Fetal Urinary Tract Malformations

Abstract

Radiology| November 01 2004 Fetal Urinary Tract Malformations AAP Grand Rounds (2004) 12 (5): 55–56. https://doi.org/10.1542/gr.12-5-55-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Fetal Urinary Tract Malformations. AAP Grand Rounds November 2004; 12 (5): 55–56. https://doi.org/10.1542/gr.12-5-55-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: congenital malformation of the urinary system, fetus Source: Cassart M, Massez A, Metens T, et al. Complementary role of MRI after sonography in assessing bilateral urinary tract anomalies in the fetus. AJR Am J Roentgenol. 2004;182:689–695. Urinary tract malformations of the fetus, detected by obstetric sonography, occur in 0.1% to 1% of all pregnancies. Uropathies correspond to 30–50% of all structural anomalies found at birth.1–,3 Recent development of fast sequence magnetic resonance imaging (MRI) has extended the use of MRI to antenatal diagnosis as an efficient technique to evaluate equivocal fetal sonographic findings, particularly neurologic anomalies. A pilot study was undertaken by investigators from Erasme University Hospital and University Children’s Hospital, Brussels, Belgium, to determine the potential contribution of adding MRI to sonography for the imaging diagnosis of fetal urinary tract anomalies of third trimester fetuses. All cases of fetuses with positive sonographic findings were discussed at a multidisciplinary conference, with MRI performed when sonographic findings suggested bilateral urinary tract anomalies but failed to provide a definite diagnosis. In 11 of 16 consecutive fetuses age 27–37 weeks with bilateral urinary tract anomalies, MRI findings were concordant with sonography and provided a diagnosis, which was subsequently confirmed by postnatal workup or postmortem examination. Diagnoses included posterior urethral valve, reflux, ureteropelvic junction obstruction, renal vein thrombosis, multicystic dysplastic kidney, megacystis microcolon, autosomal recessive polycystic disease, and hypoplastic kidney. MRI modified the sonographic diagnoses in 5 fetuses and narrowed the differential diagnosis in 1. This study indicates that in third trimester fetuses, MRI may help to characterize bilateral urinary tract anomalies when sonography is inconclusive. In selected cases, MRI may establish a more precise diagnosis and affect the decision to continue or terminate a pregnancy. Due to widespread application of third trimester ultrasonography, increasing numbers of urinary tract anomalies are being identified. Most anomalies are clearly identified,2,4 but in complex cases, MRI may provide a more detailed diagnosis. MRI is a more expensive examination than sonography and, like ultrasound, does not involve ionizing radiation to the patient. At this point, it is difficult to provide guidance about the appropriateness of MRI in various clinical circumstances. The approach of these authors in enlisting a multidisciplinary team, including pediatric surgeons, pediatricians, and radiologists, seems prudent when in utero ultrasound shows an identified bilateral renal abnormality. You do not currently have access to this content.