Potential benefits of functional magnetic resonance urography (fMRU) over MAG3 renal scan in children with obstructive uropathy.
Potential benefits of functional magnetic resonance urography (fMRU) over MAG3 renal scan in children with obstructive uropathy.
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DOI：
10.1016/j.jpurol.2021.07.005
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发表时间：
2021-10
影响因子：
2
通讯作者：
Otero H
中科院分区：
文献类型：
--
作者：
Viteri B;Calle-Toro JS;Ballester L;Darge K;Furth S;Khrichenko D;Van Batavia J;Otero H
肾功能成像，最常见的是MAG3核医学肾脏扫描，被推荐用于评估疑似梗阻性尿路疾病的尿路扩张(UTD)儿童。或者，肾功能可以用功能磁共振尿路成像(FMRU)来评估，它具有优越的解剖细节。然而，目前还没有足够的数据比较两种方法的等价性。在这项研究中，我们比较了FMRU和MAG3在表现为梗阻性尿路病变的儿童队列中的功能和梗阻参数。这是IRB批准的一项回顾，研究对象是2008年5月至2017年9月期间在一家独立的儿童医院接受FMRU的所有儿童。在6个月内也接受了MAG3肾脏扫描并且没有间隔手术干预的患者被包括在研究中。两项影像检查前均进行了膀胱插管检查。在研究期间，735名儿童进行了988项FMRU研究。最终样本包括37名独特的患者(13名女孩和24名男孩)，他们的平均年龄为6个月(范围从2个月到19岁)。研究间隔时间的中位数为70天(范围6-179天)。大多数患者(26/37，70.3%)表现为UTD P3，21/37诊断为输尿管盆腔交界处梗阻(UPJO)。肾功能分级：正常组10例，MAG3组9例，轻度组9例，中度组11例，重度组6例，FMRU组7例，重度组6例，经Wilcoxon符号等级检验，P=0.5106。在有和没有双肾的患者中，DRF的结果是相似的。在分析梗阻时，以MAG3≥为参考标准，以20min为标准，肾通过时间大于或等于6min，其特异度为94%，敏感度为62%，AUC为0.827。MAG3和FMRU测定的儿童肾功能差异无统计学意义，因此我们得出结论，它们是相似的，具有潜在的等效性。分裂肾功能正常的患者有较好的相关性。虽然这些测试在临床上是等同的，但DRF在每一临床类别(即正常、轻度、中度、重度)中的可变性并不令人惊讶，因为MAG3不能清楚地区分扩张的收集系统和功能性实质组织，而FMRU可以。以MAG3为金标准，FMRU诊断UPJO的特异度为94.74%，灵敏度提高5%，RTT分别为6min和8min。
Functional renal imaging, most commonly with MAG3 nuclear medicine renal scan, is recommended in the evaluation of children with urinary tract dilation (UTD) suspected of obstructive uropathy. Alternatively, renal function can be evaluated with functional Magnetic Resonance Urography (fMRU), which has superior anatomic detail. However, there are not enough data comparing both methods’ equivalency. In this study, we compare the functional and obstruction parameters of fMRU and MAG3 in a pediatric cohort presenting with obstructive uropathy. This is an IRB-approved retrospective review of all children undergoing fMRU at a single, free-standing children’s hospital between May 2008 and September 2017. Patients who also underwent a MAG3 renal scan within 6 months and who had no interval surgical intervention were included in the study. Bladder catheterization was performed prior to both imaging studies. 735 children had 988 fMRU studies performed during the study period. 37 unique patients (13 girls and 24 boys) with median age of 6 months (range: 2 mo–19 y) were included in the final sample. Median time interval between studies was 70 days (range 6–179 days). The majority of participants (26/37, 70.3%) presented with UTD P3 and had diagnosis of uretero-pelvic junction obstruction (UPJO) in 21/37. Differential renal function (DRF) was used to group 10 fMRU and 9 MAG3 patients as normal; 9 fMRU and 11 MAG3 as mild; 11 fMRU and 6 MAG3 as moderate; and 7 fMRU and 6 MAG3 as severe; Wilcoxon signed-rank test (p = 0.5106). Results were similar for DRF among patients with and without duplex kidneys. In the analysis of obstruction, using reference standard MAG3 ≥ 20 min, a greater or equal than 6 min renal transit time (RTT) from fMRU showed a specificity of 94%, a sensitivity of 62%, and an AUC of 0.827. The differential renal function determined by MAG3 and fMRU in children was not statistically different, therefore we concluded that it was similar and potentially equivalent. Better correlation was shown in patients who had normal split kidney function. While the tests are clinically equivalent, the variability of DRF within each clinical category (i.e., normal, mild, moderate, severe) is not surprising, because MAG3 does not clearly differentiate the dilated collecting system from the functional parenchymal tissue, while fMRU does. Using MAG3 as the gold standard, fMRU was 94.74% specific and 5% more sensitive in detecting UPJO with a RTT of 6min vs. 8min.
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