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

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

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1788-1795
Number of pages8
JournalPediatric radiology
Volume45
Issue number12
DOIs
StatePublished - Nov 1 2015

Keywords

  • Children
  • Crossing vessel
  • Magnetic resonance urography
  • Ureteropelvic junction obstruction

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging

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