Establishing a dynamic magnetic resonance genitography protocol for presurgical evaluation of genitourinary...

We present a novel, dynamic magnetic resonance (MR) genitography protocol developed for pre-surgical assessment of pediatric genitourinary malformations. This protocol has been applied in patients with cloacal malformations, covered cloacal exstrophy, imperforate anus, urogenital sinus, and conjoined twins with a pelvic connection. Traditionally, a combination of imaging modalities has been used as each has its limitations. Our approach combines catheter placement during an endoscopic exam under anesthesia with real-time, intracavitary gadolinium-enhanced magnetic resonance imaging, allowing dynamic cavity distension and simultaneous soft tissue visualization without ionizing radiation. Our protocol enables delineation of anatomical relationships and obstructed versus non-obstructed cavities, facilitating individualized surgical planning and enabling direct correlation of endoscopic to imaging observation. Additionally, 3D reconstructions and prints derived from multiphase imaging support multidisciplinary discussions, patient education, and intraoperative guidance. Here, we describe the examination under anesthesia procedures and imaging protocol development for dynamic MR genitography.