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Pediatric ureteropelvic junction obstruction: can magnetic resonance urography identify crossing vessels?

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Abstract

Background

MR Urography (MRU) is an increasingly used imaging modality for the evaluation of pediatric genitourinary obstruction.

Objective

To determine whether pediatric MR urography (MRU) reliably detects crossing vessels in the setting of suspected ureteropelvic junction (UPJ) obstruction. The clinical significance of these vessels was also evaluated.

Materials and methods

We identified pediatric patients diagnosed with UPJ obstruction by MRU between May 2009 and June 2014. MRU studies were evaluated by two pediatric radiologists for the presence or absence of crossing vessels. Ancillary imaging findings such as laterality, parenchymal thinning/scarring, trapped fluid in the proximal ureter, and presence of renal parenchymal edema were also evaluated. Imaging findings were compared to surgical findings. We used the Mann–Whitney U test to compare continuous data and the Fisher exact test to compare proportions.

Results

Twenty-four of 25 (96%) UPJ obstructions identified by MRU were surgically confirmed. MRU identified crossing vessels in 10 of these cases, with 9 cases confirmed intraoperatively (κ = 0.92 [95% CI: 0.75, 1.0]). Crossing vessels were determined to be the primary cause of UPJ obstruction in 7/9 children intraoperatively, while in two children the vessels were deemed incidental and noncontributory to the urinary tract obstruction. There was no significant difference in age or the proportions of ancillary findings when comparing children without and with obstructing vessels.

Conclusion

MRU allows detection of crossing vessels in pediatric UPJ obstruction. Although these vessels are the primary cause of obstruction in some children, they are incidental and non-contributory in others. Our study failed to convincingly identify any significant predictors (e.g., age or presence of renal parenchymal edema) that indicate when a crossing vessel is the primary cause of obstruction.

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Authors and Affiliations

  1. Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, Mott Children’s Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109, USA

    Kushal R. Parikh, Kate H. Kraft, Vesna Ivančić, Ethan A. Smith & Jonathan R. Dillman

  2. Department of Radiology, University of Texas Southwestern, Dallas, TX, USA

    Matthew R. Hammer

Authors
  1. Kushal R. Parikh
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  2. Matthew R. Hammer
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  3. Kate H. Kraft
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  4. Vesna Ivančić
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  5. Ethan A. Smith
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  6. Jonathan R. Dillman
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Correspondence to Kushal R. Parikh.

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Parikh, K.R., Hammer, M.R., Kraft, K.H. et al. Pediatric ureteropelvic junction obstruction: can magnetic resonance urography identify crossing vessels?. Pediatr Radiol 45, 1788–1795 (2015). https://doi.org/10.1007/s00247-015-3412-y

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  • DOI: https://doi.org/10.1007/s00247-015-3412-y

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