Ureteric jets, also known as ureteral jets, are the visualization of the normal physiological periodic efflux of urine from the distal end of each ureter into the bladder.
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Pathology
When the urine passing down the ureter reaches the vesicoureteric junction (VUJ), it is forced out into the bladder via a strong contraction of the smooth muscle of the ureter.
Radiographic features
Ureteric jets can be seen on most modalities, including grey scale ultrasound, color Doppler ultrasound, CT, MRI, fluoroscopy and nuclear medicine studies.
In addition, ureteric jets can be visualized during direct cystoscopy by the observation of colored dye (historically it was indigo carmine) being expelled from the ureter into the bladder.
Ultrasound
Grey scale ultrasound of the bladder demonstrates a short burst of low level echoes being emitted from the VUJ into the bladder.
Color Doppler
The speed of expulsion of the urine from the VUJ is high enough that a frequency shift occurs. Therefore the jet can be appreciated on a color Doppler study as a sudden burst of color in the bladder lasting for a few seconds 2,3.
Physiologic ureteral jets in well-hydrated patients should usually occur twice or more per minute, course anteromedially from the trigone, and traverse the patient's midline. Ureteric obstruction, especially when severe, may obliterate or divert the orientation of the ipsilateral ureteric jet. Shortening of the jet duration (normal jet duration is 6 seconds or more) is thought to be suggestive of partial ureteric obstruction.
A large amount of work has been done showing that the distinct waveforms of the ureteric jets may themselves have significance 2. The use of pulsed wave Doppler allows determination of the maximal jet velocity (Vmax), with values consistently below 19.5 cm/s suggestive of obstructive uropathy 4.
Color Doppler ultrasound measurement of ureteric jet angle represents a simple and noninvasive method as a screening tool to detect high grade vesicoureteral reflux disease in children.
The ureteric jet angle is the angle between the direction of the ureteric jet and the interureteral ridge.
The angle value in each reflux grade became significantly greater according to grade vesicoureteral reflux.
A cutoff angle of 55 degrees or greater detect grade III to V and grade IV/V reflux with a sensitivity of 85.5% and 94.7%, respectively6.
CT/MRI
On CT and MRI, the visualization of ureteric jets is one of chance, rather than by design. On CT it is usually seen on a urographic phase study when the rapid expulsion of the urine bolus is accidentally captured as the study proceeds. On MRI the change in flow characteristics in the region of the UVJ might be observable.
History and etymology
The visualization of ureteric jets on Doppler ultrasound was first described by the British radiologist Paul Dubbins et al. in 1981 5.
Practical points
in simplistic terms, the complete absence of ureteric jets on one or both sides raises the possibility of renal tract obstruction
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