Diffusion weighted imaging is a promising method to detect acute pyelonephritis in non-sedated free breathing infants

Simrén, Yvonne; Stokland, Eira; Hansson, Sverker; Sixt, Rune; Svensson, Pär‐Arne; Lagerstrand, Kerstin

doi:10.1016/j.jpurol.2020.03.027

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…Pyelonephritic foci appear dark on the ADC map. The DWI performance to detect APN is similar to both contrast enhanced CT (CECT) [ 100 ] and renal scintigraphy [ 101 , 102 , 103 ] and probably better than nuclear imaging for the detection of multiple inflammatory foci [ 103 ]. This could be advantageous in ambiguous situations where the diagnosis of APN is uncertain, especially in transplant kidneys and children.…”

Section: Diffusion-weighted Renal Imagingmentioning

confidence: 99%

Diffusion-Weighted MRI in the Genitourinary System

Perrot

Zoua

Glessgen

et al. 2022

JCM

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Diffusion weighted imaging (DWI) constitutes a major functional parameter performed in Magnetic Resonance Imaging (MRI). The DW sequence is performed by acquiring a set of native images described by their b-values, each b-value representing the strength of the diffusion MR gradients specific to that sequence. By fitting the data with models describing the motion of water in tissue, an apparent diffusion coefficient (ADC) map is built and allows the assessment of water mobility inside the tissue. The high cellularity of tumors restricts the water diffusion and decreases the value of ADC within tumors, which makes them appear hypointense on ADC maps. The role of this sequence now largely exceeds its first clinical apparitions in neuroimaging, whereby the method helped diagnose the early phases of cerebral ischemic stroke. The applications extend to whole-body imaging for both neoplastic and non-neoplastic diseases. This review emphasizes the integration of DWI in the genitourinary system imaging by outlining the sequence’s usage in female pelvis, prostate, bladder, penis, testis and kidney MRI. In gynecologic imaging, DWI is an essential sequence for the characterization of cervix tumors and endometrial carcinomas, as well as to differentiate between leiomyosarcoma and benign leiomyoma of the uterus. In ovarian epithelial neoplasms, DWI provides key information for the characterization of solid components in heterogeneous complex ovarian masses. In prostate imaging, DWI became an essential part of multi-parametric Magnetic Resonance Imaging (mpMRI) to detect prostate cancer. The Prostate Imaging–Reporting and Data System (PI-RADS) scoring the probability of significant prostate tumors has significantly contributed to this success. Its contribution has established mpMRI as a mandatory examination for the planning of prostate biopsies and radical prostatectomy. Following a similar approach, DWI was included in multiparametric protocols for the bladder and the testis. In renal imaging, DWI is not able to robustly differentiate between malignant and benign renal tumors but may be helpful to characterize tumor subtypes, including clear-cell and non-clear-cell renal carcinomas or low-fat angiomyolipomas. One of the most promising developments of renal DWI is the estimation of renal fibrosis in chronic kidney disease (CKD) patients. In conclusion, DWI constitutes a major advancement in genitourinary imaging with a central role in decision algorithms in the female pelvis and prostate cancer, now allowing promising applications in renal imaging or in the bladder and testicular mpMRI.

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Section: Diffusion-weighted Renal Imagingmentioning

confidence: 99%

Diffusion-Weighted MRI in the Genitourinary System

Perrot

Zoua

Glessgen

et al. 2022

JCM

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“…This explorative study was performed in conjunction with a recently published study [6] including infants (< 6 months of age) that had been examined with acute DMSA scintigraphy as part of the clinical routine follow-up of infants with first time community-acquired symptomatic UTI in our hospital over a period of 19 months. The MRI examinations were performed within two weeks of the acute DMSA scintigraphy.…”

Section: Patientsmentioning

confidence: 99%

“…DMSA scintigraphy and CT also has the drawback of using ionizing radiation. Therefore, diffusion weighted imaging (DWI), a non-invasive MRI-technique, has been suggested as an alternative method in the evaluation of children with symptomatic UTI [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, there are no studies on renal DTI in young infants, a patient group that would benefit from the use of this noninvasive, non-radiating, short scan technique. The potential of DWI for detection of acute pyelonephritis has recently been shown in non-sedated free breathing infants with symptomatic UTI [6]. However, in several infants' lesions the findings were equivocal and not typical for acute pyelonephritis raising the need for further characterization of such lesions.…”

Section: Introductionmentioning

confidence: 99%

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Diffusion tensor imaging based multiparametric characterization of renal lesions in infants with urinary tract infections: an explorative study

et al. 2021

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Background Conventional diffusion weighted imaging (DWI) is a promising non-invasive tool in the evaluation of infants with symptomatic urinary tract infections (UTI). The use of multiparametric diffusion tensor imaging (DTI) provides further information on renal pathology by reflecting renal microstructure. However, its potential to characterize and distinguish between renal lesions, such as acute pyelonephritic lesions, permanent renal damages or dysplastic changes has not been shown. This study aimed to evaluate the potential of multiparametric DTI for characterization of renal lesions with purpose to distinguish acute pyelonephritis from other renal lesions in young infants with their first UTI. Methods Nine kidneys in seven infants, age 1.0–5.6 months, with renal lesions i.e. uptake reductions, on acute scintigraphy performed after their first UTI, were included. The DTI examinations were performed during free breathing without sedation. The signal in the lesions and in normal renal tissue was measured in the following images: b0, b700, apparent diffusion coefficient (ADC), and fractional anisotropy (FA). In addition, DTI tractographies were produced for visibility. Results There was a difference between lesions and normal tissue in b700 signal (197 ± 52 and 164 ± 53, p = 0.011), ADC (1.22 ± 0.11 and 1.45 ± 0.15 mm2/s, p = 0.008), and FA (0.18 ± 0.03 and 0.30 ± 0.10, p = 0.008) for all nine kidneys. Six kidneys had focal lesions with increased b700 signal, decreased ADC and FA indicating acute inflammation. In three patients, the multiparametric characteristics of the lesions were diverging. Conclusion Multiparametric DTI has the potential to further characterize and distinguish acute pyelonephritis from other renal lesions in infants with symptomatic UTI.

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In vivo assessment of pediatric kidney function using multi-parametric and multi-nuclear functional magnetic resonance imaging: challenges, perspectives, and clinical applications

De Mul,

Schleef,

Filler

et al. 2024

Pediatr Nephrol

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The conventional methods for assessing kidney function, such as glomerular filtration rate and microalbuminuria, provide only partial insight into kidney function. Multi-parametric and multi-nuclear functional resonance magnetic imaging (MRI) techniques are innovative approaches to unraveling kidney physiology. Multi-parametric MRI includes various sequences to evaluate kidney perfusion, tissue oxygenation, and microstructure characterization, including fibrosis—a key pathological event in acute and chronic kidney disease and in transplant patients—without the need for invasive kidney biopsy. Multi-nuclear MRI detects nuclei other than protons. 23Na MRI enables visualization of the corticomedullary gradient and assessment of tissue sodium storage, which can be particularly relevant for personalized medicine in salt-wasting tubular disorders. Meanwhile, 31P-MRS measures intracellular phosphate and ATP variations, providing insights into oxidative metabolism in the muscle during exercise and recovery. This technique can be useful for detecting subclinical ischemia in chronic kidney disease and in tubulopathies with kidney phosphate wasting. These techniques are non-invasive and do not involve radiation exposure, making them especially suitable for longitudinal and serial assessments. They enable in vivo evaluation of kidney function on a whole-organ basis within a short acquisition time and with the ability to distinguish between medullary and cortical compartments. Therefore, they offer considerable potential for pediatric patients. In this review, we provide a brief overview of the main imaging techniques, summarize available literature data on both adult and pediatric populations, and examine the perspectives and challenges associated with multi-parametric and multi-nuclear MRI. Graphical Abstract

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Diffusion weighted imaging is a promising method to detect acute pyelonephritis in non-sedated free breathing infants

Cited by 4 publications

References 20 publications

Diffusion-Weighted MRI in the Genitourinary System

Diffusion-Weighted MRI in the Genitourinary System

Diffusion tensor imaging based multiparametric characterization of renal lesions in infants with urinary tract infections: an explorative study

In vivo assessment of pediatric kidney function using multi-parametric and multi-nuclear functional magnetic resonance imaging: challenges, perspectives, and clinical applications

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