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Pilot study on renal magnetic resonance diffusion tensor imaging: are quantitative diffusion tensor imaging values useful in the evaluation of children with ureteropelvic junction obstruction?

  • Jorge Delgado
  • Jeffrey I. Berman
  • Carolina Maya
  • Robert H. Carson
  • Susan J. Back
  • Kassa Darge
Original Article

Abstract

Background

Ureteropelvic junction (UPJ) obstruction is a common cause of renal injury in children. Indications for surgery are still controversial. Currently, there is no threshold to differentiate patients with suspected UPJ obstruction requiring surgery from the ones that do not, or to predict renal outcome after surgery. Several studies have demonstrated that diffusion tensor imaging (DTI) results may correlate with microstructural changes in the kidneys.

Objective

To evaluate the feasibility of using DTI to identify UPJ obstruction kidneys.

Materials and methods

We analyzed functional MR urography (fMRU) with renal DTI (b=0 and b=400, 20 directions, 1.5 Tesla, no respiratory triggering) in 26 kidneys of 19 children (mean age: 6.15 years) by comparing 13 kidneys with UPJ obstruction configuration that underwent pyeloplasty following the fMRU, and 13 anatomically normal age- and gender-matched kidneys. DTI tractography was reconstructed using a fractional anisotropy threshold of 0.10 and an angle threshold of 55°. User-defined regions of interest (ROIs) of the renal parenchyma (excluding collecting system) were drawn to quantify DTI parameters: fractional anisotropy, apparent diffusion coefficient (ADC), track length and track volume. The failure rate was evaluated.

Results

All DTI parameters changed with age; fractional anisotropy decreased (P<0.032). Track volume and track length increased (P<0.05). ADC increased with age in normal kidneys (P<0.001) but not in UPJ obstruction kidneys (P=0.11). After controlling for age, the fractional anisotropy (UPJ obstruction mean: 0.18, normal kidney mean: 0.21; P=0.001) and track length (UPJ obstruction mean: 11.9 mm, normal kidney mean: 15.4 mm; P<0.001) were lower in UPJ obstruction vs. normal kidneys. There was a trend toward a higher ADC in UPJ obstruction kidneys vs. normal kidneys (P=0.062). The failure rate in UPJ obstruction kidneys due to technical limitations of DTI was 13/26 (50%).

Conclusion

We demonstrated that fractional anisotropy is lower in UPJ obstruction than in normal kidneys. It is necessary to improve this technique to increase the success rate and to perform more studies to evaluate if a decrease in fractional anisotropy can differentiate UPJ obstruction kidneys from hydronephrotic kidneys without UPJ obstruction.

Keywords

Children Diffusion tensor imaging Magnetic resonance imaging Magnetic resonance urography Ureteropelvic junction obstruction Urinary tract 

Notes

Compliance with ethical standards

Conflicts of interest

Dr. J. I. Berman is a consultant for McGowan Associates. Drs. Delgado, Maya, Back and Darge and technologist Carson have no disclosures.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Radiology, The Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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