Preliminary Diagnosis: Cystitis (Bacterial)
I. What imaging technique is first-line for this diagnosis?
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Bacterial cystitis is usually diagnosed clinically (anamnesis, signs/symptoms, chemical testing, and urine culture), but imaging has a role in cases of recurrent infections or complications.
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Ultrasound (eventually extended to kidneys and the collecting system) is the first line imaging study of choice.
II. Describe the advantages and disadvantages of this technique for diagnosing cystitis.
Advantages
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Allows direct visualization of diffuse (mucosal thickening and cobblestone appearance) and focal alterations of the bladder wall and surrounding perivesical tissues (stranding of perivesical fat)
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Allows an evaluation of bladder volume before and after urination to assess reduced capacity
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May also diagnose proximal or distal obstructions to urine flow
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May eventually demonstrate renal morphologic alterations and focal lesions of the kidneys
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May assess secondary signs of collecting system obstruction, such as hydroureter and hydronephrosis
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Is a relatively inexpensive and portable imaging modality that does not use ionizing radiation
Disadvantages
In case of evaluating the collecting system, the visualization of its entire course is limited due to overlying bone, bowel gas, and depth of structures.
III. What are the contraindications for the first-line imaging technique?
No significant contraindications exist.
IV. What alternative imaging techniques are available?
MR urography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing cystitis.
Advantages
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Dynamic MRI examination may demonstrate alterations in renal parenchymal enhancement and presence of diffuse and focal alterations of the kidneys, ureters, or bladder.
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Excretory phase acquisitions allow exquisite visualization of renal pelvis, ureters, and bladder.
Disadvantages
Cost.
VI. What are the contraindications for the alternative imaging techniques?
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Contraindicated in patients with non-MR compatible metallic (ferromagnetic) hardware or foreign bodies, or those who are uncooperative or claustrophobic.
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Must assess underlying clinical conditions before administration of IV contrast, including prior known anaphylaxis to gadolinium-based contrast media or renal insufficiency.
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