Brandt AS, Kamper L, Kukuk S, Piroth W, Haage P, Roth S. An aid to decision-making in therapy of retroperitoneal fibrosis: dynamic enhancement analysis of gadolinium MRI.
J Clin Med Res 2013;
5:49-56. [PMID:
23390476 PMCID:
PMC3564568 DOI:
10.4021/jocmr1254e]
[Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/05/2022] Open
Abstract
Background
Idiopathic retroperitoneal fibrosis (IRF) as an uncommon cause of obstructive uropathy is often primarily treated medically by the attending urologist. We evaluated dynamic enhancement analysis (DEA) as a possible predictor of response to medical treatment and for treatment monitoring.
Methods
From 2007, 24 patients with fibrosis were assessed by magnetic resonance imaging (MRI) with DEA. The dynamic enhancement quotient (DEQ) was measured before therapy with prednisone (n = 12) or tamoxifen (n = 12) and in follow-up investigations after 3 and 6 months. Response to medical treatment was recorded by changes in the retroperitoneal mass on MRI and possible relief of ureteral obstruction, which was monitored by intravenous pyelogram and/or MAG3 scan after removal of DJ stents.
Results
Treatment groups did not differ significantly as to age, gender, or laboratory values, and response to medical treatment showed no significant difference between agents. Overall there were no cases of progression, 2 cases of stable disease, 11 cases of mild fibrotic regression, and 11 of significant or complete regression. DJ stents could successfully be removed in 21 of 35 renal units (60.0%). In a total of 61 DEAs the DEQ was significantly higher (P < 0.001) in patients with a good response (DEQ = 4.02) than in those with an average response (3.11) or none (2.14).
Conclusions
DEA was able to distinguish between patients with different response rates to medical treatment of IRF and may be useful to individualize therapeutic decision-making.
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