Update on Pediatric Kidney and Urinary Tract Imaging
This paper will review the current roles of imaging for assessing the pediatric kidneys and urinary tract, while emphasizing recent trends and advances in imaging techniques.
Imaging aids in the diagnosis, assessment, and follow-up of the spectrum of congenital and developmental, infectious and inflammatory, traumatic, neoplastic, vascular, and acquired renal and urinary tract conditions. While ultrasound is the workhorse imaging modality for evaluating the kidneys and urinary tract in the pediatric population, magnetic resonance imaging, computed tomography, nuclear scintigraphy, and abdominal radiography also play particular roles. Numerous recent advances have improved the diagnostic capabilities of these modalities.
Imaging plays an important role in the management of children and young adults with suspected and known renal and urologic abnormalities.
KeywordsChildren Kidneys Urinary tract Imaging Ultrasound
Compliance with Ethical Standards
Conflict of Interest
Jonathan R. Dillman declares that he has no conflict of interest. Andrew T. Trout declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.American College of Radiology (ACR) Appropriateness criteria—hematuria—child: American College of Radiology; [Available from: https://acsearch.acr.org/docs/69440/Narrative/].
- 4.Kim HK, O'Hara S, Je BK, Kraus SJ, Horn P. Feasibility of superb microvascular imaging to detect high-grade vesicoureteral reflux in children with urinary tract infection. Eur Radiol. 2018;28(1):66–73. https://doi.org/10.1007/s00330-017-4974-x.
- 6.Dillman JR, Smith EA, Davenport MS, DiPietro MA, Sanchez R, Kraft KH, et al. Can shear-wave elastography be used to discriminate obstructive hydronephrosis from nonobstructive hydronephrosis in children? Radiology. 2015;277(1):259–67. https://doi.org/10.1148/radiol.2015142884.CrossRefPubMedGoogle Scholar
- 7.Sağlam D, Bilgici MC, Kara C, Yılmaz GC, Çamlıdağ İ. Acoustic radiation force impulse elastography in determining the effects of type 1 diabetes on pancreas and kidney elasticity in children. AJR Am J Roentgenol. 2017;209(5):1143–49. https://doi.org/10.2214/AJR.17.18170.
- 8.Bekci T, Ceyhan Bilgici M, Genc G, Tekcan D, Veysel Polat A, Tomak L. Evaluation of renal parenchyma elasticity with acoustic radiation force impulse quantification in nutcracker syndrome and comparisons with grayscale Doppler sonography and laboratory findings. J Ultrasound Med. 2017;36(1):61–7. https://doi.org/10.7863/ultra.16.03010.CrossRefPubMedGoogle Scholar
- 9.• Piskunowicz M, Swieton D, Rybczynska D, Czarniak P, Szarmach A, Kaszubowski M, et al. Comparison of voiding cystourethrography and urosonography with second-generation contrast agents in simultaneous prospective study. J Ultrason. 2016;16(67):339–47. https://doi.org/10.15557/JoU.2016.0034 This article shows that voiding urosonography using micrubble contrast material instilled into the bladder has similar diagnostic perforamnce to voiding cystourethrography, but without ionizing radiation. .
- 10.•• Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014;10(6):982–98. https://doi.org/10.1016/j.jpurol.2014.10.002 This manuscript presents a newly developed classification system for describing and following prenatal and postnatal urinary tract dilation. .
- 11.Myers MT, Elder JS, Sivit CJ, Applegate KE. Unenhanced helical CT in the evaluation of the urinary tract in children and young adults following urinary tract reconstruction: comparison with sonography. Pediatr Radiol. 2001;31(3):135–9. https://doi.org/10.1007/s002470000372.CrossRefPubMedGoogle Scholar
- 12.Sade R, Ogul H, Eren S, Levent A, Kantarci M. Comparison of ultrasonography and low-dose computed tomography for the diagnosis of pediatric urolithiasis in the emergency department. Eurasian J Med. 2017;49(2):128–31. https://doi.org/10.5152/eurasianjmed.2017.17083.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Dillman JR, Caoili EM, Cohan RH, Ellis JH, Francis IR, Nan B, et al. Comparison of urinary tract distension and opacification using single-bolus 3-phase vs split-bolus 2-phase multidetector row CT urography. J Comput Assist Tomogr. 2007;31(5):750–7. https://doi.org/10.1097/RCT.0b013e318033df36.CrossRefPubMedGoogle Scholar
- 18.Glockner JF, Takahashi N, Kawashima A, Woodrum DA, Stanley DW, Takei N, et al. Non-contrast renal artery MRA using an inflow inversion recovery steady state free precession technique (Inhance): comparison with 3D contrast-enhanced MRA. J Magn Reson Imaging. 2010;31(6):1411–8. https://doi.org/10.1002/jmri.22194.CrossRefPubMedGoogle Scholar
- 22.Liang KW, Chen JW, Huang HH, Su CH, Tyan YS, Tsao TF. The performance of noncontrast magnetic resonance angiography in detecting renal artery stenosis as compared with contrast enhanced magnetic resonance angiography using conventional angiography as a reference. J Comput Assist Tomogr. 2017;41(4):619–27. https://doi.org/10.1097/RCT.0000000000000574.CrossRefPubMedGoogle Scholar
- 23.• Dickerson EC, Dillman JR, Smith EA, DiPietro MA, Lebowitz RL, Darge K. Pediatric MR urography: indications, techniques, and approach to review. Radiographics. 2015;35(4):1208–30. https://doi.org/10.1148/rg.2015140223 This review article presents state-of-the-art MRI techniques for assessing the pediatric kidneys and urianry tract, including common indications for MR imaging. .CrossRefPubMedGoogle Scholar
- 27.Subcommittee on Urinary Tract Infection SCoQI, Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595–610. https://doi.org/10.1542/peds.2011-1330.CrossRefGoogle Scholar
- 30.Jaksic E, Bogdanovic R, Artiko V, Saranovic DS, Petrasinovic Z, Petrovic M, et al. Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis. Ann Nucl Med. 2011;25(1):37–43. https://doi.org/10.1007/s12149-010-0431-5.CrossRefPubMedGoogle Scholar