MR Imaging of the Upper Urinary Tract: Techniques, Diagnostic Performance, and Imaging Biomarkers
Abstract
MRI has become an increasingly important modality for evaluating the upper urinary tract. Although CT urography remains the standard imaging modality for assessing hematuria, MRI offers distinct advantages, including superior soft-tissue contrast, functional imaging capability, and a radiation-free evaluation, making it particularly valuable in certain clinical scenarios. This review provides a comprehensive overview of MRI of the upper urinary tract, with a focus on upper tract urothelial carcinoma (UTUC). Optimized MRI techniques, including T2-weighted imaging, MR urography, diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted imaging, are discussed with respect to their complementary roles in tumor detection, characterization, and local staging. MRI findings of UTUC are summarized, emphasizing the role of DWI in improving tumor detection and assessing renal parenchymal invasion. Beyond UTUC, the review addresses MRI features of non-UTUC neoplastic lesions, infectious and inflammatory diseases, and congenital anomalies of the upper urinary tract, underscoring the value of MRI in differential diagnosis. We discuss the potential role of MRI-derived imaging biomarkers, focusing on apparent diffusion coefficient measurements as noninvasive indicators of tumor aggressiveness and invasiveness. We also introduce emerging radiomics approaches as promising, albeit investigational, tools. As technical innovations continue and clinical evidence grows, the role of MRI in the personalized evaluation and management of upper urinary tract diseases is expected to expand.
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BibTeX
@article{nakamoto2026imaging,
title = {{MR Imaging of the Upper Urinary Tract: Techniques, Diagnostic Performance, and Imaging Biomarkers}},
author = {Atsushi Nakamoto and Takashi Ota and Hideyuki Fukui and Toru Honda and Kengo Kiso and Koki Kaketaka and Takumi Tanigaki and Eriko Yoshidome and Feier Ding and Ryo Hirooka and Hiromitsu Onishi and Masatoshi Hori and Noriyuki Tomiyama},
journal = {Magnetic Resonance in Medical Sciences},
year = {2026},
month = jul,
doi = {10.2463/mrms.rev.2026-0011},
url = {https://www.jstage.jst.go.jp/article/mrms/25/3/25_rev.2026-0011/_article},
note = {CC BY},
}
RIS
TY - JOUR
TI - MR Imaging of the Upper Urinary Tract: Techniques, Diagnostic Performance, and Imaging Biomarkers
AU - Atsushi Nakamoto
AU - Takashi Ota
AU - Hideyuki Fukui
AU - Toru Honda
AU - Kengo Kiso
AU - Koki Kaketaka
AU - Takumi Tanigaki
AU - Eriko Yoshidome
AU - Feier Ding
AU - Ryo Hirooka
AU - Hiromitsu Onishi
AU - Masatoshi Hori
AU - Noriyuki Tomiyama
PY - 2026
DA - 2026/07/14
JO - Magnetic Resonance in Medical Sciences
DO - 10.2463/mrms.rev.2026-0011
UR - https://www.jstage.jst.go.jp/article/mrms/25/3/25_rev.2026-0011/_article
AB - MRI has become an increasingly important modality for evaluating the upper urinary tract. Although CT urography remains the standard imaging modality for assessing hematuria, MRI offers distinct advantages, including superior soft-tissue contrast, functional imaging capability, and a radiation-free evaluation, making it particularly valuable in certain clinical scenarios. This review provides a comprehensive overview of MRI of the upper urinary tract, with a focus on upper tract urothelial carcinoma (UTUC). Optimized MRI techniques, including T2-weighted imaging, MR urography, diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted imaging, are discussed with respect to their complementary roles in tumor detection, characterization, and local staging. MRI findings of UTUC are summarized, emphasizing the role of DWI in improving tumor detection and assessing renal parenchymal invasion. Beyond UTUC, the review addresses MRI features of non-UTUC neoplastic lesions, infectious and inflammatory diseases, and congenital anomalies of the upper urinary tract, underscoring the value of MRI in differential diagnosis. We discuss the potential role of MRI-derived imaging biomarkers, focusing on apparent diffusion coefficient measurements as noninvasive indicators of tumor aggressiveness and invasiveness. We also introduce emerging radiomics approaches as promising, albeit investigational, tools. As technical innovations continue and clinical evidence grows, the role of MRI in the personalized evaluation and management of upper urinary tract diseases is expected to expand.
SN - 1880-2206
SN - 1347-3182
ER -