Magnetic Resonance Urogram in Pediatric Urology: a Comprehensive Review of Applications and Advances

Magnetic Resonance Urography (MRU) has emerged as a powerful imaging modality in pediatric urology, offering comprehensive anatomical and functional assessment of the urinary tract without exposure to ionizing radiation. This review provides an in-depth analysis of MRU's technical aspects, clinical applications, advantages, and recent advancements. Traditional imaging techniques, such as ultrasound, voiding cystourethrography, and nuclear scintigraphy, have long been utilized for evaluating pediatric urinary tract anomalies; however, these methods have inherent limitations in anatomical resolution and functional assessment. MRU combines high-resolution anatomical imaging with dynamic functional analysis, making it particularly valuable in evaluating conditions such as hydronephrosis, ureteropelvic junction obstruction, and ectopic ureters. Advancements in MRU technology, including the use of 3T MRI for superior spatial resolution, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have enhanced its diagnostic capabilities. The ability to assess renal transit times and differential renal function allows for precise evaluation of obstructive uropathies and congenital anomalies. Despite requiring sedation in younger children and longer acquisition times, MRU has demonstrated superior accuracy compared to conventional imaging, reducing the need for multiple diagnostic studies. Recent developments in real-time MRI, faster imaging techniques, and AI-based reconstructions have further optimized MRU's efficiency and diagnostic utility. As MRU continues to evolve, its role in pediatric urology is expected to expand, potentially replacing traditional imaging modalities in select cases. This review highlights the growing significance of MRU in pediatric urinary tract evaluation, emphasizing its potential to improve clinical decision-making and patient outcomes.