Świȩtoń Dominik, Grzywińska Małgorzata, Czarniak Piotr, Gołȩbiewski Andrzej, Durawa Agata, Teodorczyk Jacek, Kaszubowski Mariusz, Piskunowicz Maciej
Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland.
Department of Human Physiology, Medical University of Gdańsk, Gdańsk, Poland.
Front Pediatr. 2022 Mar 23;10:839128. doi: 10.3389/fped.2022.839128. eCollection 2022.
Megaureter, described as ureter dilatation more than 7 mm in diameter, commonly associated with other anomalies, is still a diagnostic and therapeutic challenge. Magnetic resonance urography (MRU) appears as a promising method in urinary tract imaging, providing both anatomical and functional information. There are several postprocessing tools to assess renal function (including differential renal function) and severity of ureteral obstruction based on MRU. Still, the place of this method in the diagnostic algorithm of ureteropelvicalyceal dilatation with megaureter remains underestimated. Analysis of imaging findings in a group of children diagnosed with megaureter was done.
A retrospective analysis of magnetic resonance urography (MRU) was performed in 142 consecutive patients examined from January 2013 to September 2019. Twenty-five patients meeting the criteria of megaureter (dilatation more than 7 mm) in MRU were included in the further analysis. The MRU, ultrasound (US), and scintigraphy results were compared and analyzed together and compared with clinical data.
The sensitivity and specificity of US was comparable to the MRU in the assessment of upper urinary tract morphology ( > 0.05). In five out of 25 children, megaureter was found in each kidney; in a single case, both poles of a duplex kidney were affected. In the diagnosis of ureter ectopia, the MRU was superior to the US for which sensitivity did not exceed 16%. The US showed limited value in the diagnostics of segmental ureter dysplasia as a cause of primary megaureter when compared with MRU. Four cases were visualized in MRU studies, whereas the US examination was negative (all confirmed during surgery). There was a moderate correlation between relative renal function between fMRU and scintigraphy ( = 0.721, = 0.477) and in the severity of obstruction assessment between both methods ( = 0.441, < 0.05). However, in 10 kidneys with megaureter, the results in scintigraphy were inconclusive due to the signal from the megaureter imposing on the renal field.
MRU seems to be a preferred method in the diagnostic algorithm for megaureter, providing both anatomical and functional information. MRU is superior to US and scintigraphy in diagnosing urinary tract anomalies with megaureter.
巨输尿管被定义为直径超过7毫米的输尿管扩张，通常与其他异常相关，仍然是一个诊断和治疗难题。磁共振尿路造影（MRU）在尿路成像中似乎是一种很有前景的方法，可提供解剖和功能信息。基于MRU有几种后处理工具来评估肾功能（包括分肾功能）和输尿管梗阻的严重程度。然而，该方法在伴有巨输尿管的输尿管肾盂盏扩张诊断算法中的地位仍被低估。我们对一组诊断为巨输尿管的儿童的影像学表现进行了分析。
对2013年1月至2019年9月连续检查的142例患者的磁共振尿路造影（MRU）进行回顾性分析。25例在MRU中符合巨输尿管标准（扩张超过7毫米）的患者纳入进一步分析。将MRU、超声（US）和闪烁扫描结果一起进行比较和分析，并与临床数据进行比较。
在评估上尿路形态方面，US的敏感性和特异性与MRU相当（P>0.05）。25例儿童中有5例每个肾脏均发现巨输尿管；1例双肾盂双输尿管畸形的两极均受累。在输尿管异位的诊断中，MRU优于US，US的敏感性不超过16%。与MRU相比，US在诊断节段性输尿管发育异常作为原发性巨输尿管病因方面价值有限。MRU检查发现4例，而US检查为阴性（均在手术中证实）。fMRU与闪烁扫描之间的相对肾功能以及两种方法之间的梗阻严重程度评估存在中度相关性（r=0.721，P=0.477）和（r=0.441，P<0.05）。然而，在10例有巨输尿管的肾脏中，由于巨输尿管信号干扰肾区，闪烁扫描结果不明确。
MRU似乎是巨输尿管诊断算法中的首选方法，可提供解剖和功能信息。在诊断伴有巨输尿管的尿路异常方面，MRU优于US和闪烁扫描。
