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Dhale A, Pendkar R, Hatwar G, Dharamshi JD, Trivedi Y. Ectopic Ureter Opening in Vagina: A Rare Cause of Nonfunctional Kidney and Urinary Incontinence in a Pediatric Patient. Cureus 2024; 16:e60052. [PMID: 38854205 PMCID: PMC11162755 DOI: 10.7759/cureus.60052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/10/2024] [Indexed: 06/11/2024] Open
Abstract
An ectopic ureter is a condition characterized by a ureter, whether single or duplex, that fails to open in the trigone area of the urinary bladder but instead drains outside of it. This anomaly arises congenitally due to abnormal migration of the ureteric bud during its insertion into the urinary bladder. Here, we present a case involving an ectopic ureter draining into the vagina, with continuous urinary incontinence. We discuss the diagnosis, evaluation, and management of urinary incontinence in a female because of an ectopic ureter. A 9-year-old girl child presented with a continuous urinary leak or incontinence requiring the use of one to two pads per day that progressively became wetter throughout the day. Physical examination revealed a normal urethral meatus and vagina without obvious visible dribbling of urine at the introitus. CT urography showed significant dilation of the right ureter, causing hydroureter and ectopic insertion of the tortuous right ureter near the external urethral orifice at the vaginal vestibule, along with an atrophic right kidney. A DTPA (diethylenetriamine pentaacetate) scan indicated the nonfunctional status of the right kidney. The patient underwent a right nephroureterectomy, leading to a complete resolution of urinary incontinence. Ectopic ureter causing nonfunctional kidney and urinary leak or incontinence is rare. This case emphasizes the importance of a comprehensive diagnostic workup for achieving a better prognosis and initiating early treatment of ectopic ureter.
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Affiliation(s)
- Abhijit Dhale
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ruturaj Pendkar
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ghanshyam Hatwar
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay D Dharamshi
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yashasvi Trivedi
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Staub E. Current and potential methods to assess kidney structure and morphology in term and preterm neonates. Anat Rec (Hoboken) 2023. [PMID: 36883787 DOI: 10.1002/ar.25195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
After birth, the kidney structure in neonates adapt to the functional demands of extrauterine life. Nephrogenesis is complete in the third trimester, but glomeruli, tubuli, and vasculature mature with the rapidly increasing renal blood flow and glomerular filtration. In preterm infants, nephrogenesis remains incomplete and maturation is slower and may be aberrant. This structural and functional deficit has life-long consequences: preterm born individuals are at higher risk for chronic kidney disease and arterial hypertension later in life. This review assembles the literature on existing and potential methods to visualize neonatal kidney structure and morphology and explore their potential to longitudinally document the developmental deviation after preterm birth. X-rays with and without contrast, fluoroscopy and computed tomography (CT) involve relevant ionizing radiation exposure and, apart from CT, do not provide sufficient structural details. Ultrasound has evolved into a safe and noninvasive high-resolution imaging method which is excellent for longitudinal observations. Doppler ultrasound modes can characterize and quantify blood flow to and through the kidneys. Microvascular flow imaging has opened new possibilities of visualizing previously unseen vascular structures. Recent advances in magnetic resonance imaging display renal structure and function in unprecedented detail, but are offset by the logistical challenges of the imaging procedure and limited experience with the new techniques in neonates. Kidney biopsies visualize structure histologically, but are too invasive and remain anecdotal in newborns. All the explored methods have predominantly been examined in term newborns and require further research on longitudinal structural observation in the kidneys of preterm infants.
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Affiliation(s)
- Eveline Staub
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Balawender K, Wawrzyniak A, Pliszka A, Józefiak A, Siwak S, Sokół D, Clarke E, Olszewska A, Mazur M, Mazurek A, Barszcz K, Żytkowski A. Ectopic ureter: A concise narrative review with anatomical and clinical commentaries. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Singh S, Dahal S, Kayastha A, Thapa B, Thapa A. Duplex Collecting System with Ectopic Ureters Opening into Vagina: A Case Report. JNMA J Nepal Med Assoc 2022; 60:204-206. [PMID: 35210645 PMCID: PMC9199998 DOI: 10.31729/jnma.6570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/01/2022] Open
Abstract
Continuous urinary leakage, along with normal deliberate voiding, must suggest diagnosis of ectopic ureter, specifically in girls. Combination of a duplicated collecting system with distal, infra-sphincteric, vaginal insertion of ureter is an uncommon congenital anomaly and rare cause of urinary incontinence. We present a case report of a 7-year-old girl who presented to the urology department with urinary incontinence despite successful toilet training and history of recurrent urinary tract infections. Right duplex collecting system was seen on ultrasound. Magnetic resonance urography revealed a near complete right duplex collecting system with ectopic insertion of ureter into vagina, and aplastic uterus with bilateral normal ovaries suggestive of Mayer-Rokitansky-Kuster-Hauser syndrome. Surgical treatment consisted of "common sheath" reimplantation of ectopic ureters into bladder, with complete resolution of symptoms. This case suggests to us that congenital abnormalities of the genitourinary tract should be considered in case of urinary incontinence and recurrent urinary tract infections.
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Affiliation(s)
- Suraj Singh
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal,Correspondence: Dr Suraj Singh, Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal. , Phone +977-9849978358
| | - Sulochana Dahal
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Anuj Kayastha
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Bijay Thapa
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Anupama Thapa
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
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Grattan-Smith JD, Chow J, Kurugol S, Jones RA. Quantitative renal magnetic resonance imaging: magnetic resonance urography. Pediatr Radiol 2022; 52:228-248. [PMID: 35022851 PMCID: PMC9670866 DOI: 10.1007/s00247-021-05264-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/16/2021] [Accepted: 12/10/2021] [Indexed: 02/03/2023]
Abstract
The goal of functional renal imaging is to identify and quantitate irreversible renal damage and nephron loss, as well as potentially reversible hemodynamic changes. MR urography has evolved into a comprehensive evaluation of the urinary tract that combines anatomical imaging with functional evaluation in a single test without ionizing radiation. Quantitative functional MR imaging is based on dynamic contrast-enhanced MR acquisitions that provide progressive, visible enhancement of the renal parenchyma and urinary tract. The signal changes related to perfusion, concentration and excretion of the contrast agent can be evaluated using both quantitative and qualitative measures. Functional evaluation with MR has continued to improve as a result of significant technical advances allowing for faster image acquisition as well as the development of new tracer kinetic models of renal function. The most common indications for MR urography in children are the evaluation of congenital anomalies of the kidney and urinary tract including hydronephrosis and renal malformations, and the identification of ectopic ureters in children with incontinence. In this paper, we review the underlying acquisition schemes and techniques used to generate quantitative functional parameters including the differential renal function (DRF), asymmetry index, mean transit time (MTT), signal intensity versus time curves as well as the calculation of individual kidney glomerular filtration rate (GFR). Visual inspection and semi-quantitative assessment using the renal transit time (RTT) and calyceal transit times (CTT) are fundamental to accurate diagnosis and are used as a basis for the interpretation of the quantitative data. The importance of visual assessment of the images cannot be overstated when analyzing the quantitative measures of renal function.
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Affiliation(s)
| | - Jeanne Chow
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Sila Kurugol
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Richard A Jones
- Department of Radiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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Świȩtoń D, Grzywińska M, Czarniak P, Gołȩbiewski A, Durawa A, Teodorczyk J, Kaszubowski M, Piskunowicz M. The Emerging Role of MR Urography in Imaging Megaureters in Children. Front Pediatr 2022; 10:839128. [PMID: 35402364 PMCID: PMC8984115 DOI: 10.3389/fped.2022.839128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Megaureter, described as ureter dilatation more than 7 mm in diameter, commonly associated with other anomalies, is still a diagnostic and therapeutic challenge. Magnetic resonance urography (MRU) appears as a promising method in urinary tract imaging, providing both anatomical and functional information. There are several postprocessing tools to assess renal function (including differential renal function) and severity of ureteral obstruction based on MRU. Still, the place of this method in the diagnostic algorithm of ureteropelvicalyceal dilatation with megaureter remains underestimated. Analysis of imaging findings in a group of children diagnosed with megaureter was done. MATERIAL AND METHODS A retrospective analysis of magnetic resonance urography (MRU) was performed in 142 consecutive patients examined from January 2013 to September 2019. Twenty-five patients meeting the criteria of megaureter (dilatation more than 7 mm) in MRU were included in the further analysis. The MRU, ultrasound (US), and scintigraphy results were compared and analyzed together and compared with clinical data. RESULTS The sensitivity and specificity of US was comparable to the MRU in the assessment of upper urinary tract morphology (p > 0.05). In five out of 25 children, megaureter was found in each kidney; in a single case, both poles of a duplex kidney were affected. In the diagnosis of ureter ectopia, the MRU was superior to the US for which sensitivity did not exceed 16%. The US showed limited value in the diagnostics of segmental ureter dysplasia as a cause of primary megaureter when compared with MRU. Four cases were visualized in MRU studies, whereas the US examination was negative (all confirmed during surgery). There was a moderate correlation between relative renal function between fMRU and scintigraphy (t = 0.721, p = 0.477) and in the severity of obstruction assessment between both methods (r = 0.441, p < 0.05). However, in 10 kidneys with megaureter, the results in scintigraphy were inconclusive due to the signal from the megaureter imposing on the renal field. CONCLUSIONS MRU seems to be a preferred method in the diagnostic algorithm for megaureter, providing both anatomical and functional information. MRU is superior to US and scintigraphy in diagnosing urinary tract anomalies with megaureter.
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Affiliation(s)
- Dominik Świȩtoń
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Piotr Czarniak
- Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Gołȩbiewski
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdańsk, Gdańsk, Poland
| | - Agata Durawa
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Teodorczyk
- Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Mariusz Kaszubowski
- Faculty of Management and Economics, Department of Statistics and Econometrics, Gdańsk University of Technology, Gdańsk, Poland
| | - Maciej Piskunowicz
- First Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Uterus as one of the ectopic ureter openings: Case report. Urol Case Rep 2021; 39:101830. [PMID: 34527516 PMCID: PMC8429918 DOI: 10.1016/j.eucr.2021.101830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/24/2022] Open
Abstract
Ectopic ureter is defined as any ureter, single or duplex, that does not open in the trigonal region of the bladder. A 19-years-old girl was presented with urinary incontinence. Physical examination revealed a normal urethral meatus with pooling of urine at the introitus. A Kidney-Ureter-Bladder ultrasound revealed a duplex-system suspicion on the right side. The patient was managed by laparoscopic heminephrectomy of right ureter. The uterus gains its normal shape and sized without any fluid filling after the operative being completed. In conclusion, a complete diagnostic work up is important to achieve better prognosis and early treatment.
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8
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Tsiflikas I, Obermayr F, Werner S, Teufel M, Fuchs J, Schäfer JF. Functional magnetic resonance urography in infants: feasibility of a feed-and-sleep technique. Pediatr Radiol 2019; 49:351-357. [PMID: 30474711 DOI: 10.1007/s00247-018-4307-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/05/2018] [Accepted: 10/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Functional magnetic resonance (MR) urography has been well established in the diagnostic workup of congenital anomalies of kidneys and urinary tract, though long acquisition time requires sedation or general anesthesia in infants. OBJECTIVE To evaluate the success rate of an optimized functional MR urography protocol in infants carried out in natural sleep. MATERIALS AND METHODS We retrospectively evaluated all functional MR urographies performed under general anesthesia or during natural sleep in infants younger than 1 year between 2010 and 2017 and rated image quality in both cohorts using a 3-point Likert scale. We tested the analyzability of functional sequences using a free available software. We also calculated examination time. Finally, we compared examinations in natural sleep and those with general anesthesia using independent t-test for continuous data and Mann-Whitney U test for categorical data. RESULTS Functional MR urography could be performed successfully during natural sleep in 38 of 42 (90%) infants younger than 10 months. Four examinations were aborted before contrast medium was administrated. In the same period, 19 functional MR urographies were performed successfully under general anesthesia. Although image quality was significantly better in this group (P<0.0001), image quality was at least diagnostic in all finished examinations in natural sleep, and the functional analyzability was given in all completed examinations. There was a significant saving in examination time during natural sleep (P<0.001). CONCLUSION Functional MR urography can be successfully performed in natural sleep in infants younger than 10 months.
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Affiliation(s)
- Ilias Tsiflikas
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Florian Obermayr
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen, Tübingen, Germany.,Clinic of Pediatric Surgery, University Hospital Marburg, Marburg, Germany
| | - Sebastian Werner
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Matthias Teufel
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Jürgen F Schäfer
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Peng XX, Cheng SA, Liang QL, Luo XB, Hong XC, Yuan GL, Zhang HJ. Bilateral thoracic kidneys combined with inferior vena cava located behind the anterior abdominal wall: A case report and review of literature. World J Clin Cases 2018; 6:666-670. [PMID: 30430122 PMCID: PMC6232566 DOI: 10.12998/wjcc.v6.i13.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/16/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Ectopic thoracic kidneys are the rarest form of renal ectopia. Moreover, congenital abnormality of a primary anterior inferior vena cava (IVC) located behind the anterior abdominal wall is extremely rare. To date, only one such case has been reported. Herein, we report a rare case of a 55-year-old Chinese male with bilateral thoracic kidneys combined with an anterior IVC, a malformed liver, and a large-round-folds navel. The classification, clinical characteristics, and management options of a thoracic kidney was also summarized by literature review. To our best knowledge, the simultaneous detection of such multiple complex abnormalities has not been reported.
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Affiliation(s)
- Xiao-Xia Peng
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Shao-Ang Cheng
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Qi-Lian Liang
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Xing-Bo Luo
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Xiao-Cui Hong
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Gao-Le Yuan
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Hui-Jie Zhang
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
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Abstract
PURPOSE OF REVIEW In this article, we describe the basics of how magnetic resonance urography (MRU) is performed in the pediatric population as well as the common indications and relative performance compared to standard imaging modalities. RECENT FINDINGS Although MRU is still largely performed in major academic or specialty imaging centers, more and more applications in the pediatric setting have been described in the literature. MRU is a comprehensive imaging modality for evaluating multiple pediatric urologic conditions combining excellent anatomic detail with functional information previously only available via renal scintigraphy. While generally still reserved for problem solving, MRU should be considered for some conditions as an early imaging technique.
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Bafaraj SM. Value of Magnetic Resonance Urography Versus Computerized Tomography Urography (CTU) in Evaluation of Obstructive Uropathy: An Observational Study. Curr Med Imaging 2018; 14:129-134. [PMID: 29399012 PMCID: PMC5759170 DOI: 10.2174/1573405613666171020110522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obstructive uropathy is a common public health issue that requires imaging research for providing necessary information. The data is important for determining treatment options, and may influence selective management choices. OBJECTIVE The aim of the study is to determine whether magnetic resonance urography or computerized tomography urography is the best imaging modality among patients with suspected obstructive uropathy. METHODS Seventy patients; referred from the emergency department for the evaluation of renal colic or hematuria that highly suggested urinary tract abnormalities, were prospectively enrolled. Thirty five women and 35 men were categorized with a mean age of 43.52 years and the mean body weight of 61.31 kg. All participants underwent abdominal ultrasonography and clinical examination to detect the causes of urinary obstruction. Pregnant women were excluded from the study. Both magnetic resonance urography and computerized tomography urography were performed within 30 days of each analysis. RESULTS Only 54.3% of the participants had urinary stones. Mean size of the renal stone was 11 mm; while mean size of the ureteral stone was 3.8 mm. The approach of magnetic resonance is not only limited to diagnosis, but is also effectively involved in the real time investigations. MRU has more reliability in terms of the diagnosis and anatomic presentation of the kidneys along with the vasculature. All cases of urinary stones were detected by computed tomography (100%); whereas, 78.9% cases were detected by magnetic resonance urography. CONCLUSION Computerized tomography urography is more sensitive in detecting kidney stones; whereas, magnetic resonance urography is better in detecting pathology behind the development of kidney stones.
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Affiliation(s)
- Saeed M. Bafaraj
- Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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12
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Subdiaphragmatic Renal Ectopia: Case Report and Review of the Literature. Case Rep Nephrol 2016; 2016:1084917. [PMID: 27668105 PMCID: PMC5030433 DOI: 10.1155/2016/1084917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/17/2016] [Indexed: 12/12/2022] Open
Abstract
Background. We report the case of a male infant whose right kidney migrated to an ectopic position after birth. The migration of a kidney in postnatal life without any symptoms has not been reported in literature so far. Case Presentation. In a series of antenatal and the first postnatal ultrasound scans, the right kidney was normally located within the right renal fossa. During the first 3 months of life, the kidney migrated to a subdiaphragmatic position. This was confirmed on MRI scan. The infant was asymptomatic with normal renal function and blood pressure. Conclusion. Postnatal migration of a kidney has been described in cases of diaphragmatic hernia or nephroptosis. In this report, we describe a case of kidney migration where there were no underlying anatomical defects to provide an explanation for the kidney migration. This is the first report in literature of a case of postnatal migration of a kidney.
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Figueroa VH, Chavhan GB, Oudjhane K, Farhat W. Utility of MR urography in children suspected of having ectopic ureter. Pediatr Radiol 2014; 44:956-62. [PMID: 24535117 DOI: 10.1007/s00247-014-2905-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/21/2013] [Accepted: 01/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Conventional imaging modalities are limited in the assessment of complex lower urinary tract anomalies including ectopic insertion of ureters. MR urography can be useful in these situations. OBJECTIVE To share our experience with MR urography in assessing lower urinary tract anomalies and to determine its accuracy in depicting ectopic ureters. MATERIALS AND METHODS We conducted a retrospective review of all MR urography examinations done between November 2007 and March 2013 to note the presence or absence of duplex kidneys and insertion of ureters. We reviewed patient charts, surgical findings and results of other investigations including cystoscopy with retrograde ureterogram in order to establish presence or absence of ectopic ureter. This served as a reference standard against which we compared MR urography results. RESULTS Of 22 MR urography examinations (3 boys, 19 girls; age range 3-16 years, mean 9.2 years) performed during the study period, 19 were performed to rule out ectopic ureters, two to assess complex anatomy and one to rule out crossing vessel in ureteropelvic junction obstruction. MR urography showed ectopic ureter in 9/19 children; one proved to be a false-positive. MR urography correctly showed normal insertion in 7/19 children. In the remaining 3/19 children distal ureter could not be seen, hence insertion was indeterminate on MR urography. One of these children had an ectopic ureter on cystoscopy and surgery. Statistical analysis showed MR urography's sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to be 88.8-100%, 70-90%, 75-88.8% and 90-100% for the detection of ectopic ureter. CONCLUSION MR urography is highly accurate in the assessment of ectopic ureters. In incontinent girls, MR urography should be the method of choice for depicting or ruling out ectopic ureter.
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Affiliation(s)
- Victor H Figueroa
- Department of Pediatric Urology, The Hospital for Sick Children and University Of Toronto, Toronto, Canada
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14
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Faure A, Merrot T, Sala Q, Chaumoitre K, Guys JM, Bourliere-Najean B, Torrents J, Mundler O, Lechevallier E, Alessandrini P. Value of diagnosis imaging in the evaluation of the severity of histological lesions in duplex systems. J Pediatr Urol 2014; 10:361-7. [PMID: 24262607 DOI: 10.1016/j.jpurol.2013.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/05/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In order to determine the effectiveness of imagery in the assessment of the severity of histological lesions in duplex systems in children we compared histology results from heminephrectomies with diagnosis imaging findings [renal ultrasound (US), scintigraphy, unenhanced and contrast-enhanced magnetic resonance imagery (MRI)]. MATERIALS AND METHODS Between 2007 and 2013, 34 children with duplex system underwent surgery. The results from US (n = 34), dimer captosuccinic acid scintigraphy (n = 23) and MRI (n = 16) were compared with histological data. Five histological lesions were found (chronic interstitial inflammation, interstitial fibrosis, tubular atrophy, glomerulosclerosis and dysplasia) and categorized as severe (>25%) or moderate (≤ 25%). RESULTS Severe histological lesions were found in 76.5% and moderate lesions in 23.5%. Radiological features were compared with histological results. In US, severe parenchymal thinning was associated with chronic interstitial inflammatory. The absence of parenchymal enhancement and/or severe cortical thinning in MR urography (MRU) was significantly associated with interstitial fibrosis. All poorly functioning poles were associated with severe histological lesions (p = 0.091), but not to a specific category of lesions. CONCLUSIONS MRI sensibility was excellent (90%) in the diagnosis of poorly functioning pole. Severe thinning on US and minimal pole function on MRU can be used to predict the severity of histological lesions.
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Affiliation(s)
- Alice Faure
- Department of Pediatric Surgery, Hospital Nord, APHM, Aix-Marseille University, Chemin des Bourrely, Marseille 13015, France.
| | - Thierry Merrot
- Department of Pediatric Surgery, Hospital Nord, APHM, Aix-Marseille University, Chemin des Bourrely, Marseille 13015, France
| | - Quentin Sala
- Department of Nuclear Medicine, Hospital Timone, APHM, Aix-Marseille University, Marseille, France
| | - Kathia Chaumoitre
- Department of Medical Imaging, Hospital Nord, APHM, Aix-Marseille University, Marseille, France
| | - Jean-Michel Guys
- Department of Pediatric Surgery, Hospital Timone, APHM, Aix-Marseille University, Marseille, France
| | - Brigitte Bourliere-Najean
- Department of Pediatric Radiology, Hospital Timone, APHM, Aix-Marseille University, Marseille, France
| | - Julia Torrents
- Department of Pathology, Hospital Timone, APHM, Aix-Marseille University, Marseille, France
| | - Olivier Mundler
- Department of Nuclear Medicine, Hospital Timone, APHM, Aix-Marseille University, Marseille, France
| | - Eric Lechevallier
- Department of Urology, Hospital Conception, APHM, Aix-Marseille University, Marseille, France
| | - Pierre Alessandrini
- Department of Pediatric Surgery, Hospital Nord, APHM, Aix-Marseille University, Chemin des Bourrely, Marseille 13015, France
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Emad-Eldin S, Abdelaziz O, El-Diasty TA. Diagnostic value of combined static-excretory MR Urography in children with hydronephrosis. J Adv Res 2014; 6:145-53. [PMID: 25750748 PMCID: PMC4348446 DOI: 10.1016/j.jare.2014.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/19/2014] [Accepted: 01/21/2014] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to determine the feasibility, accuracy and diagnostic potential of combined static-excretory MR Urography in children with sonographically detected hydronephrosis. We prospectively evaluated 28 children (11 girls and 17 boys), mean age 8.3 years (range 2 months–16 years). Static-excretory MR Urography was performed in all cases. The results of MR Urography were compared with the results of other imaging modalities, cystoscopy and surgery. In 28 children, 61 renal units were evaluated by MR Urography (the renal unit is the kidney and its draining ureter). The final diagnoses included: normal renal units (n = 23); uretropelvic junction obstruction (n = 14); megaureter (n = 8); midureteric stricture (n = 1), complicated duplicated systems (n = 5), post ESWL non-obstructive dilation (n = 2), extrarenal pelvis (n = 4), dysplastic kidney (n = 4). Complex pathology and more than one disease entity in were found in 7 children. The MRI diagnosis correlated with the final diagnosis in 57 units, with diagnostic accuracy 93.4%. In conclusions static and excretory MRU give both morphological and functional information in a single examination without exposure to ionizing radiation and iodinated contrast agent. It is a valuable imaging technique for children with upper urinary tract dilatation; especially in cases of complex congenital pathologies and severely hydronephrotic kidney.
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Affiliation(s)
- Sally Emad-Eldin
- Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | - Omar Abdelaziz
- Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | - Tarek A El-Diasty
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Adeb M, Darge K, Dillman JR, Carr M, Epelman M. Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am 2013; 21:717-30. [PMID: 24183522 DOI: 10.1016/j.mric.2013.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Duplex renal collecting systems are common congenital anomalies of the upper urinary tract. In most cases they are incidental findings and not associated with additional pathologies. They demonstrate, however, higher incidences of hydroureteronephrosis, ureteroceles, and ectopic ureters. The most comprehensive morphologic and functional evaluation of duplex systems can be achieved using magnetic resonance urography. Functional magnetic resonance urography allows better separation of the renal poles, thus more accurate calculation of the differential renal functions compared with renal scintigraphy. Magnetic resonance urography is the study of choice when upper urinary tract anatomy is complex or when functional evaluation is needed.
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Affiliation(s)
- Melkamu Adeb
- Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Prakash J, Singh BP, Sankhwar S, Goel A. Normal functioning single system ectopic ureter draining into a Gartner's cyst: laparoscopic management. BMJ Case Rep 2013; 2013:bcr2013009563. [PMID: 23737579 PMCID: PMC3702997 DOI: 10.1136/bcr-2013-009563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Association of single system ectopic ureter with normal functioning bilateral kidney and absence of congenital anomalies is very rarely reported in the literature. We are reporting for the first time a case of this type of anomaly in which uretral ectopia was draining into a Gartner's cyst and was managed by laparoscopy. A 16 year girl presented with normal voiding with continuous dribbling since birth. Voiding cystourethrogram, intravenous urogram, cystovaginoscopy and retrograde contrast study confirmed the diagnosis. Ultrasound of the whole abdomen and physical examination ruled out any associated congenital anomalies. Transperitoneal laparoscopic ureteric reimplantation was performed and distal stump was ligated. On follow-up at 3 months she was completely dry; her vaginoscopy showed disappearance of cystic bulge and her voiding cystourethrogram showed normal study without any reflux. When single system ectopic ureter opens into small-to-moderate size wide opened mouth vaginal Gartner's cyst, laparoscopic ureteric reimplantation and ligation of distal stump is an appropriate procedure.
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Affiliation(s)
- Jai Prakash
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
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Grimaldi C, Bourlière Najean B, Guys JM, Petit P. [Urinary dribbling in girls: which investigations in 2012?]. Arch Pediatr 2013; 20:640-5. [PMID: 23639836 DOI: 10.1016/j.arcped.2013.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 12/20/2012] [Accepted: 03/19/2013] [Indexed: 11/17/2022]
Abstract
Continuous urinary leakage, despite normal deliberate voiding, must suggest the diagnosis of ectopic ureter, more specifically in girls. Ectopic ureter is usually associated with duplex kidney and complete ureteral duplication. The strategy of investigations has changed over the past few years, due to MRI development in the analysis of urinary tract malformations. We report the case of a 4-year-old girl who presented with these symptoms and had a suspicion of left duplex kidney on the prenatal ultrasonography (US). Two US examinations during the first months of life were compatible with a left duplex kidney without any complication. Another US at the age of 4 years was reported as normal. We completed the investigation with MR urography, which revealed a left duplex kidney with a poorly functioning dysplastic upper pole, and the orifice of the ureter of this upper pole inserting in the vagina. The surgical treatment, realized by celioscopy, was partial nephrectomy of the upper pole, removing most of the ectopic ureter. US is the first exam to investigate urinary tract malformations. However, duplex kidney with small dysplastic pole and ectopic insertion of a nondilated ureter may be difficult to see, and a normal US should never end the investigations. Intravenous urography and renal scintigraphy used to be the reference complementary exams, but are now replaced by MR urography. Without using ionizing radiation, MR urography can visualize duplex kidney and ectopic ureteral insertion with high resolution, and evaluates renal function of each kidney and each pole. These morphological and functional data are essential to determine the surgical treatment.
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Affiliation(s)
- C Grimaldi
- Service de radiologie pédiatrique, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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Static fluid magnetic resonance urography in evaluation of ureteral ectopia: Experience in 10 pediatric cases. ALEXANDRIA JOURNAL OF MEDICINE 2013. [DOI: 10.1016/j.ajme.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Magnetic resonance urography (MRU) provides high resolution imaging of the urogenital system and the use of paramagnetic contrast agents enables a functional depiction. This review summarizes existing data concerning this diagnostic procedure in pediatric urology. A systematic search and assessment of the literature was performed.A total of 12 studies were reviewed in detail. In mostly small study populations a great heterogeneity concerning methodology, use of comparative examinations and standards of reference was noted. Besides the quality of anatomical imaging, the functional study of renal excretory function and differential renal function was also assessed. Only a few studies performed statistical analyses.The authors' rating of MRU was mostly positive. Due to methodical weaknesses, lack of independent standards of reference and statistical analyses the overall level of evidence was low. Further high quality studies will be necessary to assess the value of MRU for the diagnostic workup in pediatric urology.
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Bhargava P, Dighe MK, Lee JH, Wang C. Multimodality Imaging of Ureteric Disease. Radiol Clin North Am 2012; 50:271-99, vi. [DOI: 10.1016/j.rcl.2012.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Thambidorai CR, Anuar Z. Magnetic resonance urography in duplex kidney with ectopic ureteral insertion. J Indian Assoc Pediatr Surg 2011; 16:115-7. [PMID: 21897576 PMCID: PMC3160054 DOI: 10.4103/0971-9261.83500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a report on the use of magnetic resonance urography (MRU) in a 6-year-old girl who presented with urinary incontinence. She had a left duplex kidney with poorly functioning upper moiety and ectopic insertion of the dilated upper pole ureter. MRU has been shown to be superior to conventional imaging techniques in delineating poorly functioning moieties of duplex kidneys and ectopic ureters.
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Jones RA, Votaw JR, Salman K, Sharma P, Lurie C, Kalb B, Martin DR. Magnetic resonance imaging evaluation of renal structure and function related to disease: Technical review of image acquisition, postprocessing, and mathematical modeling steps. J Magn Reson Imaging 2011; 33:1270-83. [DOI: 10.1002/jmri.22335] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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[Imaging evaluation of renal function: principles and limitations]. ACTA ACUST UNITED AC 2011; 92:280-90. [PMID: 21549884 DOI: 10.1016/j.jradio.2011.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 03/07/2011] [Indexed: 11/20/2022]
Abstract
The kidney performs multiple functions. Glomerular filtration is the most studied of these functions. In clinical practice, the surgical indication for patients with unilateral uropathy is frequently based on the split renal function as demonstrated by scintigraphy. MRI is not yet validated as a technique but nonetheless offers an interesting non-radiating alternative to achieve both morphological and functional renal evaluation. Recent pulse sequences such as diffusion, arterial spin labeling, and blood oxygenation dependent imaging may also provide additional information. CT and US remain of limited value for the evaluation of renal function.
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Obstructive diseases of the urinary tract in children: lessons from the last 15 years. Pediatr Radiol 2010; 40:947-55. [PMID: 20432013 DOI: 10.1007/s00247-010-1590-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 01/24/2010] [Indexed: 01/01/2023]
Abstract
Imaging urinary tract obstruction is a common query in paediatric uroradiology. With the advent of a more conservative treatment approach, the task of imaging today is to distinguish as early as possible those kidneys that do not require surgery, from those that will deteriorate and lose function and/or growth potential and thus benefit from surgery. At present, in spite of significant advancements in imaging and the introduction of diuretic paediatric MR-urography, there is still no reliable a-priori pro-futuro assessment. Thus, repeated follow-up imaging is often necessary for monitoring. Imaging usually starts with US; the major additional complementary and more function-oriented tools are diuretic renal scintigraphy and MR-urography. The frequency and timing as well as the detailed protocol vary within institutions, partly because of differences in the criteria that are used for indicating surgery. Intra-venous urography (IVU) for obstruction has practically vanished apart from for a few exceptions, and the "Whitaker" test is today seldom performed, being reserved for complicated cases.
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28
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Vivier PH, Dolores M, Taylor M, Elbaz F, Liard A, Dacher JN. MR urography in children. Part 1: how we do the F0 technique. Pediatr Radiol 2010; 40:732-8. [PMID: 20182706 DOI: 10.1007/s00247-009-1538-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 11/22/2009] [Indexed: 02/06/2023]
Abstract
MR urography (MRU) has been widely accepted as a substitute to intravenous urography for investigating children with a dilated urinary tract after preliminary assessment by US and voiding cystourethrography. Hydronephrosis is by far the main indication for MRU because upper tract dilatation is a frequent condition in infants and children. Recent advances in technology have allowed MR to go beyond morphology and to assess renal function parameters such as split renal function and drainage. In this article we report our routine practice of the F0 MRU technique. The main advantages of our protocol are no requirement for general anaesthesia, no bladder catheterization, use of low-dose gadolinium-based contrast agent (0.05-0.1 mmol/kg) and total acquisition time of 30 min or less.
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Affiliation(s)
- Pierre-Hugues Vivier
- Department of Radiology, University Hospital of Rouen, 1 rue de Germont, Rouen, 76031, France
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Renjen P, Bellah R, Hellinger JC, Darge K. Pediatric Urologic Advanced Imaging: Techniques and Applications. Urol Clin North Am 2010; 37:307-18. [DOI: 10.1016/j.ucl.2010.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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MR urography in children. Part 2: how to use ImageJ MR urography processing software. Pediatr Radiol 2010; 40:739-46. [PMID: 20182707 DOI: 10.1007/s00247-009-1536-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 11/22/2009] [Indexed: 10/19/2022]
Abstract
MR urography (MRU) is an emerging technique particularly useful in paediatric uroradiology. The most common indication is the investigation of hydronephrosis. Combined static and dynamic contrast-enhanced MRU (DCE-MRU) provides both morphological and functional information in a single examination. However, specific post-processing must be performed and to our knowledge, dedicated software is not available in conventional workstations. Investigators involved in MRU classically use homemade software that is not freely accessible. For these reasons, we have developed a software program that is freely downloadable on the National Institute of Health (NIH) website. We report and describe in this study the features of this software program.
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High resolution MR for evaluation of lower urogenital tract malformations in infants and children: feasibility and preliminary experiences. Eur J Radiol 2010; 78:388-93. [PMID: 20138451 DOI: 10.1016/j.ejrad.2010.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 01/01/2010] [Accepted: 01/08/2010] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This retrospective study aimed to assess the value of supplementing heavily T2-weighted, high resolution MR-imaging for detailed anatomic assessment in paediatric lower urogenital tract (UGT) malformations. PATIENTS/METHODS Sixteen patients (6 male and 10 female, median age=1.8 years, range=0-9 years) with suspected malformations of the lower UGT who were retrospectively identified from the PACS underwent a clinically indicated standard MR-urography study. In order to facilitate a better anatomic assessment of questioned specific lower UGT structures, an additional three-dimensional Constructive Interference in Steady State-sequence (3D-CISS) had been acquired in these patients. The final diagnosis was established by all imaging results and surgical or laprascopic findings. The findings from the CISS-sequence were compared to the results from standard MR-urography for complementary anatomic information and conspicuity. RESULTS Diagnostic 3D-CISS image quality was achieved in all patients. The 3D-CISS confirmed an ectopic ureteral insertion in six patients and reliably excluded ectopic insertion in 10 patients, whereas conventional MR-urography showed an ectopic insertion of the ureter in one case. In six patients with retrovesical complex formations (suspicious for an ectopic cystic renal bud or a cystic genital structure) the 3D-CISS showed increased conspicuity scores for image quality. CONCLUSION The additional 3D-CISS-sequence increases the diagnostic yield in the pelvis in children with complex malformations of the lower UGT such as ectopic ureteral insertion or suspected cystic renal or genital malformations at only minimal additional time, compared to standard MR-urography.
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The clinical utility and safety of the endoscopic treatment of vesicoureteral reflux in patients with duplex ureters. J Pediatr Urol 2010; 6:15-22. [PMID: 19625219 DOI: 10.1016/j.jpurol.2009.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 05/28/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE A systemic review of published literature on the use of bulking agents in the treatment of vesicoureteral reflux (VUR) in patients with duplex systems was performed in order to evaluate the diagnostic challenges; determine success rates, and compare with use in single systems; and evaluate safety, in particular of Deflux. METHODS A PubMed/Medline search was conducted for index articles discussing duplex ureters published in 1963-2007. All types of publications were included. A multiple linear regression analysis was performed. RESULTS Overall, 28 different treatment arms originating in 17 separate studies (19 publications) satisfied the inclusion criteria for linear regression efficacy analysis. Data were available on 2879 patients: 2400 with single and 479 with duplex systems. Ten publications provided information on the frequency of failure to diagnose duplex systems using specific techniques. An overall 18% failure rate to detect duplex systems was reported for combined techniques. For patients in whom favorable anatomic location of ureters allowed successful endoscopic injection of a bulking agent, correction of VUR was achieved in 53-100% of cases. A univariant analysis showed no difference in success rate between single and duplex systems with the use of Deflux, or other bulking agent. The predicted probability of success in a single system was 68% and in a duplex system 64%. CONCLUSIONS There is significant potential for failing to detect duplex systems prior to preparing an individual for either open or endoscopic treatment. From the studies available, endoscopic injection of bulking agents is highly successful in correcting mild-to-moderate VUR in duplex systems, with no reports of serious or clinically significant adverse effects. At a minimum, duplex systems would not seem to be a contraindication to the use of Deflux or any other bulking agent.
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Abstract
Excellent contrast resolution and lack of ionizing radiation make magnetic resonance urography (MRU) a promising technique for noninvasively evaluating the entire urinary tract. While MRU currently lags behind CT urography (CTU) in spatial resolution and efficiency, new hardware and sequence developments have contributed to a resurgence of interest in MRU techniques. By combining unenhanced sequences with multiphase contrast-enhanced and excretory phase imaging, a comprehensive assessment of the kidneys, ureters, bladder, and surrounding structures is possible with image quality rivaling that obtained with other techniques. At the same time, formidable challenges remain to be overcome and further clinical validation is necessary before MRU can replace other forms of urography. In this article, we demonstrate the current potential of MRU to demonstrate a spectrum of urologic pathology involving the kidneys, ureters, and bladder while discussing the limitations and current status of this evolving technique.
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Affiliation(s)
- John R Leyendecker
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Joshi MP, Shah HS, Parelkar SV, Agrawal AA, Sanghvi B. Role of magnetic resonance urography in diagnosis of duplex renal system: Our initial experience at a tertiary care institute. Indian J Urol 2009; 25:52-5. [PMID: 19468429 PMCID: PMC2684297 DOI: 10.4103/0970-1591.45537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: To determine diagnostic value of magnetic resonance urography in cases of duplex renal system. Method: Twenty cases between five month to nine years with suspected or known duplex renal system were evaluated by ultrasound (USG), micturating cystourethrography (MCU), intravenous urography (IVU) and magnetic resonance urography (MRU). The findings of these diagnostic imaging studies were then compared with each other and against the results of final diagnosis established at surgery. Results: Duplex renal system could be identified in two of these cases on USG, was diagnosed in four in IVU and could be diagnosed in all cases with MRU. Conclusion: MRU is superior and far accurate than IVU, MCU and USG in diagnosing duplex renal system.
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Affiliation(s)
- Milind P Joshi
- Department of Paediatric Surgery, KEM Hospital, Mumbai, India
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36
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Vivier PH, Blondiaux E, Dolores M, Marouteau-Pasquier N, Brasseur M, Petitjean C, Dacher JN. [Functional MR urography in children]. ACTA ACUST UNITED AC 2009; 90:11-9. [PMID: 19182709 DOI: 10.1016/s0221-0363(09)70073-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
MR Urography (MRU) provides both morphologic and functional information without radiation exposure. It enables the assessment of split renal function, excretion, and quantification of obstruction. MRU is thus complementary to ultrasonography in the assessment of pre- and post-natal obstructive uropathies in children. If available, MRU should be definitely preferred to intravenous urography.
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Affiliation(s)
- P H Vivier
- Service de Radiologie, CHU C. Nicolle, 1, rue de Germont, 76031 Rouen Cedex, France
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37
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Silverman SG, Leyendecker JR, Amis ES. What Is the Current Role of CT Urography and MR Urography in the Evaluation of the Urinary Tract? Radiology 2009; 250:309-23. [DOI: 10.1148/radiol.2502080534] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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MR urography: technique and results for the evaluation of urinary obstruction in the pediatric population. Magn Reson Imaging Clin N Am 2008; 16:643-60, viii-ix. [PMID: 18926428 DOI: 10.1016/j.mric.2008.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
MR urography has the potential to revolutionize imaging of the urinary tract in both adults and children, because of its ability to provide an unprecedented level of anatomic information and quantitative functional evaluation of each kidney. MR urography can now provide useful assessment of obstructive uropathy and may provide predictive information about which children will benefit from surgery. It has the potential to identify parameters that indicate a significant obstruction as opposed to self-limited hydronephrosis. Further technical developments in the field will produce greater insights into the pathophysiology of not only urologic disorders but also disorders of the kidney itself.
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39
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Michael R. Potential of MR-imaging in the paediatric abdomen. Eur J Radiol 2008; 68:235-44. [PMID: 18848412 DOI: 10.1016/j.ejrad.2008.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 07/16/2008] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the potential and relevant applications of MR-imaging (MRI) in typical paediatric abdominal conditions and diseases. METHOD The commonly used indications, applications, and sequences as well as typical imaging findings of paediatric abdominal MRI are presented and discussed, with emphasis on specific paediatric needs and queries. Only applications as used in routine clinical work are listed, other more sophisticated and advanced techniques will only briefly be mentioned. Furthermore, some aspects of paediatric MR Urography are presented and discussed. CONCLUSION Though conventional imaging methods (ultrasound and plain film) are valuable and - particularly in the paediatric abdomen - form the mainstay of routine imaging in paediatric abdominal radiology, some conditions require sectional imaging. MRI is increasingly applied to these queries in neonates, infants and children as an alternative method to CT without any radiation burden, and - when performed adequately and skilfully - can answer most treatment relevant questions. MR will increasingly be applied with new applications and broader availability also with functional information deriving from new equipment and research offering an ideal one stop imaging approach to many conditions also in children.
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Affiliation(s)
- Riccabona Michael
- Department of Radiology, Division of Paediatric Radiology, LKH Graz, University Hospital, Auenbruggenplatz, A-8036 Graz, Austria.
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Leyendecker JR, Barnes CE, Zagoria RJ. MR urography: techniques and clinical applications. Radiographics 2008; 28:23-46; discussion 46-7. [PMID: 18203929 DOI: 10.1148/rg.281075077] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Magnetic resonance (MR) urography comprises an evolving group of techniques with the potential for allowing optimal noninvasive evaluation of many abnormalities of the urinary tract. MR urography is clinically useful in the evaluation of suspected urinary tract obstruction, hematuria, and congenital anomalies, as well as surgically altered anatomy, and can be particularly beneficial in pediatric or pregnant patients or when ionizing radiation is to be avoided. The most common MR urographic techniques for displaying the urinary tract can be divided into two categories: static-fluid MR urography and excretory MR urography. Static-fluid MR urography makes use of heavily T2-weighted sequences to image the urinary tract as a static collection of fluid, can be repeated sequentially (cine MR urography) to better demonstrate the ureters in their entirety and to confirm the presence of fixed stenoses, and is most successful in patients with dilated or obstructed collecting systems. Excretory MR urography is performed during the excretory phase of enhancement after the intravenous administration of gadolinium-based contrast material; thus, the patient must have sufficient renal function to allow the excretion and even distribution of the contrast material. Diuretic administration is an important adjunct to excretory MR urography, which can better demonstrate nondilated systems. Static-fluid and excretory MR urography can be combined with conventional MR imaging for comprehensive evaluation of the urinary tract. The successful interpretation of MR urographic examinations requires familiarity with the many pitfalls and artifacts that can be encountered with these techniques.
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Affiliation(s)
- John R Leyendecker
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Cerwinka WH, Damien Grattan-Smith J, Kirsch AJ. Magnetic resonance urography in pediatric urology. J Pediatr Urol 2008; 4:74-82; quiz 82-3. [PMID: 18631897 DOI: 10.1016/j.jpurol.2007.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Accepted: 08/17/2007] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Magnetic resonance urography (MRU) has emerged as a powerful diagnostic tool in the evaluation of the pediatric genitourinary tract. The purpose of this review is to familiarize the reader with the basic techniques, strengths and limitations, as well as the current and potential future applications of MRU in pediatric urology. RECENT FINDINGS MRU can provide detailed anatomical information and assess renal function and drainage in a single study. MRU does not employ ionizing radiation and may be utilized in patients with iodine-based contrast allergy or impaired renal function. MRU has been most often applied to the evaluation of hydronephrosis and provides valuable insight into a wide range of obstructive uropathies. MRU was shown to be superior to renal scintigraphy for the diagnosis of pyelonephritis and renal scarring. The use of MRU for the assessment of urolithiasis and vesicoureteral reflux is limited and technical refinements are required. Potential future applications include fetal MRU, virtual endoscopy, and MRU-guided procedures. The development of new contrast agents and new image-processing software will further enhance the diagnostic potential of MRU in pediatric urology. SUMMARY MRU is currently thought of as a problem-solving tool to define anatomy and function when conventional methods fall short. This technique is likely to emerge as the imaging modality of choice for children with complex genitourinary pathology.
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Affiliation(s)
- Wolfgang H Cerwinka
- Children's Healthcare of Atlanta, Emory University School of Medicine, 5445 Meridian Mark Road, Suite 420, Atlanta, GA 30342, USA.
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MR urography evaluation of obstructive uropathy. Pediatr Radiol 2008; 38 Suppl 1:S49-69. [PMID: 18071689 DOI: 10.1007/s00247-007-0667-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
Hydronephrosis and the evaluation of obstructive uropathy are the most common indications for MR urography in our practice. Typically our patients fall into one of two groups: infants with antenatal hydronephrosis and older children who present with abdominal pain, hematuria or urinary tract infection. Obstruction in children is usually chronic and partial. Intermittent episodes of increased pressure occur when the urine production exceeds the capacity for drainage. MR urography uses a fluid and diuretic challenge to assess the hydronephrotic kidney. High-quality anatomic images provide a morphologic assessment of the hydronephrotic system. Although it is relatively straightforward to determine if a system is not obstructed on the basis of the renal transit time (RTT), no single parameter is adequate to fully characterize obstruction. By evaluating the changes in signal intensity in the renal parenchyma following contrast administration, the hydronephrotic systems are classified as compensated or decompensated. Delayed RTT and the presence of urine-contrast levels indicate stasis. Calyceal transit time and the difference between the volumetric and the Patlak differential renal function (vDRF-pDRF) are measures of the physiologic changes within the kidney. Additionally, MR urography provides prognostic information by assessing the quality of the renal parenchyma and identifying uropathy preoperatively. MR urography combines both anatomic and functional information in a single test and is capable of providing a comprehensive evaluation of obstructive uropathy that could ultimately help select those patients most likely to benefit from surgical intervention.
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Abstract
Ultrasonography is the screening method of choice for the evaluation of the fetus. It is safe, inexpensive, and easily performed. However, it is operator dependent, and evaluation may be limited because of fetal position, maternal obesity, overlying bone, and/or oligohydramnios. Magnetic resonance imaging is an alternative modality that uses no ionizing radiation, has excellent tissue contrast and a large field of view, is not limited by obesity or overlying bone, and can image the fetus in multiple planes, no matter the fetal lie. Faster scanning techniques allow studies to be performed without sedation in the second and third trimester with minimal motion artifact.
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Affiliation(s)
- Dorothy Bulas
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, George Washington University School of Medicine, Washington, DC 20010, USA.
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Kline-Fath BM, Calvo-Garcia MA, O'Hara SM, Racadio JM. Water imaging (hydrography) in the fetus: the value of a heavily T2-weighted sequence. Pediatr Radiol 2007; 37:133-40. [PMID: 17136362 DOI: 10.1007/s00247-006-0353-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 09/26/2006] [Accepted: 10/10/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Since the development of fast imaging sequences, MR has proved to be a helpful tool in the evaluation of fetal pathology. Because of the high water content of fetal tissues and pathology, hydrography imaging (MR fetography) can provide additional diagnostic information. OBJECTIVE To demonstrate the benefit of MR fetography in fetal imaging. MATERIALS AND METHODS From 2004 to 2005, 126 fetal MR examinations were performed for evaluation of an abnormality depicted on an antenatal sonogram. Single-shot fast spin-echo MR imaging and MR fetography were performed through the area of fetal pathology. The two studies were retrospectively compared. RESULTS The primary diagnosis was not changed with the addition of MR fetography. New findings, particularly in the kidneys and spine, were identified in 9% of the patients. When fetal pathology was of high water content (80% patients), the MR fetography imaging increased diagnostic confidence. In 11% of the patients, those with cardiovascular or low water pathology, the MR fetography was not beneficial. CONCLUSION The mainstay of fetal imaging is currently the HASTE and SSFSE sequences. However, MR fetography is an excellent adjunct that highlights fetal pathology by reinforcing the diagnosis, identifying additional findings, and providing high-contrast high-resolution images that are helpful when counseling clinicians and patients.
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Affiliation(s)
- Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, Cincinnati, OH, USA.
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Straub P, Horváth G, Dávidovics S, Pintér A. [Magnetic resonance urography in the diagnosis of the ectopic ureters]. Orv Hetil 2007; 148:105-9. [PMID: 17289613 DOI: 10.1556/oh.2007.27887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ectopic ureters are often very difficult to diagnose with conventional diagnostic modalities (physical examination, ultrasound, intravenous urography, cystography, urethro-cystoscopy, isotop examinations) in children. AIM OF THE STUDY The authors report their experience with a relatively new method, the magnetic resonance urography (MRU) diagnosing ectopic ureters in childhood. METHOD MRU was used in 7 girls to detect an ectopic ureter in the last 3 years. On the basis of typical clinical signs, an ectopic ureter was suspected in all patients, but it could not be demonstrated by conventional diagnostic methods. Thus, MRU was done to confirm the suspected diagnosis. RESULTS In all of the 7 patients, the examinations demonstrated ectopic ureters with the intraoperative findings further confirming the pre-operative diagnosis. In 2 patients, the intraoperative findings of the upper urinary tract anomalies were slightly different from the MRU report. CONCLUSION The MRU is a reliable diagnostic method to diagnose ectopic ureters which are not easily detectable with conventional diagnostic modalities.
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Affiliation(s)
- Péter Straub
- Egészségügyi Centrum, Gyermekgyógyászati Klinika.
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Riccabona M. (Paediatric) magnetic resonance urography: just fancy images or a new important diagnostic tool? Curr Opin Urol 2007; 17:48-55. [PMID: 17143111 DOI: 10.1097/mou.0b013e3280119889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Magnetic resonance urography has become an established imaging tool in uroradiology. Its potential to assess anatomy and function makes it an ideal tool for evaluation of urinary tract malformations, renal cysts, genito-urinary tract tumours, infections and renal transplants. This review tries to highlight the potential of magnetic resonance urography in the light of new advances, particularly focusing on paediatric applications. RECENT FINDINGS Technical innovations such as diaphragmatic tracking, parallel or propeller imaging, faster gradients and higher field strength improve applicability in infants and children. Dynamic studies enable assessment of renal functional parameters such as split renal function, glomerular filtration rate or urinary drainage. Recent advances in magnetic resonance spectroscopy, diffusion imaging and perfusion imaging and new contrast agents promise to widen the potential of magnetic resonance urography as a functional imaging tool, not only in paediatrics but also for other magnetic resonance applications in the genito-urinary tract, such as prostate imaging or in the staging of ovarian and endometrial cancer. SUMMARY Besides ultrasound being used as the initial imaging method, particularly in children (and as computed tomography in adults), magnetic resonance urography can be envisioned as the major imaging modality for almost all (paediatric) uroradiological queries, consequently creating a growing demand for available equipment and procedural expertise.
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Affiliation(s)
- Michael Riccabona
- Department of Radiology, Division of Paediatric Radiology, University Hospital Graz, Austria.
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Abstract
PURPOSE OF REVIEW Magnetic resonance imaging has emerged as a powerful diagnostic tool for the imaging of the pediatric genitourinary tract. The aim of this review is to familiarize the reader with the current applications and basic techniques utilizing magnetic resonance imaging in pediatric uroradiology. RECENT FINDINGS Magnetic resonance imaging can provide both a detailed anatomic and functional assessment of the pediatric genitourinary tract in a single study without the use of ionizing radiation. Magnetic resonance urography combines static and dynamic evaluation of the urinary tract following contrast administration and has been most often applied to the evaluation of hydronephrosis. In addition to unparalleled anatomic assessment, it allows for the evaluation of glomerular filtration rate, renal transit time, and differential renal function. It also provides unique insights into a wide range of obstructive uropathies and has been demonstrated to be useful in the evaluation of complex genitourinary anomalies. Magnetic resonance voiding cystourethrography has been used to rule out vesicoureteral reflux. Magnetic resonance imaging has also been demonstrated to be superior to nuclear scintigraphy for the diagnosis of pyelonephritis and renal scarring. SUMMARY Magnetic resonance imaging has emerged as a powerful tool for the diagnosis of pediatric genitourinary anomalies. It provides functional and anatomic assessment with a single procedure that in most cases is superior to conventional procedures. Magnetic resonance imaging will probably become the modality of choice for the imaging of pediatric genitourinary tract anomalies.
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Affiliation(s)
- Andrew J Kirsch
- Departments of Pediatric Urology, Emory University School of Medicine, Atlanta, Georgia 30342, USA.
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Grattan-Smith JD, Jones RA. MR urography in children. Pediatr Radiol 2006; 36:1119-32; quiz 1228-9. [PMID: 16791588 DOI: 10.1007/s00247-006-0222-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Revised: 03/20/2006] [Accepted: 04/07/2006] [Indexed: 02/07/2023]
Abstract
MR urography represents the next step in the evolution of uroradiology in children by combining superb anatomic imaging with quantitative functional evaluation in a single examination that does not use ionizing radiation. MR imaging has inherently greater soft-tissue contrast than other imaging techniques. When used in conjunction with dynamic scanning after administration of a contrast agent, it provides non-invasive analysis of the perfusion, concentration and excretion of each kidney. The purpose of this review is to outline our experience with more than 500 MR urograms in children. We outline our technique in detail, showing how we calculate differential renal function and how we assess concentration and excretion in the different regions of the kidney. We show that the dynamic contrast-enhanced data can be processed to yield quantitative measures of individual kidney GFR. In the clinical section we show how MR urography adds unique aspects to the anatomic evaluation of the urinary tract, and by combining the anatomic information with functional information, how we assess hydronephrosis and obstructive uropathy, congenital malformations, pyelonephritis and renal scarring.
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Affiliation(s)
- J Damien Grattan-Smith
- Department of Radiology, Children's Healthcare of Atlanta, 1001 Johnson Ferry Road, Atlanta, GA 30342, USA.
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Rohrschneider WK, Schenk JP. [Functional and morphological MR imaging of the upper urinary tract in the pediatric age group]. Radiologe 2006; 45:1092-100. [PMID: 16184374 DOI: 10.1007/s00117-005-1247-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
MR imaging is being increasingly used for the diagnosis of congenital urinary tract obstruction. The following conditions have to be fulfilled to provide an MR urography technique which is useful for the pediatric age group: (1) the combination of morphology and function, (2) a high-resolution morphological image, (3) a morphological image independent of kidney function, (4) reliable determination of split renal function and (5) of urinary excretion. This is best accomplished with a combination of a T1-weighted fast GE sequence post-contrast and a heavily T2-weighted 3D IR-TSE sequence. Selected sequence parameters are important for optimization as well as for a correct functional assessment. Then MR urography is superior to the conventional methods of excretory urography, ultrasound, and scintigraphy in the morphological depiction of the urinary tract even of complex malformations as well as in a detailed functional assessment. In particular, this method is useful in the situation of complicated duplex kidneys, dystopic kidneys, unclear morphology, or discrepant former results and perioperative assessment. The main advantages are avoiding radiation and obtaining a simultaneous functional-morphological diagnosis.
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Affiliation(s)
- W K Rohrschneider
- Sektion Pädiatrische Radiologie, St.-Annastiftskrankenhaus Ludwigshafen. wiltrud.rohrschneider@st.-annastiftskrankenhaus.de
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Memarsadeghi M, Riccabona M, Heinz-Peer G. [MR urography: principles, examination techniques, indications]. Radiologe 2006; 45:915-23. [PMID: 15971042 DOI: 10.1007/s00117-005-1225-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
MR urography is an evolving and promising technique in the evaluation of the urinary tract. MR urography is currently considered the method of choice for imaging of the renal parenchyma and the collecting systems in patients who cannot undergo routine radiographic studies such as pregnant women, pediatric patients, patients allergic to iodinated contrast agents, or patients with impaired renal function. The future development of MR urography in terms of functional, cellular, and molecular imaging is presently the subject of research. The ability of MR imaging to provide quantitative functional information (e.g., on blood flow, perfusion, glomerular filtration rate, and excretion as well as urine drainage) in addition to morphologic assessment of the parenchyma and the collecting system could lead to a single, "all-in-one approach" examination technique.
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Affiliation(s)
- M Memarsadeghi
- Klinik für Radiodiagnostik, Medizinische Universität Wien, Osterreich.
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