Rabia Mihriban Kılınç, AFAK DURUR KARAKAYA, Afak DURUR KAYA

Çocuk Hastalarda Üreteropelvik Bileşke Darlıklarının Değerlendirilmesinde Dinamik MR Ürografi

Bu çalışmada üreteropelvik bileşke obstrüksiyonlarına bağlı hidronefroz bulunan çocuklarda dinamik manyetik rezonans (MR) ürografinin morfolojik ve fonksiyonel katkılarını saptamayı amaçladık. 2009-2012 yılları arasında pediatri kliniğine başvuran ve üreteropelvik bileşke darlığı tanısı ile dinamik MR ürografi ile incelenen 16 hastanın kayıtları retrospektif olarak değerlendirilmiştir. Hastaların hepsine aynı zamanda renal ultrasonografi de uygulanmıştı. Ayrıca 8 hasta diüretikli renal sintigrafi ile tetkik edilmişti. MR ürografi sonuçları, morfolojik ve fonksiyonel açıdan ultrasonografi bulguları, diüretikli renal sintigrafi sonuçları ve operasyon bulguları ile karşılaştırılmıştı. Morfolojik değerlendirme bakımından dinamik MR ürografi bir hastada, US ile benzer şekilde obstrüksiyonun seviyesini belirlemede başarısız oldu. Diğer hastaların tamamında dinamik MR ürografi ve ultrasonografi obstrüksiyonun seviyesini doğru olarak belirledi. Bu sonuçlar operasyonda teyit edildi. Fonksiyonel değerlendirmede bu hasta grubunda dinamik MR ürografi ve diüretikli renal sintigrafi benzer sonuçlar gösterdi. Dinamik MR ürografi, üreteropelvik bileşke darlıklarının morfolojik ve fonksiyonel değerlendirmesinde, doğru ve güvenilir bir yöntemdir.

Anahtar Kelimeler:

Üreteropelvik bileşke darlığı, dinamik manyetik rezonans ürografi, pediatrik hasta

Dynamic MR Urography in the Asssesment of Ureteropelvic Junction Obstruction in Pediatric Patients

The aim of this study was to determine morphologic and functional benefits of dynamic magnetic rezonans urography (MRU) at pediatric patients with ureteropelvic junction obstruction. Between 2009-2012, sixteen pediatric patients with known ureteropelvic junction obstruction were evaluated by ultrasound and dynamic MRU retrospectively. Eight of them also had diuretic renal scintigraphy. The findings of MRU were then compared with ultrasonography for morphological evaluation, diuretic renal scintigraphy for functional evaluation and against the results of final diagnosis established at surgery. MRU failed in one patient to find obstruction like ultrasound. MRU and ultrasound was successful to evaluate morphology of urınary system all of the other patients. Results were confirmed with surgery. MRU and diuretic renal scintigraphy were similar for functional evaluation. Dynamic MRU is reliable method for morphologic and functional evaliation of pediatric ureteropelvic junction obstruction.

Keywords:

Ureteropelvic junction obstruction, dynamic magnetic rezonans urography, pediatric patients,

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Borthne A. Nordshus T, Reiseter T, Geitung JT, Gjesdal KI, Babovic A, Bjerre A, Loe B. MR urography: the future gold standard in paediatric urogenital imaging ? Pediatr Radiol. 1999;29(9): 694-701.
Borthne A, Pierre-Jerome C. Nordshus, Reiseter T. MR urography in children: current status and future development. Eur Radiol. 2000; 10(3): 503-11.
Riccabona M, Simbnınner J, Ring E, Ruppert-Kohlmayr A, Ebner F, Fotter R. Feasibility of MR urograpy in neonates and infants with anomalies of the upper urinary tract. Eur Radiol. 2002;12(6):1442-50.
Rohrschneider WK, Haufe S, Weisel M, Tönshoff B, Wunsch R, Darge K, Clorius JH, Tröger J. Functional and morphologic evaluation of congenital urinary tract dilatation by using combined static-dynamic MR urography: findings in kidneys with a single collecting system. Radiology. 2002;224(3):683-94.
Avni FE, Bali MA, Regnault M, Damry N, Degroot F, Metens T, Matos C. MR urography in children. Eur J Radiol. 2002;43(2):154-66.
Verswijvel GA, Oyen RH, Van Hoppel HP, Goethuys H, Maes B, Vaninbrouckx J, Bosmans H, Marchal G. Magnetic resonance imaging in the assessment of urologic disease: an all-in-one approach. Eur Radiol. 2000;10(10):1614-9.
Hennig J, Freidburg H. Clinical applications and methodological developments of the RARE tecnique. Magn Reson imaging. 1988;6(4):391-5.
Rothpearl A, Frager D, Subramanium A, Bashist J, Baer J, Kay C, Cooke K, Raia C. MR urography: Tecnique and application. Radiology. 1995;94(1):125-30.
Klein LT, Frager D, Subramanium A, Lowe F. Use of magnetic resonance urography. Eur J Radiol. 1998;52(4):602-8.
Rohrschneider WK, Hoffend J, Becker K, Clorius JH, Darge K, Kooijman H, Tröger J. Combined static- dynamic MR urography for the simultaneous evaluation of morphology and functıon in urinary tract obstruction (I). Evaluation of the normal status in an animal model. Pediatr Radiol. 2000; 0(8): 511-22.
Rohrschneider WK, Becker K, Hoffend J, Clorius JH, Darge K, Kooijman H, Tröger J. Combined static- dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction (II). Findings in experimentally induced üreteric stenosis. Pediatr Radiol. 2000;30(8):523-32.
Roy C, Saussine C, Jacqmin D. Magnetic resonance urography. BJU Int. 2000; 86(1):42-7. Spencer JA, Tomlinson AJ, Weston MJ, Lloyd SN. Early report: Comparison of Breathhold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy. Clin Radiol. 2000;55(6):446-53.
Nolte-Ernsting CCA, Adam GB, Günther RW. MR urography. examination techniques and clinical applications. Eur Radiol. 2001;11(3):355-72.
Nolte-Emsting CCA, Tacke J, Adam GB, Haage P, Jung P, Jakse G, Günther RW. Diüretic-enhanced gadolinium excretory MR urography: comparison of conventional gradient-echo sequences and echo-planar imaging. Eur Radiol. 2001;11(1):18-27.
Szopinski K, Szopinska M, Borowka A, Jakubowski W. Magnetic resonance urography: initial experience of low dose Gd-DTPA-enhanced tecnique. Eur Radiol. 2000;10(7):1158
Zielonko J, Studniarek M, Markuszevski M. MR urography of obstructive uropathy: Diagnostic value of method in selected clinical groups. Eur Radiol. 2003;13(4):802-9.
Frush DP, Bisset GS 3rd, Hail SC. Pediatric sedation in radiology: the practise of safe sleep. AJR. 1996;167(6):1381-7.
Nakayama Y. Yamashita Y, Matsuno Y, Tang Y, Namimoto T, Kadota M, Mitsuzaki K, Abe Y, Katahira K, Arakawa A, Takahashi M. Fast breath-hold T2- weighted MRl of the kidney by meahs of Half- Fourier single shot turbo spin echo: comparison with high resolution turbo spin echo sequence. J Comput Assist Tomogr. 2001;25(1):55-60.
Regan F, Bolhman ME, Khazan R, Rodriquez R, Schultze-Haakh H. MR urography using HASTE imaging in the assasment of ureteric obstruction. AJR. 1996;167(5):1115-20.
Blandino A, Gaeta M, Minutoli F, Scribano E, Vinci S, Famulari C, Pandolfo I. MR pyelography in 115 patients with a dilated renal collecting system. Acta Radiol. 2001;42(5):532-6.
Prasad VP, Priatna A. Fuctional imaging of the kidneys with fast MRI tecniques. Eur J Radiol. 1999;29(2):133-48.
Koff SA, Campbell K. Nonoperative management of unilateral neonatal hydronephrosis. J Urol. 1992;148(2 pt 2) 525-36.
Harbert JC, Fraley EE, Deckers PJ. Alternation in radiaoactive isotope renogram pattern with urinary bladder filled. JAMA. 1970;211(5):810-1.
Cartwright PC, Duckett JW, Keating MA, Snyder HM 3rd, Escala J, Blyth B, Heyman S. Managing apparent ureteropelvic junction obstruction in the newborn. J Urol. 1992;148(4):1224-8.
Conway CC, Maizels M. The 'well-tempered' diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis. J Nucl Med. 1992;33(1):2047-51.
O'Reilly P, Aureli M, Britton K, Kletter K, Rosenthal L, Testa T. Consensus on diuresis renography for investigating the dilated upper urinary tract. J Nucl Med. 1996;37(11):1872-6.
Kade H, Meredith OM Jr, Taplin GV, Wınter CC. Radioisotope renogram; external test for individual kidney function and upper urinary tract patency. J Lab Clin Med. 1956;48(6):886-901.
English PJ, Testa HJ, Lawson RS, Edwards EC. Modified method of diuresis renography for the assessment of equivocal pelviureteric junction obstruction. Br J Urol. 1987;59(1):10-4.
Sadowski EA, Bennett LK, Chan MR, Wentland AL, Garrett AL, Garrett RW, Djamali A. Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology. 2007;243(1):148-57.
Kuo PH, Kanal E, Abu-Alfa AK, Cowper SE. Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology. 2007;242(3):647-9.