Русский
Comparison of functional magnetic resonance urography and dynamic renal scintigraphy in the functional assessment of ureteropelvic junction obstruction in children
DOI: https://dx.doi.org/10.18565/urology.2021.1.90-94
V.V. Sizonov, M.I. Kogan, A.KH-A. Shidaev, V.A. Redkin, V.M. Orlov, K.P. Piskunov
1) Rostov Medical State University, Rostov-on-Don, Russia; 2) Regional Children’s Clinical Hospital, Rostov-on-Don, Russia; 3) Clinical and Diagnostic Center «Zdorovie», Rostov-on-Don, Russia
Purpose. In order to determine the role and significance of functional magnetic resonance urography (fMRU) in the diagnosis of ureteropelvic junction obstruction (UPJO), a comparative analysis of the results of fMRU and dynamic renal scintigraphy (DRS) was carried out.
Materials and methods. From January 2017 to December 2019, fMRU and diuretic DRS were performed in 36 patients (mean age 89±63 months). Boys - 26 (72.2%), girls – 10 (27.8%). Left-sided hydronephrosis was detected in 23 (63.9%) children, right-sided in 12 (33.3%) patients, and bilateral lesions in 1 (2.8%) patient (2 renal units (RU)). Antenatal hydronephrosis was detected in 9 (25%) patients, and postnatally in 27 (75%) patients. According to ultrasound data, grade II hydronephrosis occurred in 11 (29.8%) RU, grade III - in 21 RU (56.7%), and grade IV – in 5 RU (13.5%) according to the SFU classification. A diuretic test was performed in 26 patients.
Results. Median and quartiles of differential renal function (DRF) according to fMRU data on the affected side were 37% [29; 43], and according to DRS - 46% [40;49]. When performing fMRU, a positive diuretic test was detected in 20 patients, 5 patients – negative and 1 patient – doubtful, and according to the DRS data, 12 patients had a positive test, 10 patients – negative and 4 patients – doubtful. Differences in DRF between fMRU and DRS varied between 0.7-33%. The average value of differences in DRF on the affected side was 11.3±8.5%. When comparing the results of DRF on the affected side, a moderate correlation was found on the Cheddock scale (r=0.59, p<0.05) between fMRU and DRS data. In comparison of the DRF using the Wilcoxon test, statistically significant differences were revealed (p<0,05).
Summary. Our experience demonstrates the high potential of fMRU in terms of replacing the classical methods of diagnosis of UPJO in children, taking into account the high correlation coefficients between the results of fMRU and DRS. Standardization of the fMRU protocol will increase the diagnostic relevance of information and in the future will make fMRU the only necessary study to determine management tactics for patients with UPJO.
Materials and methods. From January 2017 to December 2019, fMRU and diuretic DRS were performed in 36 patients (mean age 89±63 months). Boys - 26 (72.2%), girls – 10 (27.8%). Left-sided hydronephrosis was detected in 23 (63.9%) children, right-sided in 12 (33.3%) patients, and bilateral lesions in 1 (2.8%) patient (2 renal units (RU)). Antenatal hydronephrosis was detected in 9 (25%) patients, and postnatally in 27 (75%) patients. According to ultrasound data, grade II hydronephrosis occurred in 11 (29.8%) RU, grade III - in 21 RU (56.7%), and grade IV – in 5 RU (13.5%) according to the SFU classification. A diuretic test was performed in 26 patients.
Results. Median and quartiles of differential renal function (DRF) according to fMRU data on the affected side were 37% [29; 43], and according to DRS - 46% [40;49]. When performing fMRU, a positive diuretic test was detected in 20 patients, 5 patients – negative and 1 patient – doubtful, and according to the DRS data, 12 patients had a positive test, 10 patients – negative and 4 patients – doubtful. Differences in DRF between fMRU and DRS varied between 0.7-33%. The average value of differences in DRF on the affected side was 11.3±8.5%. When comparing the results of DRF on the affected side, a moderate correlation was found on the Cheddock scale (r=0.59, p<0.05) between fMRU and DRS data. In comparison of the DRF using the Wilcoxon test, statistically significant differences were revealed (p<0,05).
Summary. Our experience demonstrates the high potential of fMRU in terms of replacing the classical methods of diagnosis of UPJO in children, taking into account the high correlation coefficients between the results of fMRU and DRS. Standardization of the fMRU protocol will increase the diagnostic relevance of information and in the future will make fMRU the only necessary study to determine management tactics for patients with UPJO.
Keywords: dynamic renal scintigraphy, functional magnetic resonance urography, ureteropelvic junction obstruction, Keyword: hydronephrosis, children
About the Autors
Corresponding author: M.I. Kogan – M.D., Dr.Sc.(M), Full Professor; Head, Dept. of Urology and Human Reproductive Health (with the Pediatric Urology and Andrology course), Rostov State Medical University, Rostov-on-Don, Russia; e-mail: dept_kogan@mail.ru
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