Detection of obstructive uropathy and assessment of differential renal function using two functional magnetic resonance urography tools. A comparison with diuretic renal scintigraphy in infants and children.
OBJECTIVE
After detection of obstructive uropathy (OU), the indication for or against surgery is primarily based on the differential renal function (DRF). This is to compare functional magnetic resonance urography (fMRU) with dynamic renal scintigraphy (DRS) to assess OU and DRF in infants and children.


METHODS
Retrospective analysis in 30 patients (female: 16; male: 14; median age: 5.5 years [0.2-16.5]), divided into subgroup A (age: 0-2 years; n = 16) and B (> 2-17 years; n = 14). fMRU was assessed by measuring renal transit time (RTT) and volumetric DRF with CHOP fMRU tool (CT) and ImageJ MRU plug-in (IJ). OU detection by fMRU was compared with DRS (standard of reference) using areas under the curves (AUC) in ROC analyses. Concordant DRF was assumed if absolute deviation between fMRU and DRS was ≤ 5 %.


RESULTS
DRS confirmed fixed OU in 4/31 kidneys (12.9 %) in subgroup A. AUC of CT was 0.94 compared with 0.93 by IJ. Subgroup B showed fixed OU in 1/21 kidneys (4.8 %) with AUCs of 0.98 each. RTT measured neither by CT nor by IJ in confirmed fixed OU was < 1200 s - resulting in negative predictive values of 1.0 each. In subgroup A, DRF was concordant in 81.3 % of the kidneys for CT and DRS compared with 75.0 % for IJ and DRS. In subgroup B, CT and DRS were concordant in 91.7 %, and IJ and DRS in 45.8 % of the kidneys.


CONCLUSIONS
fMRU accurately excluded fixed OU in infants and children, independent from the software used for quantification. However, assessment of DRF with fMRU deviated from DRS especially in infants who may profit most from early intervention. Thus, fMRU cannot fully replace DRS as primary functional examination. If, for clinical reasons, fMRU is performed in first place and it cannot exclude fixed OU, it should be followed by DRS for validation and DRF quantification.
Philipp
P
Genseke
Julian MM Rogasch, M.D., Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Tel. +49(0)391 67 13000, Fax +49(0)391 67 13016, E-Mail: julianrogasch@gmx.de.
Julian M M
JM
Rogasch
Ingo G
IG
Steffen
Grit
G
Neumann
Ivayla
I
Apostolova
Juri
J
Ruf
Anke
A
Rißmann
Dagobert
D
Wiemann
Uwe-Bernd
UB
Liehr
Martin
M
Schostak
Holger
H
Amthauer
Christian
C
Furth
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004232:Diuretics; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D007677:Kidney Function Tests / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011866:Radioisotope Renography / Q000379:methods*; D011877:Radionuclide Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software; D014524:Urethral Obstruction / Q000000981:diagnostic imaging*; D014567:Urography / Q000379:methods
D004232:Diuretics
CHOP fMRU tool; ImageJ MRU plug-in; diuretic renal scintigraphy; fMRU; obstructive uropathy; renal transit time