Interactive magnetic resonance voiding cystourethrography (iMRVC) for vesicoureteric reflux (VUR) in unsedated infants: a feasibility study

• Published in: European radiology 2011-09, Vol.21 (9), p.1874-1881
• Main Authors: Arthurs, Owen J., Edwards, Andrea D., Joubert, Ilse, Graves, Martin J., Set, Pat A K, Lomas, David J.
• Format: Article
• Language: English
• Subjects: Anesthesia; Bladder; Cohort Studies; Conscious Sedation; Diagnostic Radiology; Feasibility Studies; Female; Humans; Imaging; Infant; Infant, Newborn; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Neuroradiology; Patients; Pediatric; Pediatrics; Radiation; Radiography, Interventional - methods; Radiology; Sensitivity and Specificity; Severity of Illness Index; Ultrasonic imaging; Ultrasound; Urethra - diagnostic imaging; Urinary Bladder - diagnostic imaging; Urination; Urogenital system; Vesico-Ureteral Reflux - diagnosis; Vesico-Ureteral Reflux - diagnostic imaging; X-rays
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-011-2124-4

Objectives The current reference standard for diagnosing vesicoureteric reflux is the X-ray-based Micturating CystoUrethroGram (MCUG). The aim of this study was to evaluate the feasibility of performing interactive Magnetic Resonance voiding cysto-urethrography (iMRVC) in un-sedated infants. Methods Twelve infants underwent conventional single-cycle MCUG followed by iMRVC. In iMRVC, patients were examined using an in-house developed fluoroscopic pulse sequence, which allows on-the-fly control of image contrast and geometry. A single acquisition was performed during bladder filling, during and after micturition, with interactive control over imaging parameters. Images were assessed for diagnostic quality and presence of VUR. Results Every case of reflux identified with MCUG was identified on iMRVC (100% sensitivity). Over 24 renal units, there was 88% concordance (21/24) according to the presence of reflux between the two methods. There were three “false positives” detected by MRI, giving a specificity of 83.3%, PPV of 66.7% and NPV of 100%. Conclusion iMRVC is a feasible method for evaluating the renal tract in infants without the need for radiation or sedation. A formal evaluation is required to establish its diagnostic potential.