Rodríguez L V, Spielman D, Herfkens R J, Shortliffe L D
Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
J Urol. 2001 Sep;166(3):1023-7.
We studied the effectiveness of magnetic resonance imaging (MRI) for evaluating hydronephrosis, differential renal function, vesicoureteral reflux and renal scarring in children.
A total of 16 patients with hydronephrosis were evaluated with MRI. Coronal T1 and axial T1 and T2-weighted images were obtained before and after the administration of intravenous contrast material. Patients with vesicoureteral reflux underwent magnetic resonance voiding cystourethrography. Differential renal function was estimated from differential parenchymal volumes determined from MRI using computer software. The results were compared to standard imaging modalities.
A total of 19 MRI studies were performed in 16 patients, including 3 for ureteropelvic junction obstruction, 11 for vesicoureteral reflux and 2 for other conditions. MRI provided the best anatomic detail and clear corticomedullary differentiation. MRI identified renal scarring and cortical thinning in 8 cases, while mercaptoacetyltriglycine 3 scans did not show any renal scarring and single photon emission computerized tomography-dimercapto-succinic acid nuclear scans diagnosed only 4 of 5 cases. There was good correlation between differential function obtained from nuclear scans and differential parenchymal volumes obtained from MRI (correlation coefficient 0.86, r2 = 0.74). Magnetic resonance voiding cystourethrography diagnosed reflux in 4 of 5 patients in whom vesicoureteral reflux was previously documented by standard voiding cystourethrography.
MRI provides an alternative for the evaluation of hydronephrosis in children by combining the information provided by functional and anatomic nuclear scans, voiding cystourethrography and ultrasonography in a single study without ionizing radiation. MRI appears to be as good as existing modalities in the evaluation of renal scarring and cortical thinning.
我们研究了磁共振成像（MRI）在评估儿童肾积水、分肾功能、膀胱输尿管反流和肾瘢痕形成方面的有效性。
共有16例肾积水患者接受了MRI评估。在静脉注射造影剂前后获取冠状位T1、轴位T1和T2加权图像。膀胱输尿管反流患者接受磁共振排尿膀胱尿道造影。使用计算机软件根据MRI确定的实质体积差异估算分肾功能。将结果与标准成像方式进行比较。
16例患者共进行了19次MRI检查，其中3例为肾盂输尿管连接部梗阻，11例为膀胱输尿管反流，2例为其他情况。MRI提供了最佳的解剖细节和清晰的皮髓质区分。MRI在8例中发现了肾瘢痕形成和皮质变薄，而巯基乙酰三甘氨酸扫描未显示任何肾瘢痕形成，单光子发射计算机断层扫描 - 二巯基丁二酸核素扫描仅诊断出5例中的4例。核素扫描获得的分肾功能与MRI获得的实质体积差异之间存在良好的相关性（相关系数0.86，r2 = 0.74）。磁共振排尿膀胱尿道造影在5例先前经标准排尿膀胱尿道造影记录有膀胱输尿管反流的患者中诊断出4例反流。
MRI通过在一项无电离辐射的研究中结合功能和解剖核素扫描、排尿膀胱尿道造影及超声检查提供的信息，为评估儿童肾积水提供了一种替代方法。在评估肾瘢痕形成和皮质变薄方面，MRI似乎与现有方式一样好。
