Publications

Aims This study aims to evaluate the (a) accuracy of conventional and diffusion-weighted-imaging (DWI) sequences in the
diagnosis of acute pyelonephritis and (b) minimum apparent diffusion coefficient (ADC) values for the diagnosis of acute
pyelonephritis and the differentiation of renal abscesses from acute pyelonephritis.
Materials and methods Ultrasound, conventional MRI sequences, and DWI were used to evaluate the kidneys in 68 patients
suspected to have acute pyelonephritis. Multiple similar regions of interest (ROIs) were placed over the renal parenchyma
with visually identifiable diffusion restriction, over the non-diffusion-restricted renal parenchyma of affected kidneys and
over the normal kidneys. Corresponding minimum ADCs were noted for analysis. Pyelonephritis was confirmed based on
clinical criteria, laboratory findings, and by resolution/development of known complications of pyelonephritis.
Result DWI showed the highest sensitivity(100%), while DWI read with T2-weighted imaging (both being positive) showed
the highest specificity(100%) for the diagnosis of acute pyelonephritis in our population with a high baseline creatinine.
The minimum-ADC of the nephritic diffusion-restricted area in patients with confirmed pyelonephritis was significantly
lower than the minimum-ADC in patients without pyelonephritis [(0.934±0.220, mean±SD) vs (1.804±0.404)× ­10−3 s/
mm2
] (p<0.001). ROC cut-off of minimum-ADC for the diagnosis of acute pyelonephritis was 1.202× ­10−3 s/mm2
(area
under curve 0.978). The minimum-ADC of the abscesses were significantly lower when compared to the minimum-ADC of
the nephritic diffusion-restricted portion of the same kidney [(0.633±0.248) vs (0.850±0.191)× ­10−3 s/mm2

] (p<0.001).
Conclusion DWI is an excellent stand-alone imaging tool that can be combined with conventional sequences for the diagnosis
of APN even in patients with high serum-creatinine or other contraindications to intravenous contrast. Further, ADC values
can be used to differentiate between renal abscesses and uncomplicated pyelonephritis.