MR Voiding Cystography for Evaluation of Vesicoureteral Reflux
ABSTRACT OBJECTIVE: The purpose of our study is to present a real-time interactive continuous fluoroscopy MRI technique for vesicoureteral reflux (VUR) diagnosis. CONCLUSION: MR voiding cystography with a real-time interactive MR fluoroscopic technique on an open MRI magnet is feasible for the evaluation of VUR in children.
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ABSTRACT: OBJECTIVES: The current gold standard for diagnosing vesicoureteric reflux in unsedated infants is the X-ray-based Micturating CystoUrethroGram (MCUG). The aim of this study was to assess the diagnostic performance of interactive MRI for voiding cysto-urethrography (iMRVC). METHODS: 25 infants underwent conventional MCUG followed by iMRVC. In iMRVC, patients were examined using a real-time MR technique, which allows interactive control of image contrast and imaging plane location, before, during and after micturition. Images were assessed for presence and grade of VUR. Parental feedback on both procedures was evaluated. RESULTS: iMRVC gave a sensitivity of 100%, specificity of 90.5% (95% CI: 81.6-99.4%), PPV of 66.7% and NPV of 100% in this population. There was 88% concordance (44/50 renal units) according to the presence of VUR between the two methods, with iMRVC up-grading VUR in 6 units (12%). There was very good agreement regarding VUR grade: Kappa=0.66±0.11 (95% CI 0.43-0.88). 60% of parents preferred the MRI, but did not score the two tests differently. CONCLUSION: Interactive MRI allows dynamic imaging of the whole urinary tract without ionising radiation exposure. iMRVC gives comparable results to the MCUG, and is acceptable to parents.European journal of radiology 12/2012; DOI:10.1016/j.ejrad.2012.10.024 · 2.16 Impact Factor
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ABSTRACT: BACKGROUND: Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requires accurate evaluation of the presence and position of such fistulas. Fluoroscopy is currently the chosen modality for the detection of fistulas. The role of MRI is unexplored. OBJECTIVE: To compare the diagnostic accuracy of MR versus fluoroscopic fistulography in the pre-operative evaluation of infants with anorectal malformation. MATERIALS AND METHODS: We conducted a pilot study of infants requiring defunctioning colostomy for initial management of anorectal malformation. Dynamic sagittal steady-state free-precession MRI of the pelvis was acquired during introduction of saline into the mucous fistulas. Findings were compared among MR fistulography, fluoroscopic fistulography and intraoperative inspection. RESULTS: Eight children were included. Median age at fistulography was 15 weeks, inter-quartile range 13-20 weeks; all were boys. There was full agreement among MR fistulography, fluoroscopic fistulography and surgical findings. CONCLUSION: The pilot data suggest that MR fistulography is promising in the pre-operative evaluation of children with anorectal malformation.Pediatric Radiology 03/2013; 43(8). DOI:10.1007/s00247-013-2653-x · 1.65 Impact Factor
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ABSTRACT: The purpose of the present study is to determine the accuracy of magnetic resonance voiding cystourethrography (MRVCUG) for diagnosis of vesicoureteral reflux (VUR) in children and adolescents with recurrent urinary tract infection (UTI). During the cross-sectional study from May 2009 to June 2011, 30 patients' (60 kidney-ureter units) MRVCUG findings by 1.5 T magnetic resonance imaging (MRI) were compared with voiding cystourethrography (VCUG) findings in patients with urinary tract infection. The sensitivity, specificity, positive and negative predictive values for MRVCUG were calculated. The sensitivity, specificity, positive and negative predictive values and accuracy for MRVCUG for detecting VUR were respectively 92.68% (95% CI: 80.57-97.48%), 68.42% (95% CI: 46.01-84.64%), 86.36% (95% CI: 71.95-94.33%), 81.25% (95% CI: 53.69-95.02%), and 85% (95% CI: 80.40-89.60%. The level of agreement between MRVCUG and VCUG findings for diagnosis VUR was very good (P < 0.001, according to Cohen's kappa value = 0.638). Studying correlation of low grade VUR (grade I and II) and high grade VUR (grade III-V) showed a very good agreement between MRVCUG and VCUG findings (P < 0.001, Cohen's kappa value = 0.754). MRVCUG could accurately reveal the presence and severity of VUR, especially in cases with high-grade (grade III-V) VUR in both children and adolescents.Journal of research in medical sciences 01/2013; 18(1):31-6. · 0.61 Impact Factor