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Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections?

by Eoin C. Kavanagh, Stephanie Ryan, Atif Awan, Siobhan McCourbrey, Rachel O'Connor, Veronica Donoghue
Pediatric Radiology ()

Abstract

BACKGROUND: Renal parenchymal defects may be a consequence of urinary tract infections (UTI) in childhood. MRI is a non-radiation imaging modality compared with DMSA scanning. OBJECTIVE: To compare DMSA with MRI for the detection of renal parenchymal defects in children presenting for radiological investigation after a first UTI. MATERIALS AND METHODS: Both DMSA and MRI were performed at the same appointment in 37 children (aged 4 months-13 years; mean 4.5 years) with a history of UTI. Both planar and SPECT DMSA were performed. MRI of the kidneys employed axial and coronal T1-, T2- and fat-saturated T1-weighted (T1-W) sequences. Some children had imaging after IV contrast medium. RESULTS: The coronal fat-saturated T1-W sequence was the best sequence and it detected all the findings on MRI. MRI had a sensitivity of 77% and a specificity of 87% for the detection of a scarred kidney using DMSA as the gold standard. MRI diagnosed pyelonephritis in two children that had been interpreted as scarring on DMSA. CONCLUSIONS: Renal MRI using a single, coronal, fat-saturated T1-W sequence is a rapid, accurate and minimally invasive technique for the detection of renal scarring that does not employ ionizing radiation.

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