title: MRI and suspected acute pyelonephritis in children: comparison of diffusion-weighted imaging with gadolinium-enhanced T1-weighted imaging.
abstract: OBJECTIVE
  To evaluate the performance of diffusion-weighted imaging (DWI) against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1-WI) in children.
  
  
  METHODS
  Thirty-nine consecutive patients (mean age 5.7 years) with suspected acute pyelonephritis underwent magnetic resonance imaging (MRI) including DWI and (the reference standard) Gd-T1-WI. Each study was read in double-blinded fashion by two radiologists. Each kidney was graded as normal or abnormal. Sensitivity and specificity of DWI were computed. Agreement between sequences and interobserver reproducibility were calculated (Cohen κ statistic and the McNemar tests).
  
  
  RESULTS
  Thirty-two kidneys (41 %) had hypo-enhancing areas on Gd-T1-W images. The sensitivity and specificity of DWI were 100 % (32/32) and 93.5 % (43/46). DWI demonstrated excellent agreement (κ = 0.92,) with Gd-T1-W, with no significant difference (P = 0.25) in detection of abnormal lesions. Interobserver reproducibility was excellent with DWI (κ = 0.79).
  
  
  CONCLUSIONS
  DWI enabled similar detection of abnormal areas to Gd-T1-WI and may provide an injection-free means of evaluation of acute pyelonephritis.
  
  
  CONCLUSIONS
  • Diffusion weighted magnetic resonance imaging (DWI) can confirm acute pyelonepritis. • DWI provided comparable results to gadolinium enhanced T1-W MRI in acute pyelonepritis. • Contrast medium injection could be avoided for diagnosing acute pyelonephritis by MRI. • MRI with T2-WI and DWI provide a fast and comprehensive diagnostic tool.
authors.affiliation: Rouen University Hospital, CHU C. Nicolle, Service de radiopédiatrie, 1 rue de Germont, 76031, Rouen, Cedex, France, pierre-hugues.vivier@chu-rouen.fr.
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Vivier
authors.forename: Asmaa
authors.initials: A
authors.lastname: Sallem
authors.forename: Marion
authors.initials: M
authors.lastname: Beurdeley
authors.forename: Ruth P
authors.initials: RP
authors.lastname: Lim
authors.forename: Julien
authors.initials: J
authors.lastname: Leroux
authors.forename: Jérome
authors.initials: J
authors.lastname: Caudron
authors.forename: Cyril
authors.initials: C
authors.lastname: Coudray
authors.forename: Agnès
authors.initials: A
authors.lastname: Liard
authors.forename: Isabelle
authors.initials: I
authors.lastname: Michelet
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Dacher
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007223:Infant; D007668:Kidney / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011704:Pyelonephritis / Q000175:diagnosis*; D012372:ROC Curve; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA