Detection of obstructive uropathy and assessment of differential renal function using two functional magnetic resonance urography tools. A comparison with diuretic renal scintigraphy in infants and children

TY - JOUR

T1 - Detection of obstructive uropathy and assessment of differential renal function using two functional magnetic resonance urography tools. A comparison with diuretic renal scintigraphy in infants and children

AU - Genseke, Philipp

AU - Rogasch, Julian M M

AU - Steffen, Ingo G

AU - Neumann, Grit

AU - Apostolova, Ivayla

AU - Ruf, Juri

AU - Rißmann, Anke

AU - Wiemann, Dagobert

AU - Liehr, Uwe-Bernd

AU - Schostak, Martin

AU - Amthauer, Holger

AU - Furth, Christian

PY - 2017/2/14

Y1 - 2017/2/14

N2 - AIM: After detection of obstructive uropathy (OU), the indication for or against surgery is primarily based on the differential renal function (DRF). This is to compare functional magnetic resonance urography (fMRU) with dynamic renal scintigraphy (DRS) to assess OU and DRF in infants and children.PATIENTS, METHODS: Retrospective analysis in 30 patients (female: 16; male: 14; median age: 5.5 years [0.2-16.5]), divided into subgroup A (age: 0-2 years; n = 16) and B (> 2-17 years; n = 14). fMRU was assessed by measuring renal transit time (RTT) and volumetric DRF with CHOP fMRU tool (CT) and ImageJ MRU plug-in (IJ). OU detection by fMRU was compared with DRS (standard of reference) using areas under the curves (AUC) in ROC analyses. Concordant DRF was assumed if absolute deviation between fMRU and DRS was ≤ 5 %.RESULTS: DRS confirmed fixed OU in 4/31 kidneys (12.9 %) in subgroup A. AUC of CT was 0.94 compared with 0.93 by IJ. Subgroup B showed fixed OU in 1/21 kidneys (4.8 %) with AUCs of 0.98 each. RTT measured neither by CT nor by IJ in confirmed fixed OU was < 1200 s - resulting in negative predictive values of 1.0 each. In subgroup A, DRF was concordant in 81.3 % of the kidneys for CT and DRS compared with 75.0 % for IJ and DRS. In subgroup B, CT and DRS were concordant in 91.7 %, and IJ and DRS in 45.8 % of the kidneys.CONCLUSION: fMRU accurately excluded fixed OU in infants and children, independent from the software used for quantification. However, assessment of DRF with fMRU deviated from DRS especially in infants who may profit most from early intervention. Thus, fMRU cannot fully replace DRS as primary functional examination. If, for clinical reasons, fMRU is performed in first place and it cannot exclude fixed OU, it should be followed by DRS for validation and DRF quantification.

AB - AIM: After detection of obstructive uropathy (OU), the indication for or against surgery is primarily based on the differential renal function (DRF). This is to compare functional magnetic resonance urography (fMRU) with dynamic renal scintigraphy (DRS) to assess OU and DRF in infants and children.PATIENTS, METHODS: Retrospective analysis in 30 patients (female: 16; male: 14; median age: 5.5 years [0.2-16.5]), divided into subgroup A (age: 0-2 years; n = 16) and B (> 2-17 years; n = 14). fMRU was assessed by measuring renal transit time (RTT) and volumetric DRF with CHOP fMRU tool (CT) and ImageJ MRU plug-in (IJ). OU detection by fMRU was compared with DRS (standard of reference) using areas under the curves (AUC) in ROC analyses. Concordant DRF was assumed if absolute deviation between fMRU and DRS was ≤ 5 %.RESULTS: DRS confirmed fixed OU in 4/31 kidneys (12.9 %) in subgroup A. AUC of CT was 0.94 compared with 0.93 by IJ. Subgroup B showed fixed OU in 1/21 kidneys (4.8 %) with AUCs of 0.98 each. RTT measured neither by CT nor by IJ in confirmed fixed OU was < 1200 s - resulting in negative predictive values of 1.0 each. In subgroup A, DRF was concordant in 81.3 % of the kidneys for CT and DRS compared with 75.0 % for IJ and DRS. In subgroup B, CT and DRS were concordant in 91.7 %, and IJ and DRS in 45.8 % of the kidneys.CONCLUSION: fMRU accurately excluded fixed OU in infants and children, independent from the software used for quantification. However, assessment of DRF with fMRU deviated from DRS especially in infants who may profit most from early intervention. Thus, fMRU cannot fully replace DRS as primary functional examination. If, for clinical reasons, fMRU is performed in first place and it cannot exclude fixed OU, it should be followed by DRS for validation and DRF quantification.

KW - Adolescent

KW - Child

KW - Child, Preschool

KW - Diuretics

KW - Female

KW - Humans

KW - Image Interpretation, Computer-Assisted

KW - Infant

KW - Infant, Newborn

KW - Kidney Function Tests

KW - Magnetic Resonance Imaging

KW - Male

KW - Radioisotope Renography

KW - Radionuclide Imaging

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Software

KW - Urethral Obstruction

KW - Urography

KW - Comparative Study

KW - Evaluation Studies

KW - Journal Article

U2 - 10.3413/Nukmed-0833-16-06

DO - 10.3413/Nukmed-0833-16-06

M3 - SCORING: Journal article

C2 - 27683747

VL - 56

SP - 39

EP - 46

JO - NUKLEARMED-NUCL MED

JF - NUKLEARMED-NUCL MED

SN - 0029-5566

IS - 1

ER -