title: Utility of MR urography in children suspected of having ectopic ureter.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatric Urology, The Hospital for Sick Children and University Of Toronto, Toronto, Canada.
authors.forename: Victor H
authors.initials: VH
authors.lastname: Figueroa
authors.forename: Govind B
authors.initials: GB
authors.lastname: Chavhan
authors.forename: Kamaldine
authors.initials: K
authors.lastname: Oudjhane
authors.forename: Walid
authors.initials: W
authors.lastname: Farhat
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014513:Ureter / Q000002:abnormalities* / Q000473:pathology; D014564:Urogenital Abnormalities / Q000175:diagnosis*; D014567:Urography