MRI may offer a valuable alternative imaging method to diagnosing acute pyelonephritis without exposing patients to ionizing radiation or iodinated CT contrast. Our retrospective study evaluates the accuracy of 4 characteristic MRI findings in diagnosing acute pyelonephritis: (1) T2 hyperintense perinephric edema, (2) loss of corticomedullary differentiation on T2 images, (3) striated nephrogram on contrast-enhanced images, and (4) parenchymal restricted diffusion. Analysis of 108 MRI exams demonstrated that each of the 4 MRI findings was a significant predictor of pyelonephritis. Furthermore, assessing all 4 findings together provided a greater improvement in diagnostic accuracy when compared to any individual finding alone.
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