Functional and morphologic evaluation of congenital urinary tract dilatation by using combined static-dynamic MR urography: findings in kidneys with a single collecting system

Abstract

Purpose: To assess combined static-dynamic magnetic resonance (MR) urography in the evaluation of congenital urinary tract dilatation in infants and children.

Materials and methods: Sixty-two patients with urinary tract dilatation underwent prospective examination with combined static-dynamic MR urography. A combination examination involved use of a static T2-weighted three-dimensional inversion-recovery fast spin-echo sequence and a dynamic T1-weighted two-dimensional fast field-echo sequence with gadopentetate dimeglumine-DTPA and furosemide application. Twelve additional patients underwent examination with only static MR urography. Thus, both image quality and morphologic features were assessed in 74 patients with the use of MR urography. The results were compared with those of ultrasonography and, when available, conventional urography or surgery. In 62 patients, the dynamic sequence was used to calculate split renal function from renograms generated from parenchymal regions of interest and to assess urinary excretion from whole-kidney renograms. Results were compared with those of diuretic renal scintigraphy (DRS) for split function (Spearman rank correlation coefficient) and urinary excretion (kappa coefficient).

Results: Stenoses at the ureteropelvic (n = 33) and ureterovesical (n = 31) junctions and within the ureter (n = 3) and nonstenotic dilatation (n = 23) were clearly depicted, while the normal urinary tract (n = 51) was depicted in its entirety in 47 of 51 examinations. Image quality was considered good or excellent in 95% of the kidney-ureter units. For split renal function, dynamic MR urography and DRS showed significant correlation (r = 0.92, P <.001). For urinary excretion, MR urography and DRS showed strong agreement (kappa = 0.67), with concordant classification of urinary excretion in 59 (81%) of 73 abnormal kidney-ureter units and in all 47 (100%) normal kidney-ureter units.

Conclusion: Combined static-dynamic MR urography provides high-quality depiction of the urinary tract in infants and children, while allowing accurate determination of single-kidney function and reliable evaluation of urinary excretion.