There was no significant difference in the accuracy of the triphasic abdominal CT relative to nephrographic phase alone [22]. Thereby, detection of urothelial stones is similar with unenhanced and contrast-enhanced CT. CT Abdomen CT of the abdomen without IV contrast has high accuracy for detection or renal stones, and CT of the abdomen with IV contrast has high accuracy for the diagnosis of APN. However, CT of the abdomen alone does not allow for a comprehensive assessment of the entire genitourinary tract [1,8,14-21]. CT imaging should include the pelvis to detect potential pelvic abnormalities including urolithiasis in the distal ureters or urinary bladder, congenital abnormalities of the distal ureters and abnormal insertion sites, and abnormalities of the urinary bladder, among other potential sources of APN. CTU CTU There is insufficient evidence to support the use of CTU for detection of suspected APN in the complicated patient. There is variability in the CTU imaging technique. 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 a complicated patient. DMSA Renal Scan CT may have higher accuracy than DMSA renal scintigraphy for detection of APN and certainly has higher accuracy for detection of stones, which cannot be directly visualized by renal scintigraphy [24]. Fluoroscopy Antegrade Pyelography Antegrade pyelography is not beneficial in the imaging evaluation for suspected APN in a patient with a history of renal stones or renal obstruction [15]. Fluoroscopy Voiding Cystourethrography VCUG is not beneficial in the imaging evaluation for suspected APN in a patient with a history of renal stones or renal obstruction [15].
Acute Pyelonephritis. There was no significant difference in the accuracy of the triphasic abdominal CT relative to nephrographic phase alone [22]. Thereby, detection of urothelial stones is similar with unenhanced and contrast-enhanced CT. CT Abdomen CT of the abdomen without IV contrast has high accuracy for detection or renal stones, and CT of the abdomen with IV contrast has high accuracy for the diagnosis of APN. However, CT of the abdomen alone does not allow for a comprehensive assessment of the entire genitourinary tract [1,8,14-21]. CT imaging should include the pelvis to detect potential pelvic abnormalities including urolithiasis in the distal ureters or urinary bladder, congenital abnormalities of the distal ureters and abnormal insertion sites, and abnormalities of the urinary bladder, among other potential sources of APN. CTU CTU There is insufficient evidence to support the use of CTU for detection of suspected APN in the complicated patient. There is variability in the CTU imaging technique. 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 a complicated patient. DMSA Renal Scan CT may have higher accuracy than DMSA renal scintigraphy for detection of APN and certainly has higher accuracy for detection of stones, which cannot be directly visualized by renal scintigraphy [24]. Fluoroscopy Antegrade Pyelography Antegrade pyelography is not beneficial in the imaging evaluation for suspected APN in a patient with a history of renal stones or renal obstruction [15]. Fluoroscopy Voiding Cystourethrography VCUG is not beneficial in the imaging evaluation for suspected APN in a patient with a history of renal stones or renal obstruction [15].