The Diagnosis and Medical Management of Primary Vesicoureteral Reflux

Greenfield, Saul P.; Wan, Julian

doi:10.1016/b978-1-4160-3204-5.00023-2

Cited by 2 publications

(2 citation statements)

References 261 publications

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“…There have been some reports by others using MRI . However, in these studies information regarding visualization of the urethra has been limited and inconsistent . Furthermore, most of the previous studies on MRVCUG were conducted in adults who can voluntarily cooperate during the examination .…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance voiding cystourethrography (MRVCUG): A potential alternative to standard VCUG

Johnin

Takazakura

Furukawa

et al. 2013

Magnetic Resonance Imaging

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance voiding cystourethrography (MRVCUG): A potential alternative to standard VCUG

Johnin

Takazakura

Furukawa

et al. 2013

Magnetic Resonance Imaging

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“…Renal damage is also seen in infants evaluated for antenatal hydronephrosis with renal scintigraphy, even in the absence of infection (50). Renal damage detected by scintigraphy in infants with no demonstrable UTI has been termed “congenital reflux nephropathy” (51).…”

Section: Reflux Nephropathy and Renal Dysplasiamentioning

confidence: 99%

Pediatric magnetic resonance urography

Jones

Grattan‐Smith

Little

2011

Magnetic Resonance Imaging

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Magnetic resonance urography (MRU) is a powerful clinical tool that fuses anatomic information with functional data in a single test without the use of ionizing radiation. This article provides an overview of the technical aspects, as well as common clinical applications with an emphasis on the evaluation of hydronephrosis. A fluid challenge is an essential part of our MRU protocol and enables the definition of compensated or decompensated kidneys within the spectrum of hydronephrosis. This classification may have prognostic implications when surgery is being considered. In addition, underlying uropathy can be identified on the anatomical scans and renal scarring can be seen on both the anatomical and dynamic scans. MRU can identify and categorize dysmorphic kidneys in vivo and may provide insight into congenital abnormalities seen in conjunction with vesicoureteric reflux. MRU is still in its infancy and as the technique develops and becomes widely available, it seems likely that it will supplant renal scintigraphy in the evaluation of renal tract disorders in children. MAGNETIC RESONANCE UROGRAPHY (MRU) represents the next step in the evolution of uroradiology in children because it fuses superb anatomic and functional imaging in a single test that does not use ionizing radiation. MRU has advantages over other modalities in that it generates tissue contrast from a variety of sources. In addition to spin echo T1 and T2 images, dynamic imaging is performed in conjunction with the injection of a gadolinium-based contrast agent (GBCA) in order to assess the concentrating and excretory functions of the kidney. The evaluation of the contrast dynamics is similar to renal scintigraphy but with the important distinction that the signals originating from the renal parenchyma can be separated from those originating from the collecting system. While MR is not used routinely to assess the degree of vesicoureteric reflux (VUR), it can detect the anatomical consequences of VUR in terms of dilated ureters, distorted anatomy of the collecting system and renal scarring, and the functional consequences of renal scarring.We have performed MR urograms on close to 2000 children over the last 8 years and have found that meticulous attention to patient preparation and scanning technique is essential if high-quality images are to be reliably obtained, with appropriate hydration and sedation being key factors in the success of the examination. There have been several publications assessing the ability of MRU to reliably quantify the glomerular filtration rate (GFR) using an arterial input function (AIF) derived from the aorta and the signal curves measured in the renal parenchyma (1-3); however, there are still a number of problems to be addressed before this becomes a clinical reality (4). Thus, we have based our approach on deriving measures that can be thought of as indices of renal function in that they are correlated with, but not necessarily equal to, the GFR. We use these to derive several measures of differential renal function...

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The Diagnosis and Medical Management of Primary Vesicoureteral Reflux

Cited by 2 publications

References 261 publications

Magnetic resonance voiding cystourethrography (MRVCUG): A potential alternative to standard VCUG

Magnetic resonance voiding cystourethrography (MRVCUG): A potential alternative to standard VCUG

Pediatric magnetic resonance urography

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