title: Diagnostic yield of lumbosacral magnetic resonance imaging requested by paediatric urology consultations.
abstract: OBJECTIVE
  In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by paediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism.
  
  
  METHODS
  A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the paediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analysed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0.
  
  
  RESULTS
  We analysed 21 patients during the period 2011-2015. The median age was 6 years (3-10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, P=.04; OR= 34; 95%CI: 1.5-781 for both endpoints).
  
  
  CONCLUSIONS
  The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopaedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, «cramps») can experience a greater diagnostic yield or positive predictive value.
authors.affiliation: Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: mfndezibieta@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Fernández-Ibieta
authors.affiliation: Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: J
authors.initials: J
authors.lastname: Rojas Ticona
authors.affiliation: Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: V
authors.initials: V
authors.lastname: Villamil
authors.affiliation: Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Guirao Piñera
authors.affiliation: Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: A
authors.initials: A
authors.lastname: López García
authors.affiliation: Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: G
authors.initials: G
authors.lastname: Zambudio Carmona
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D008161:Lumbosacral Region / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009436:Neural Tube Defects / Q000150:complications / Q000000981:diagnostic imaging*; D010372:Pediatrics; D012017:Referral and Consultation; D012189:Retrospective Studies; D014572:Urology
keywords: Disfunción del tracto urinario inferior; Disrafismo espinal oculto; Espina bífida oculta; Lower urinary tract dysfunction; Magnetic resonance; Mielodisplasia; Myelodysplasia; Occult spinal dysraphism; Resonancia magnética; Spina bifida occulta