MRI運用於K他命相關尿路症狀之評估
吳怡萱1,2、詹鎮豪2、石明誠3、李永進1,2、李經家2、吳文正2,4、阮雍順2,4
1高雄市立小港醫院 泌尿科
2高雄醫學大學附設醫院 泌尿部
3高雄醫學大學附設醫院 影像科
4高雄市立大同醫院 泌尿科
Magnetic resonance urography for evaluation of ketamine-associated uropathy
Yi-Hsuan Wu1,2, Jhen-Hao Jhan2, Paul Ming - Chen Shih3, Yung-Chin Lee1,2, Ching-Chia Li1,2, Wen-Jeng Wu2,4, Yung-Shun Juan2,4
1Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
3Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
4Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
Purpose: The aims of this study were to investigate the presence and distribution of ketamine-associated uropathy, to determine the predictors of hydronephrosis, and to check clinical and imaging correlation by reviewing magnetic resonance urography (MRU) images.
Methods: MRU examinations were performed in 20 patientsdiagnosed with ketamine-associated uropathy between 2015 and 2016 at our institution. The MRU protocols included static-fluid T2-weighted sequences, and excretory T1-weighted sequences (excretory MRU) after contrast administration to detect lesions of the kidneys and collecting system. The patients' age, gender, Visual Analogue Scale (VAS), ketamine exposure time and MRU features were recorded retrospectively.
Results: A total of 20 patients participated in this study. The average age was 29.3 and average ketamine exposure time was 97.6 months. The average thickness of bladder wall and ureter were 0.36 cm and 0.27 cm. Eight patients (40%) had perivesical inflammation and ten patients (50%) had hydronephrosis, including four patients with unilateral hydronephrosis and six patients with bilateral hydronephrosis. Logistic regression revealed the VAS and ureteral wall thickening were associated with hydronephrosis (p=0.005 and 0.037). VAS was also independently associated with poor renal function (p<0.001). Longer ketamine exposure time was not a significant risk factor for hydronephrosis or poor renal function.
Conclusions: MRU images can provide details of ketamine-associated uropathy and allow physicians to identify the involvement of upper urinary tract. Patients with higher VAS are at risk for hydronephrosis and renal function deterioration.