Using intravoxel incoherent motion MR imaging to evaluate cortical defects in the first episode of upper urinary tract infections: preliminary results.
OBJECTIVE
To compare intravoxel incoherent motion diffusion weight imaging IVIM-DWI MRI with DMSA for the evaluation of cortical defect in pediatric upper urinary tract infection (UTI) patients.


METHODS
Forty-three kidneys of 22 pediatric patients with the first episode of febrile upper UTI were evaluated. DWI using IVIM model was performed with eight b factors. The presence of cortical defect was evaluated on apparent diffusion coefficient (ADC) map. DMSA was used as the standard of reference. ADC, true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (F) in both defect and nondefect area were calculated and compared.


RESULTS
Cortical defects were detected in 14 kidneys by IVIM-DWI. The sensitivity, specificity, positive predictive value, and negative predictive value of IVIM-DWI MRI for the detection of defects was 93.3%, 100%, 100%, and 96.5%, respectively. Mean values of ADC, D, D*, and F were 1.12 ± 0.15, 1.05 ± 0.10, 33 ± 17 (× 10(-3) mm(2) /s), and 0.14 ± 0.09 in the defect foci. In normal foci, ADC, D, D*, and F were 1.37 ± 0.09, 1.31 ± 0.10, 43 ± 19 (× 10(-3) mm(2) /s), and 0.12 ± 0.04, respectively. ADC and D were significantly lower in defect group than nondefect group (P < 0.01).


CONCLUSIONS
IVIM-DWI can allow both direct visualization and quantitative measurement of cortical defects.
Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Chang Hee
CH
Lee
Kee Hwan
KH
Yoo
Bo-Kyung
BK
Je
In Seong
IS
Kim
Berthold
B
Kiefer
Yang Shin
YS
Park
Kyeong Ah
KA
Kim
Cheol Min
CM
Park
D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted; D007223:Infant; D007672:Kidney Cortex / Q000473:pathology; D008297:Male; D009038:Motion; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
APN; DWI; IVIM; MRI; kidney; pediatrics