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.
Similar content being viewed by others
References
Weiss DA, Kadakia S, Kurzweil R et al (2015) Detection of crossing vessels in pediatric ureteropelvic junction obstruction: clinical patterns and imaging findings. J Pediatr Urol 11:173 e171–173 e175
Dillman JR, Trout AT, Smith EA (2016) MR urography in children and adolescents: techniques and clinical applications. Abdom Radiol (NY) 41:1007–1019
Darge K, Higgins M, Hwang TJ et al (2013) Magnetic resonance and computed tomography in pediatric urology: an imaging overview for current and future daily practice. Radiol Clin North Am 51:583–598
Jaimes C, Darge K, Khrichenko D et al (2014) Diffusion tensor imaging and tractography of the kidney in children: feasibility and preliminary experience. Pediatr Radiol 44:30–41
Romao RL, Farhat WA, Pippi Salle JL et al (2012) Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction. J Urol 188:2347–2353
Kogan BA (2013) Chapter 37. Disorders of the ureter &ureteropelvic junction. In: McAninch JW, Lue TF (eds) Smith & Tanagho's general urology, 18th edn. The McGraw-Hill Companies, New York
Hagmann P, Jonasson L, Maeder P et al (2006) Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond. Radiographics 26:S205–S223
Li Y, Lee MM, Worters PW et al (2017) Pilot study of renal diffusion tensor imaging as a correlate to histopathology in pediatric renal allografts. AJR Am J Roentgenol 208:1358–1364
Liu Z, Xu Y, Zhang J et al (2015) Chronic kidney disease: pathological and functional assessment with diffusion tensor imaging at 3T MR. Eur Radiol 25:652–660
Lanzman RS, Ljimani A, Pentang G et al (2013) Kidney transplant: functional assessment with diffusion-tensor MR imaging at 3T. Radiology 266:218–225
Hueper K, Gutberlet M, Rodt T et al (2011) Diffusion tensor imaging and tractography for assessment of renal allograft dysfunction-initial results. Eur Radiol 21:2427–2433
Delgado J, Bedoya MA, Adeb M et al (2015) Optimizing functional MR urography: prime time for a 30-minutes-or-less fMRU. Pediatr Radiol 45:1333–1343
Khrichenko D, Darge K (2010) Functional analysis in MR urography - made simple. Pediatr Radiol 40:182–199
Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 23:478–480
Riccabona M, Avni FE, Blickman JG et al (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145
Dickerson EC, Dillman JR, Smith EA et al (2015) Pediatric MR urography: indications, techniques, and approach to review. Radiographics 35:1208–1230
Grattan-Smith JD, Little SB, Jones RA (2008) Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia. Pediatr Radiol 38:S83–105
Wang R, Benner T, Sorensen AG et al (2007) Diffusion Toolkit: A software package for diffusion imaging data processing and tractography. Proceedings of the 15th Meeting of the International Society for Magnetic Resonance in Medicine. International Society for Magnetic Resonance in Medicine, Berkley, California
Kido A, Kataoka M, Yamamoto A et al (2010) Diffusion tensor MRI of the kidney at 3.0 and 1.5 Tesla. Acta Radiol 51:1059–1063
Kataoka M, Kido A, Yamamoto A et al (2009) Diffusion tensor imaging of kidneys with respiratory triggering: optimization of parameters to demonstrate anisotropic structures on fraction anisotropy maps. J Magn Reson Imaging 29:736–744
Notohamiprodjo M, Glaser C, Herrmann KA et al (2008) Diffusion tensor imaging of the kidney with parallel imaging: initial clinical experience. Investig Radiol 43:677–685
Notohamiprodjo M, Dietrich O, Horger W et al (2010) Diffusion tensor imaging (DTI) of the kidney at 3 tesla-feasibility, protocol evaluation and comparison to 1.5 Tesla. Investig Radiol 45:245–254
Seif M, Mani LY, Lu H et al (2016) Diffusion tensor imaging of the human kidney: does image registration permit scanning without respiratory triggering? J Magn Reson Imaging 44:327–334
Darge K, Anupindi SA, Jaramillo D (2011) MR imaging of the abdomen and pelvis in infants, children, and adolescents. Radiology 261:12–29
Williams B, Tareen B, Resnick MI (2007) Pathophysiology and treatment of ureteropelvic junction obstruction. Curr Urol Rep 8:111–117
Hara S (2016) Current pathological perspectives on chronic rejection in renal allografts. Clin Exp Nephrol 21:943–951
Chandarana H, Lee VS (2009) Renal functional MRI: are we ready for clinical application? AJR Am J Roentgenol 192:1550–1557
Sigmund EE, Vivier PH, Sui D et al (2012) Intravoxel incoherent motion and diffusion-tensor imaging in renal tissue under hydration and furosemide flow challenges. Radiology 263:758–769
Tubre RW, Gatti JM (2015) Surgical approaches to pediatric ureteropelvic junction obstruction. Curr Urol Rep 16:72
Calder AD, Hiorns MP, Abhyankar A et al (2007) Contrast-enhanced magnetic resonance angiography for the detection of crossing renal vessels in children with symptomatic ureteropelvic junction obstruction: comparison with operative findings. Pediatr Radiol 37:356–361
Renjen P, Bellah R, Hellinger JC et al (2010) Pediatric urologic advanced imaging: techniques and applications. Urol Clin North Am 37:307–318
Rigas A, Karamanolakis D, Bogdanos I et al (2003) Pelvi-ureteric junction obstruction by crossing renal vessels: clinical and imaging features. BJU Int 92:101–103
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Delgado, J., Berman, J.I., Maya, C. et al. 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?. Pediatr Radiol 49, 175–186 (2019). https://doi.org/10.1007/s00247-018-4268-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-018-4268-8