Diffusion-weighted imaging and apparent diffusion coefficient values versus contrast-enhanced MR imaging in the identification and characterisation of acute pyelonephritis.

OBJECTIVE: To compare contrast-enhanced (CEMR) and diffusion-weighted (DWI) magnetic resonance imaging in diagnosing acute pyelonephritis (APN) and to assess ADC measurement reliability in differentiating among normal renal parenchyma, APN and abscesses.
METHODS: Eighty-eight patients (80 women, mean age 36.5 years) with clinical suspicion of APN were retrospectively reviewed. An experienced observer quantified lesions with a score ranging from 0 to 3. DWI and CEMR were compared on the basis of the assigned score, total examination number (88) and on presence (36)/absence (52) of abscesses. ADC values, calculated at the healthy parenchyma, APN and abscessed were compared to each other.
RESULTS: Agreement between CEMR and DWI was 94.3 % (83/88 patients; P < 0.05). In the APN group, DWI was awarded the highest visibility score compared to CEMR (P = 0.05), while in the abscess group CEMR had the highest score (P = 0.04). The difference between ADC values of the APN-healthy parenchyma and abscess-APN groups was significant (P < 0.05). The area under the ROC curve of ADC values of the APN-healthy and abscess-APN groups were found to be 0.94 (95 % CI; cutoff value = 2) and 0.78 (95 % CI; cutoff value = 1.2) respectively.
CONCLUSIONS: Diffusion-weighted imaging appears reliable in the diagnosis and follow-up of acute pyelonephritis and could provide a reasonable alternative to contrast-enhanced magnetic resonance imaging.