Jessica Rodigas1, Hanne Kirsch1, Ulrike John2, Philipp Seifert3, Thomas Winkens3, Martin Stenzel4, Hans-Joachim Mentzel1. 1. 1 Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, Jena 07747, Germany. 2. 2 Section of Pediatric Nephrology, Department of Pediatrics, University Hospital Jena, Jena, Germany. 3. 3 Department of Nuclear Medicine, University Hospital Jena, Jena, Germany. 4. 4 Pediatric Radiology, Kliniken Köln, Köln, Germany.
Abstract
OBJECTIVE: The purpose of this study is to compare functional MR urography (MRU) with the results of ultrasound and radionuclide 99mTc-mercaptoacetyltriglycine (MAG3) scintigraphy in evaluating morphologic findings, split renal function, and urinary tract obstruction in pediatric patients. MATERIALS AND METHODS: Pediatric patients with proven congenital anomalies of the kidney and urinary tract were included (n = 112). The morphologic findings of MRU were compared with previous diagnostic ultrasound findings. For evaluation of split renal function and urinary tract obstruction, MAG3 scintigraphy was used as a reference standard. RESULTS: MRU provided detailed morphologic information of the whole urinary tract for all 112 patients. In 94.6% of cases (n = 106), diagnostic findings could be verified, and in 5.4% of cases (n = 6), more detailed information could be gained. Equivalent split renal function showed good concordance between functional MRU and MAG3 scintigraphy. However, in kidneys with restricted function (< 35%), functional MRU underestimated the remaining renal function, with a mean difference of 6.6% and an SD of 24.4%. For evaluation of relevant urinary tract obstruction, the sensitivity of functional MRU was 100%, specificity was 81.6%, positive predictive value was 70.8%, and negative predictive value was 100%. CONCLUSION: Regarding split renal function, functional MRU shows a lack of accuracy in comparison with the clinical standard MAG3 scintigraphy, especially in patients with severely diminished function of one kidney. However, functional MRU allows an adequate assessment of urinary tract obstruction and a high-resolution morphologic evaluation of the whole urinary tract. Thus, functional MRU is suitable to add diagnostic value, especially as a complementary examination for complex individual cases in the presurgical state.
OBJECTIVE: The purpose of this study is to compare functional MR urography (MRU) with the results of ultrasound and radionuclide 99mTc-mercaptoacetyltriglycine (MAG3) scintigraphy in evaluating morphologic findings, split renal function, and urinary tract obstruction in pediatric patients. MATERIALS AND METHODS: Pediatric patients with proven congenital anomalies of the kidney and urinary tract were included (n = 112). The morphologic findings of MRU were compared with previous diagnostic ultrasound findings. For evaluation of split renal function and urinary tract obstruction, MAG3 scintigraphy was used as a reference standard. RESULTS: MRU provided detailed morphologic information of the whole urinary tract for all 112 patients. In 94.6% of cases (n = 106), diagnostic findings could be verified, and in 5.4% of cases (n = 6), more detailed information could be gained. Equivalent split renal function showed good concordance between functional MRU and MAG3 scintigraphy. However, in kidneys with restricted function (< 35%), functional MRU underestimated the remaining renal function, with a mean difference of 6.6% and an SD of 24.4%. For evaluation of relevant urinary tract obstruction, the sensitivity of functional MRU was 100%, specificity was 81.6%, positive predictive value was 70.8%, and negative predictive value was 100%. CONCLUSION: Regarding split renal function, functional MRU shows a lack of accuracy in comparison with the clinical standard MAG3 scintigraphy, especially in patients with severely diminished function of one kidney. However, functional MRU allows an adequate assessment of urinary tract obstruction and a high-resolution morphologic evaluation of the whole urinary tract. Thus, functional MRU is suitable to add diagnostic value, especially as a complementary examination for complex individual cases in the presurgical state.
Authors: Dominik Świȩtoń; Małgorzata Grzywińska; Piotr Czarniak; Andrzej Gołȩbiewski; Agata Durawa; Jacek Teodorczyk; Mariusz Kaszubowski; Maciej Piskunowicz Journal: Front Pediatr Date: 2022-03-23 Impact factor: 3.418