Chan Sherwin S, Ntoulia Aikaterini, Khrichenko Dmitry, Back Susan J, Tasian Gregory E, Dillman Jonathan R, Darge Kassa
Department of Radiology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Radiol. 2017 Dec;47(13):1707-1720. doi: 10.1007/s00247-017-3927-5. Epub 2017 Aug 24.
Renal fusion is on a spectrum of congenital abnormalities that occur due to disruption of the migration process of the embryonic kidneys from the pelvis to the retroperitoneal renal fossae. Clinically, renal fusion anomalies are often found incidentally and associated with increased risk for complications, such as urinary tract obstruction, infection and urolithiasis. These anomalies are most commonly imaged using ultrasound for anatomical definition and less frequently using renal scintigraphy to quantify differential renal function and assess urinary tract drainage. Functional magnetic resonance urography (fMRU) is an advanced imaging technique that combines the excellent soft-tissue contrast of conventional magnetic resonance (MR) images with the quantitative assessment based on contrast medium uptake and excretion kinetics to provide information on renal function and drainage. fMRU has been shown to be clinically useful in evaluating a number of urological conditions. A highly sensitive and radiation-free imaging modality, fMRU can provide detailed morphological and functional information that can facilitate conservative and/or surgical management of children with renal fusion anomalies. This paper reviews the embryological basis of the different types of renal fusion anomalies, their imaging appearances at fMRU, complications associated with fusion anomalies, and the important role of fMRU in diagnosing and managing children with these anomalies.
肾融合是一系列先天性异常，其发生是由于胚胎肾从盆腔向腹膜后肾窝迁移过程受到干扰所致。临床上，肾融合异常常为偶然发现，并与并发症风险增加相关，如尿路梗阻、感染和尿路结石。这些异常最常通过超声进行解剖学定义成像，较少使用肾闪烁显像来量化分肾功能和评估尿路引流。功能磁共振尿路造影（fMRU）是一种先进的成像技术，它将传统磁共振（MR）图像出色的软组织对比度与基于造影剂摄取和排泄动力学的定量评估相结合，以提供肾功能和引流方面的信息。fMRU已被证明在评估多种泌尿系统疾病方面具有临床实用性。作为一种高灵敏度且无辐射的成像方式，fMRU可以提供详细的形态学和功能信息，有助于对患有肾融合异常的儿童进行保守和/或手术治疗。本文综述了不同类型肾融合异常的胚胎学基础、其在fMRU上的影像学表现、与融合异常相关的并发症，以及fMRU在诊断和治疗患有这些异常的儿童中的重要作用。
