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Morphologic and functional evaluation of duplicated renal collecting systems with MR urography: A descriptive analysis

      Highlights

      • Duplex renal collecting systems are mostly detected as incidental finding on imaging performed for other indications.
      • fMRU provides comprehensive morphologic and functional information of duplicated renal collecting systems in children.
      • fMRU is useful for assessing urologic abnormalities as well as demonstrating barely or non-functioning renal poles.
      • fMRU images allow delineation of each renal moiety in complicated duplex systems to help surgical planning.

      Abstract

      Purpose

      To describe the morphology and function of duplicated collecting systems in pediatric patients undergoing functional MR urography (fMRU).

      Methods

      This is a HIPAA compliant IRB approved retrospective study of all patients with duplicated renal collecting systems undergoing fMRU at our institution between 2010 and 2017. Two pediatric radiologists evaluated the studies to determine the presence, morphology and function of duplicated collecting systems using both T2-weighted and dynamic post-contrast fat saturated T1-weighted images. Assessed morphologic features included pelvic and calyceal dilation, partial or complete ureteral duplication, ureteral dilation, ectopic ureteral insertion and ureteroceles. Functional analysis was carried out per moiety.

      Results

      A total of 86 examinations (63 girls; 23 boys), median age 2.6 years (Standard Deviation 6.4 years, interquartile range: 0.4–10.3 years) and 107 kidneys (39 right; 30 left and 19 bilateral), which yielded 214 evaluable moieties, were included in the final sample. One hundred and sixty-three (76.1%) of the moieties had normal morphological features and normal functional results (average calyceal transit time and renal transit time of 2 min 28 s and 3 min 16 s, respectively). The remaining 51 moieties (23.8%) were hypoplastic or dysplastic. Seventy-seven (35.9%) had pelvic and calyceal dilation. Slightly more than half of the kidneys had complete ureteral duplication (60/107; 56%); 50 (50/107, 46.7%) had ectopic ureters (23 intra- and 27 extravesical) and 9 (9/107, 8.4%) had ureteroceles.

      Conclusion

      fMRU provides comprehensive information regarding the morphology and function of duplicated renal collecting systems in children. In particular, fMRU is useful for assessing barely or non-functioning renal poles and ectopic ureters.

      Keywords

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