9 2% (22/24) of patients had positive findings on MRI, specifically on DWI and ADC images [54]. Studies in ad ult patients without renal transplants hav e shown that DWI can be useful in the diagnosis of uncomplicated pyelonephritis [28-30]. APN, renal abscesses, and pyonephrosis have lower ADC values than normal renal cortical parenchyma [28]. As such, DWI and ADC provide a viable alternative to contrast-enhanced MRI or CT [30].
Acute Pyelonephritis. The added benefit of an excretory phase from any CTU image acquisition protocol is likely negligible with respect to detection and characterization of APN in this patient cohort. DMSA Renal Scan DMSA renal scintigraphy is not beneficial in the imaging evaluation for suspected APN in a patient with a pelvic renal transplant and native kidneys in situ [15]. Fluoroscopy Antegrade Pyelography Antegrade pyelography is not beneficial in the imaging evaluation for suspected APN in a patient with a pelvic renal transplant and native kidneys in situ [15]. Fluoroscopy Voiding Cystourethrography VCUG is not beneficial in the imaging evaluation for suspected APN in a patient with a pelvic renal transplant and native kidneys in situ [15]. Acute Pyelonephritis MRI Abdomen and Pelvis There is limited literature on the use of MRI of the abdomen and pelvis in the evaluation of suspected APN in a patient with a pelvic renal transplant and native kidneys in situ. APN is rare in native kidneys. However, APN of a renal allograft is more common, and renal transplant recipients are at high risk for complications from a variety of factors, including immunosuppression [52]. In a p rospective study of renal transplant recipients with suspected APN (n = 5 6), contrast-enhanced MRI was positive in 66% (37/56) of patients [53] . In a small retrospective study of 24 kidney transplant recipients who underwent MRI without IV contrast and had clinical suspicion of APN, 9 2% (22/24) of patients had positive findings on MRI, specifically on DWI and ADC images [54]. Studies in ad ult patients without renal transplants hav e shown that DWI can be useful in the diagnosis of uncomplicated pyelonephritis [28-30]. APN, renal abscesses, and pyonephrosis have lower ADC values than normal renal cortical parenchyma [28]. As such, DWI and ADC provide a viable alternative to contrast-enhanced MRI or CT [30].