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Der Radiologe

, Volume 45, Issue 12, pp 1078–1084 | Cite as

Moderne Bildgebung beim Harnweginfekt im Kindesalter

  • M. RiccabonaEmail author
  • R. Fotter
Kinderuroradiologie

Zusammenfassung

Die bildgebende Diagnostik beim kindlichen Harnweginfekt (HWI) wird weiterhin heftig diskutiert. Zwar existieren etablierte Bildgebungsalgorithmen, insbesondere für das Kleinkindesalter; neue Erkenntnisse bzw. Aufgabenstellungen haben aber zu einer Änderung des Therapiekonzepts mit Auswirkungen auf die Bildgebung geführt. Zusätzlich haben technische (Weiter)Entwicklungen das Potenzial der Bildgebung erweitert; v. a. MRT und moderne Ultraschallverfahren versprechen eine weniger invasive und strahlenfreie Diagnosemöglichkeit.

Ziel dieser Übersichtsarbeit ist es, die wichtigsten neuen Erkenntnisse anzuführen, die wesentlichen Neuerungen in der Bildgebung zu benennen und zu beschreiben, und die aus diesen Faktoren resultierenden Auswirkungen auf die Bildgebung beim kindlichen HWI anzuführen. Schließlich soll versucht werden, einen Vorschlag für einen stufenweise aufgebauten Bildgebungsalgorithmus aus US, Nierenszintigraphie, MRT sowie MCU — wenngleich mit strengerer Indikationsstellung — zu präsentieren, der diese Aspekte berücksichtigt, ohne alles wohlbegründet Etablierte vorschnell über Bord zu werfen.

Schlüsselwörter

Moderne Bildgebung Sonographie Magnetresonanztomographie (MRT) Nierenszintigraphie Harntraktinfektion Kindesalter 

Modern imaging technology for childhood urinary tract infection

Abstract

Imaging in childhood urinary tract infection (UTI) is still a matter of debate. There are established guidelines, however new knowledge and the changed medical environment have enhanced this ongoing discussion. These new insights have impacted therapy and consequently the imaging algorithm.

Modern imaging methods — particularly MRI and modern ultrasound (US) — are less invasive with a lower radiation burden. Additionally, it has been shown that VUR is a poor predictor for renal scarring out, which affects long-term results. Furthermore, the majority of UT malformations is depicted by prenatal US. The most crucial aspect of improving long-term outcome appears to be the early and reliable depiction of UTI and effective treatment to prevent renal scarring.

This review tries to present this new knowledge and to discuss the potential of modern imaging. Recent changes in imaging algorithms are highlighted and an outcome-oriented algorithm that addresses these recent developments is proposed, without lightly abandoning established standards. It consists of an orienting US and — for depiction of renal involvement — amplitude coded color Doppler sonography or renal static scintigraphy (considered the gold standard, particularly for evaluating scars); in future MRI may play a role. Based on this concept, only patients with renal damage as well as patients with complex urinary tract malformations or intractable recurrent UTI may have to undergo VCUG.

Keywords

Modern imaging Ultrasound Magnetic resonance imaging (MRI) Renal scintigraphy Urinary tract infection Childhood 

Notes

Interessenkonflikt:

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Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Abteilung KinderradiologieRadiologische Universitätsklinik Graz
  2. 2.Abteilung KinderradiologieRadiologische UniversitätsklinikGraz

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