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Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections?

Kavanagh EC, Ryan S, Awan A, McCourbrey S, O'Connor R, Donoghue V

Department of Radiology, Children's University Hospital, Temple Street, Dublin, Ireland.

BACKGROUND: Renal parenchymal defects may be a consequence of urinary tract infections (UTI) in childhood. MRI is a non-radiation imaging modality compared with DMSA scanning. OBJECTIVE: To compare DMSA with MRI for the detection of renal parenchymal defects in children presenting for radiological investigation after a first UTI. MATERIALS AND METHODS: Both DMSA and MRI were performed at the same appointment in 37 children (aged 4 months-13 years; mean 4.5 years) with a history of UTI. Both planar and SPECT DMSA were performed. MRI of the kidneys employed axial and coronal T1-, T2- and fat-saturated T1-weighted (T1-W) sequences. Some children had imaging after IV contrast medium. RESULTS: The coronal fat-saturated T1-W sequence was the best sequence and it detected all the findings on MRI. MRI had a sensitivity of 77% and a specificity of 87% for the detection of a scarred kidney using DMSA as the gold standard. MRI diagnosed pyelonephritis in two children that had been interpreted as scarring on DMSA. CONCLUSIONS: Renal MRI using a single, coronal, fat-saturated T1-W sequence is a rapid, accurate and minimally invasive technique for the detection of renal scarring that does not employ ionizing radiation.

Published 8 April 2005 in Pediatr Radiol, 35(3): 275-81.
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