Workshops 1–3

Magnetic resonance (MR) urography has an expanding role as a problem solving tool in treated cancer. Hydronephrosis is common with abdominopelvic neoplasms and whilst the majority are satisfactorily investigated by urography, ultrasound (US), computed tomography (CT), invasive imaging or endourological techniques, some hydronephroses remain unexplained. These may occur in patients with renal impairment, contrast allergy, poor performance status or who pose problems with instrumentation or cannulation of the urinary tract. A simple, rapid and effective technique combines overview heavily T2-weighted images of the urinary tract, e.g. single shot fast spin echo (SSFSE) which allow identification of the point of obstruction followed by high resolution T2-weighted images in two orthogonal planes through this region of interest. The study requires no patient preparation as it relies upon intrinsic contrast between obstructed urine and soft tissues. A duration of 20 min or less is well tolerated by even sick patients. MR urography has a more limited role in the diagnosis of primary tumours of the urothelium but again may be useful when contrast or CT urography is contraindicated or non-diagnostic. T2-weighted techniques are able to identify obstructing or structuring lesions. There are more limited data for the use of MR urography to diagnose small urothelial tumours in the upper tracts but it appears that even contrast enhanced MR excretory urography lacks the detail of traditional X-ray urography. Finally, MR urography may be applied as a rapid non-invasive method of investigation of urinary incontinence or suspected fistulation in the treated cancer patient.