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Magnetic resonance urography in children: evaluation of suspected ureteral ectopia in duplex systems
G Staatz1, D Rohrmann, C C Nolte-Ernsting
1Department of Diagnostic Radiology, University Hospital of the RWTH Aachen, Aachen, Germany.
Insights
Magnetic resonance urography accurately diagnoses ectopic ureters and ureteroceles in pediatric duplex systems. Combining static fluid and excretory techniques enhances evaluation of these complex urinary tract abnormalities.
Area of Science:
- Pediatric radiology
- Urogenital imaging
- Medical diagnostics
Background:
- Duplex systems are common congenital anomalies.
- Ectopic ureters and ureteroceles can cause significant morbidity.
- Accurate diagnosis is crucial for appropriate management in children.
Purpose of the Study:
- To assess the diagnostic accuracy of magnetic resonance urography (MRU) in children.
- To evaluate MRU for suspected ectopic ureters and ureteroceles within duplex systems.
Main Methods:
- 14 children (4 weeks to 8 years) with 18 duplex systems underwent 1.5T MRU.
- T2-weighted static fluid MRU and T1-weighted excretory MRU (post-gadolinium) were performed.
- Furosemide was administered to enhance urographic imaging.
Main Results:
- MRU examinations were completed successfully without sedation.
- T1-weighted excretory MRU accuracy was dependent on renal function.
- Ectopic ureters in poorly functioning moieties were best visualized with T2-weighted imaging.
Conclusions:
- Respiratory-gated excretory and static fluid MRU are complementary techniques.
- Combined MRU approaches provide high diagnostic accuracy for ectopic ureters and ureteroceles in pediatric duplex systems.
Purpose:
We evaluate the diagnostic accuracy of magnetic resonance urography in children with suspected ectopic ureters and ureteroceles in duplex systems.
Materials And Methods:
A total of 14 children 4 weeks to 8 years old with a total of 18 duplex systems underwent magnetic resonance urography using a 1.5 tesla scanner. After injection of low dose furosemide, half-Fourier rapid acquisition with relaxation enhancement images were obtained for T2-weighted static fluid magnetic resonance urography. Respiratory gated 3-dimensional gradient echo images were acquired for T1-weighted excretory magnetic resonance urography 5 to 30 minutes after intravenously administered gadolinium.
Results:
All magnetic resonance examinations were successfully performed without sedation. The diagnostic accuracy of T1-weighted excretory magnetic resonance urography depended on the renal function. Twelve duplex systems with a normal excretory function, including 6 bifid ureters and 6 upper moieties with inferomedial ectopic ureters, were analyzed correctly with the exception of a 6 mm. ureterocele in 1 case. In 6 duplex systems with poor or nonfunctioning upper moieties ectopic ureters were only demonstrated on T2-weighted magnetic resonance urograms.
Conclusions:
Respiratory gated excretory and static fluid magnetic resonance urography complement each other in the evaluation of duplex systems in children and provide high accuracy in the evaluation of suspected ectopic ureters and ureteroceles.