In MR urethrography, high-resolution images in multiple planes are obtained along the entire course of the urethra. Imaging may be performed with varying degrees of bladder distention, with intravenous contrast, and even in relation to voiding. Resulting data permit diagnosis or exclusion of urethral diverticulum with a high degree of confidence.
Previously, patients with suspected urethral diverticulum were forced to undergo invasive procedures such as voiding cystourethrograms (VCUG), with substantial radiation dose. They can now be imaged safely and painlessly. Furthermore, MR urethrography permits visualization of extraluminal pathology that is invisible to competing technologies such as cystoscopy and VCUG. Cystoscopy remains indispensable for evaluation of the bladder mucosa.
Patient Selection and Indications
A urethral diverticulum may result in a range of troublesome yet nonspecific symptoms. If left untreated, a urethral diverticulum may lead to serious complications including infection, stone formation, and malignancy. The symptoms include:
- urinary frequency
- urinary urgency
- urinary incontinence or post-void dribbling
- vaginal pain
- palpable anterior vaginal mass or recurrent swelling
- recurrent urinary tract infections
Difficulty imaging the urethra had previously contributed to delay in diagnosis, sometimes leading to invasive procedures and unnecessary surgeries. Furthermore, MR urethrography can diagnose overlapping pathology such as Bartholin’s gland cysts or Gartner’s duct cysts. Finally, in patients with a known lesion or pathology, MR urethrography may assist in surgical planning.
Standard MRI Precautions should be employed. No other patient preparation is necessary.
Gadolinium may be given to assess vascularity, the presence of granulation tissue, and to help exclude tumor. It is indicated in patients with a history of hematuria, prior malignancy, or chronic infections. In patients allergic to gadolinium or in those with renal failure who are at risk for NSF, a non–contrast version of the study can be performed.
The majority of the test is performed with the patient free breathing, but breath holds of short duration may be required depending on the patient’s body habitus and degree of pelvic motion with normal respiration.
Reporting and Outcomes
By using high magnetic field strengths up to 3 Tesla as well as specialty MRI coils, Wellstar can offer higher resolution images without prolonging scan times. By obtaining detailed patient histories before each examination, we can select the most specialized protocol to address the clinical question. Quantum radiology’s strong relationship with referring clinicians from obstetricians and gynecologists, to urologists, and colorectal surgeons enables us to cater to their specific concerns, correlate imaging findings with surgical pathology, and continually improve our performance.
MRI provides soft-tissue contrast superior to competing modalities. It provides an extremely sensitive depiction of fluid and edema. The addition of Gadolinium increases detection of subtle inflammation and small masses, and allows assessment of multiple vascular phases.
As other portions of the pelvis are imaged during MR Urethrography, pathology in other organs may often be detected incidentally. A comprehensive report detailing findings in the pelvis and in the urethra is provided to the referring clinician. If urgent findings are encountered, these are relayed in real time by telephone. A copy of the examination and report is furnished to the patient upon request. The exam may also be reviewed directly with the radiologist in the radiology department at a Wellstar facility.