Prenatal Diagnosis of Polycystic Kidney Disease with Hydroureter: A Comparison of Magnetic Resonance Imaging with Two-and Three-Dimensional Ultrasound

Abstract

Objective: To compare magnetic resonance imaging (MRI) with 2-dimensional (2D) and 3-dimensional (3D) ultrasound for the prenatal diagnosis of a polycystic kidney with hydroureter. Case Report(s): A 30-year-old Taiwanese women, gravida 2, para 0, was referred to our antenatal clinic under the impression of fetal bowel obstruction at 30-weeksi¦ gestational age. Two- dimensional (level II) ultrasound was performed at our institutions and a polycystic kidney was impressed. Hydroureter was suspected, but dilatation of the bowel could not be ruled out. 3-D ultrasound confirmed the diagnosis of polycystic kidney but hydroureter or bowel obstruction remained undetermined. A T2-weighted MR image which was obtained in 3 orthogonal planes confirmed the fetal polycystic kidney combined with hydroureter. Postnatal pediatric renal sonography demonstrated left cystic kidney disease with hydroureter. Tc-99m DTPA radionuclide study revealed marked impaired left renal function. Recurrent urinary tract infection and fever in the infant were noted, and the infant received a left nephroureterectomy at the age of 3 months old. Surgical findings included polycystic kidney and obstruction of the urinary tract at the junction of the renal pelvis and the ureter. The pathology report demonstrated multicystic kidney disease, megaloureter, and hydroureter. The postnatal diagnosis proved the antenatal diagnosis by MRI. Conclusion(s): We found that coronal scanning of the fetus could be performed more easily by magnetic resonance imaging. The MRI scan can provide better demonstration of hydroureter than is possible with ultrasound antenatally.