Abstract
BackgroundConventional diffusion weighted imaging (DWI) is a promising non-invasive tool in the evaluation of infants with symptomatic urinary tract infections (UTI). The use of multiparametric diffusion tensor imaging (DTI) provides further information on renal pathology by reflecting renal microstructure. However, its potential to characterize and distinguish between renal lesions, such as acute pyelonephritic lesions, permanent renal damages or dysplastic changes has not been shown. This study aimed to evaluate the potential of multiparametric DTI for characterization of renal lesions with purpose to distinguish acute pyelonephritis from other renal lesions in young infants with their first UTI.MethodsNine kidneys in seven infants, age 1.0–5.6 months, with renal lesions i.e. uptake reductions, on acute scintigraphy performed after their first UTI, were included. The DTI examinations were performed during free breathing without sedation. The signal in the lesions and in normal renal tissue was measured in the following images: b0, b700, apparent diffusion coefficient (ADC), and fractional anisotropy (FA). In addition, DTI tractographies were produced for visibility.ResultsThere was a difference between lesions and normal tissue in b700 signal (197 ± 52 and 164 ± 53, p = 0.011), ADC (1.22 ± 0.11 and 1.45 ± 0.15 mm2/s, p = 0.008), and FA (0.18 ± 0.03 and 0.30 ± 0.10, p = 0.008) for all nine kidneys. Six kidneys had focal lesions with increased b700 signal, decreased ADC and FA indicating acute inflammation. In three patients, the multiparametric characteristics of the lesions were diverging.ConclusionMultiparametric DTI has the potential to further characterize and distinguish acute pyelonephritis from other renal lesions in infants with symptomatic UTI.
Highlights
Conventional diffusion weighted imaging (DWI) is a promising non-invasive tool in the evaluation of infants with symptomatic urinary tract infections (UTI)
When further imaging is needed, for example to evaluate the extent of engagement of the renal tissue or to identify complications of the infection, dependent on availability, 99mTc-Dimercaptosuccinic acid (DMSA) scintigraphy, computed tomography (CT) or contrast enhanced magnetic resonance imaging (MRI) can be used
Aim: To study the potential of multiparametric diffusion tensor imaging (DTI) for characterization of renal lesions with purpose to distinguish different renal lesions in young infants with their first UTI. Patients This explorative study was performed in conjunction with a recently published study [6] including infants (< 6 months of age) that had been examined with acute DMSA scintigraphy as part of the clinical routine follow-up of infants with first time community-acquired symptomatic UTI in our hospital over a period of 19 months
Summary
Conventional diffusion weighted imaging (DWI) is a promising non-invasive tool in the evaluation of infants with symptomatic urinary tract infections (UTI). This study aimed to evaluate the potential of multiparametric DTI for characterization of renal lesions with purpose to distinguish acute pyelonephritis from other renal lesions in young infants with their first UTI. When further imaging is needed, for example to evaluate the extent of engagement of the renal tissue or to identify complications of the infection, dependent on availability, 99mTc-Dimercaptosuccinic acid (DMSA) scintigraphy, computed tomography (CT) or contrast enhanced magnetic resonance imaging (MRI) can be used. Diffusion weighted imaging (DWI), a non-invasive MRI-technique, has been suggested as an alternative method in the evaluation of children with symptomatic UTI [2,3,4,5,6]
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