Abstract
Background: Obstructive congenital anomalies of the kidney and urinary tract have a high risk of kidney failure if not surgically corrected. Dynamic renal scintigraphy is the gold standard technique to evaluate drainage curves and split renal function (SRF).Objectives: To compare functional magnetic resonance (MR) urography with dynamic renal scintigraphy in measuring volumetric SRF and in the classification of drainage curves in patients with congenital anomalies of the kidney and urinary tract.Materials and Methods: We retrospectively collected patients with hydroureteronephrosis or pelvicalyceal dilatation at renal ultrasound, who underwent both functional MR urography and dynamic renal scintigraphy (DRS) within 6 months. DRS studies were evaluated by a single nuclear medicine physician with a double reading. Functional MR urography renograms were blind evaluated twice by two radiologists. The functional MR urographyintra- and inter-reading agreements as well as the agreement between the two imaging techniques were calculated. SRF was evaluated by Area Under the Curve and Rutland-Patlak methods. Drainage curves were classified as normal, borderline or accumulation patterns by both the techniques.Results: Fifty-two children were studied, 14 with bilateral involvement. A total of 104 kidney-urinary tracts were considered: 38 normal and 66 dilated. Considering Area Under the Curve and Rutland-Patlak for SRF, the intra- and inter-reader agreements of functional MR urography had excellent and good results, respectively, and the two techniques demonstrated a good concordance (r2: 67% for Area Under the Curve and 72% for Rutland-Patlak). Considering drainage curves, the inter-readers agreement for functional MR urography and the concordance between the two techniques were moderate (Cohen's k, respectively, 55.7 and 56.3%).Conclusions: According to our results, there are no significant differences between functional MR urography and DRS in measuring volumetric SRF and in the classification of drainage curves in patients with congenital anomalies of the kidney and urinary tract.
Highlights
MATERIALS AND METHODSCongenital obstructive uropathy is the most frequent anomaly of the urinary tract occurring in up to 2% of normal pregnancies [1, 2]
Eight subjects were excluded because Dynamic renal scintigraphy (DRS) or functional Magnetic Resonance (MR) urography data to derive volumetric split renal function (SRF) and drainage curve were unavailable
DRS exams were limited in few cases by a late acquisition resulting in poor arterial input function, while 16 kidney-urinary tracts were not evaluable for volumetric SRF and/or drainage curve for patient movements or contrast medium extravasation during functional MR urography
Summary
MATERIALS AND METHODSCongenital obstructive uropathy is the most frequent anomaly of the urinary tract occurring in up to 2% of normal pregnancies [1, 2]. Dynamic renal scintigraphy (DRS) is the current gold standard technique to evaluate obstruction (by drainage curve) and to measure the split renal function (SRF) between the two kidneys in children and young adults [4, 5], driving therapeutic decisions. Functional MR urography is becoming established within clinical practice as it provides a depiction of deep anatomical details thanks to its intrinsically high soft-tissue contrast [11,12,13]. This is extremely useful on complex phenotypes such as congenital anomalies of the kidney and urinary tract (CAKUT) spectrum diseases, with the further benefit of eliminating the exposure to ionizing radiation. Dynamic renal scintigraphy is the gold standard technique to evaluate drainage curves and split renal function (SRF)
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