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Magnetic resonance imaging in children with voiding dysfunction: is it indicated?

J L Pippi Salle1, G Capolicchio, A M Houle

  • 1Department of Pediatric Urology, Montreal Children's Hospital, McGill University, Quebec, Canada.

The Journal of Urology
|August 27, 1998
PubMed
Summary

Magnetic resonance imaging (MRI) has limited value for children with voiding dysfunction and normal exams. It should be reserved for patients with neuro-orthopedic findings or skeletal deformities.

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Area of Science:

  • Pediatric Urology
  • Neurourology
  • Pediatric Radiology

Background:

  • Complicated voiding dysfunction in children often warrants investigation.
  • Neuro-orthopedic examination is a standard part of the assessment.
  • The role of spinal MRI in this specific population is not well-defined.

Purpose of the Study:

  • To evaluate the diagnostic utility of lumbosacral spinal cord magnetic resonance imaging (MRI).
  • To assess children presenting with complicated voiding dysfunction and normal neuro-orthopedic findings.

Main Methods:

  • Retrospective review of 32 children with complicated enuresis referred for neurosurgical evaluation.
  • Exclusion of 9 patients due to anomalies or unmet criteria, leaving 23 eligible children.
  • Analysis of neuro-orthopedic examinations, urodynamic studies, and spinal MRI findings.

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Main Results:

  • Skeletal abnormalities, primarily spina bifida occulta, were found in 70% of patients.
  • Spinal MRI revealed abnormalities in only 2 patients (8.7%), including a tethered cord with lipoma and a syrinx.
  • Urodynamic studies showed various abnormalities like detrusor instability and hypertonia.

Conclusions:

  • Magnetic resonance imaging (MRI) has limited value in diagnosing the cause of voiding dysfunction in children with a normal neuro-orthopedic assessment.
  • MRI should be reserved for pediatric patients with concurrent neuro-orthopedic findings or complex skeletal deformities identified on plain X-ray.
  • The findings suggest a selective approach to MRI utilization in pediatric voiding dysfunction.