Magnetic resonance urography (MRU): technique mastery and illustrative case reviews

Magnetic Resonance Urography (MRU) is a comprehensive, non-invasive imaging technique that offers detailed anatomical and functional assessment of the urinary system without radiation exposure. It is particularly valuable in pediatric, pregnant, and renally impaired patients, and in those with CT contrast allergies. Multiparametric MRU sequences can evaluate congenital anomalies, functional obstruction, urothelial tumors, and postoperative anatomy. Advancements in imaging technology such as respiratory gating, compressed sensing, and motion correction, have significantly improved image quality and patient comfort. The introduction of the Vesical Imaging Reporting and Data System (VI-RADS) has standardized bladder cancer staging, aiding in inter-reader reproducibility and treatment planning. This review outlines MRU technique, protocol optimization, artifact mitigation strategies, and specific pediatric and oncologic applications. Illustrative cases highlight the versatility of MRU in clinical practice. With advanced MRI techniques, increasing expertise among radiologists and familiarity among urologists, MRU is emerging as a first-line modality in select urologic conditions.