Декларация за оригиналност - МЕДИЦИНСКИ УНИВЕРСИТЕТ ...

X. Summary
Magnetic resonance urography in children
MR urography (MRU) is a new, attractive imaging modality that was introduced to
paediatric uroradiology more than a decade ago and has evolved into an effective
imaging tool for the evaluation of various urologic abnormalities in children. MRU
provides both morphological and functional information by means of different
sequences with or without injection of gadolinium. The method is most commonly
applied for the evaluation of hydronephrosis and provides valuable insight into a wide
range of obstructive uropathies and is also beneficial in tumors and in the diagnosis
of pyelonephritis and renal scarring MRU where it has been shown to be superior to
renal scintigraphy. Post processing algorithms permits the evaluation of the split
renal function by generating time-intensity curves representative for the renal
function, as well as many other parameters. The use of MRU for the assessment of
urolithiasis, vesicoureteral reflux, renal trauma, and fetal urinary tract abnormalities is
still limited and technical refinements are required. Judicious use of gadoliniumbased
contrast agents in children at risk for nephrogenic systemic fibrosis should be
employed with attention focused on from today so as to avoid new occurrences.
Potential future applications include virtual endoscopy and MRU-guided procedures.
The aim of our work is to promote the use of MRU in given paediatric queries trying
to provide a safe and reliable MR protocol for anatomic imaging that is generally
accepted. For this reason our ambition together with the ESPR uroradiology task
force and the ESUR paediatric working is to join forces to define imaging and
procedural recommendations in paediatric uroradiology. The aim of this process is
not only to standardize paediatric uroradiologic imaging but also to reduce
invasiveness and radiation dose. The new proposals are consensus-based, as use
and indications have changed and approaches on how to perform the MRU
examination in children differ in the literature. We are also describing our experience
in functional MRU on the basis of recent technical innovations and post processing
functional analysis tools. The lack of standardization for quantitative renal functional
evaluation and urinary drainage assessment requires new studies, comparison of the
different approaches as we have already started to perform and extensive
interdisciplinary consultations. Classic morphometric methods have been applied to
MR urography studies for overall assessment of anatomic kidney information. We
also used experimental models at 7T MRI to assess new contrast agents with kidney
excretion as alternative to gadolinium in cases of kidney dysfunction which we
consider harmless for mammalians in selected doses.
MRU has the potential to revolutionize imaging of the urinary tract and to become in
future the leading diagnostic modality of the wide spectrum of pathological conditions
affecting the urinary tract in newborns and children. It integrates exquisite anatomical
information with a variety of functional data and avoids ionizing radiation. MRU is
increasingly employed as a problem solver when conventional imaging studies
remain inconclusive and its growing application will likely improve availability and
cost in the future.
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