Skip to main content
Erschienen in: Pediatric Nephrology 7/2014

01.07.2014 | Original Article

Efficacy of magnetic resonance urography in detecting renal scars in children with vesicoureteral reflux

verfasst von: Ali Koçyiğit, Selçuk Yüksel, Recep Bayram, İsmail Yılmaz, Nevzat Karabulut

Erschienen in: Pediatric Nephrology | Ausgabe 7/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

The detection of renal scars is of paramount importance for optimal clinical management of patients with urinary tract infection (UTI) and vesicoureteral reflux (VUR). The aim of our study was to compare the efficacy of unenhanced magnetic resonance urography (MRU) and Tc-99m dimercaptosuccinic acid (Tc-DMSA) scintigraphy to dectect renal scars.

Methods

Unenhanced MRU and Tc-DMSA scintigraphy were performed in 49 children (10 boys, 39 girls; mean age 7.4 ± 4.2 years, range 1–15 years) with documented VUR. MR imaging scans were obtained within 7 days after voiding cystourethrogram (VCUG) and Tc-DMSA scintigraphy. The diagnostic performance of MRU in renal scar detection was calculated relative to that of the Tc-DMSA scan.

Results

The renal scar detection rate of Tc-DMSA scintigraphy and unenhanced MRU in kidneys with VUR was 32.4 and 25.9 %, respectively. The sensitivity and specificity of MRU in the detection of renal scars was 80 and 82.6 % in kidneys with VUR, respectively. There was no statistically significant difference in lesion detection between MRU and Tc-DMSA scintigraphy (P > 0.05). MRU and Tc-DMSA scintigraphy showed good agreement (κ = 0.60).

Conclusions

Unenhanced MRU is a robust technique for the morphologic assessment of the urinary system and detection of renal scars. The lack of radiation and contrast material makes this technique a much safer alternative to scintigraphy in children with VUR, particularly in those who require follow-up scanning and, consequently, considerable radiation exposure.
Literatur
1.
Zurück zum Zitat Stefanidis CJ, Siomou E (2007) Imaging strategies for vesicoureteral reflux diagnosis. Pediatr Nephrol 22:937–947PubMedCrossRef Stefanidis CJ, Siomou E (2007) Imaging strategies for vesicoureteral reflux diagnosis. Pediatr Nephrol 22:937–947PubMedCrossRef
2.
Zurück zum Zitat Orellana P, Baquedano P, Rangarajan V, Zhao JH, Eng ND, Fettich J, Chaiwatanarat T, Sonmezoglu K, Kumar D, Park YH, Samuel AM, Sixt R, Bhatnagar V, Padhy AK (2004) Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. Results of a coordinated research project. Pediatr Nephrol 19:1122–1126PubMedCrossRef Orellana P, Baquedano P, Rangarajan V, Zhao JH, Eng ND, Fettich J, Chaiwatanarat T, Sonmezoglu K, Kumar D, Park YH, Samuel AM, Sixt R, Bhatnagar V, Padhy AK (2004) Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. Results of a coordinated research project. Pediatr Nephrol 19:1122–1126PubMedCrossRef
3.
Zurück zum Zitat Polito C, Rambaldi PF, Signoriello G, Mansi L, La Manna A (2006) Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux. Pediatr Nephrol 21:521–526PubMedCrossRef Polito C, Rambaldi PF, Signoriello G, Mansi L, La Manna A (2006) Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux. Pediatr Nephrol 21:521–526PubMedCrossRef
4.
5.
Zurück zum Zitat Kovanlikaya A, Okkay N, Cakmakci H, Ozdoğan O, Degirmenci B, Kavukcu S (2004) Comparison of MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis: preliminary experience. Eur J Radiol 49:76–80PubMedCrossRef Kovanlikaya A, Okkay N, Cakmakci H, Ozdoğan O, Degirmenci B, Kavukcu S (2004) Comparison of MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis: preliminary experience. Eur J Radiol 49:76–80PubMedCrossRef
6.
Zurück zum Zitat White GW, Gibby WA, Tweedle MF (2006) Comparison of Gd (DTPA-BMA) (Omniscan) versus Gd (HP-DO3A) (ProHance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy. Invest Radiol 41:272–278PubMedCrossRef White GW, Gibby WA, Tweedle MF (2006) Comparison of Gd (DTPA-BMA) (Omniscan) versus Gd (HP-DO3A) (ProHance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy. Invest Radiol 41:272–278PubMedCrossRef
7.
Zurück zum Zitat [No authors listed] (1981) Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. Pediatrics 67:392–400 [No authors listed] (1981) Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. Pediatrics 67:392–400
8.
9.
Zurück zum Zitat Verswijvel GA, Oyen RH, Van Poppel HP, Goethuys H, Maes B, Vaninbrouckx J, Bosmans H, Marchal G (2000) Magnetic resonance imaging in the assessment of urologic disease: an all-in-one approach. Eur Radiol 10:1614–1619PubMedCrossRef Verswijvel GA, Oyen RH, Van Poppel HP, Goethuys H, Maes B, Vaninbrouckx J, Bosmans H, Marchal G (2000) Magnetic resonance imaging in the assessment of urologic disease: an all-in-one approach. Eur Radiol 10:1614–1619PubMedCrossRef
10.
Zurück zum Zitat Garin EH, Campos A, Homsy Y (1998) Primary vesicoureteral reflux: review of current concepts. Pediatr Nephrol 12:249–256PubMedCrossRef Garin EH, Campos A, Homsy Y (1998) Primary vesicoureteral reflux: review of current concepts. Pediatr Nephrol 12:249–256PubMedCrossRef
11.
Zurück zum Zitat Yeung CK, Godley ML, Dhillon HK, Gordon I, Duffy PG, Ransley PG (1997) The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis. Br J Urol 80:319–327PubMedCrossRef Yeung CK, Godley ML, Dhillon HK, Gordon I, Duffy PG, Ransley PG (1997) The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis. Br J Urol 80:319–327PubMedCrossRef
12.
Zurück zum Zitat Lee JH, Son CH, Lee MS, Park YS (2006) Vesicoureteral reflux increases the risk of renal scars: a study of unilateral reflux. Pediatr Nephrol 21:1281–1284PubMedCrossRef Lee JH, Son CH, Lee MS, Park YS (2006) Vesicoureteral reflux increases the risk of renal scars: a study of unilateral reflux. Pediatr Nephrol 21:1281–1284PubMedCrossRef
13.
Zurück zum Zitat Chan YL, Chan KW, Yeung CK, Roebuck DJ, Chu WC, Lee KH, Metreweli C (1999) Potential utility of MRI in the evaluation of children at risk of renal scarring. Pediatr Radiol 29:856–862PubMedCrossRef Chan YL, Chan KW, Yeung CK, Roebuck DJ, Chu WC, Lee KH, Metreweli C (1999) Potential utility of MRI in the evaluation of children at risk of renal scarring. Pediatr Radiol 29:856–862PubMedCrossRef
14.
Zurück zum Zitat Kavanagh EC, Ryan S, Awan A, McCourbrey S, O’Connor R, Donoghue V (2005) Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections? Pediatr Radiol 35:275–281PubMedCrossRef Kavanagh EC, Ryan S, Awan A, McCourbrey S, O’Connor R, Donoghue V (2005) Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections? Pediatr Radiol 35:275–281PubMedCrossRef
15.
Zurück zum Zitat Thomsen HS (2008) Is NSF only the tip of the “gadolinium toxicity” iceberg? J Magn Reson Imaging 28:284–286PubMedCrossRef Thomsen HS (2008) Is NSF only the tip of the “gadolinium toxicity” iceberg? J Magn Reson Imaging 28:284–286PubMedCrossRef
16.
Zurück zum Zitat Tweedle MF, Wedeking P, Kumar K (1995) Biodistribution of radiolabeled formulated gadopentetate, gadoteridol, gadoterate and gadodiamide in mice and rats. Invest Radiol 30:372–380PubMedCrossRef Tweedle MF, Wedeking P, Kumar K (1995) Biodistribution of radiolabeled formulated gadopentetate, gadoteridol, gadoterate and gadodiamide in mice and rats. Invest Radiol 30:372–380PubMedCrossRef
Metadaten
Titel
Efficacy of magnetic resonance urography in detecting renal scars in children with vesicoureteral reflux
verfasst von
Ali Koçyiğit
Selçuk Yüksel
Recep Bayram
İsmail Yılmaz
Nevzat Karabulut
Publikationsdatum
01.07.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Nephrology / Ausgabe 7/2014
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-014-2766-y

Weitere Artikel der Ausgabe 7/2014

Pediatric Nephrology 7/2014 Zur Ausgabe

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.