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Wong MCY, Sertorio F, Damasio MB, Incarbone V, Beati F, Bodria M, Pistorio A, Ghiggeri GM, Magnano GM, Mattioli G. Surgical validation of functional magnetic resonance urography in the study of ureteropelvic junction obstruction in a pediatric cohort. J Pediatr Urol 2019; 15:168-175. [PMID: 30553558 DOI: 10.1016/j.jpurol.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ureteropelvic junction obstruction (UPJO) is one of the most common urological diseases in children. The etiology can be intrinsic, extrinsic (crossing vessel [CV] or adhesions), or mixed. To date, ultrasonography and scintigraphy are considered gold-standard imaging techniques for the study of UPJO. Functional magnetic resonance urography (fMRU) combines anatomical and functional information and has been recently evaluated for the detection of CVs in UPJO. OBJECTIVE The objective of the study was to evaluate the concordance between fMRU and surgery in determining the etiology of UPJO and the presence of obstructing/non-obstructing CVs. STUDY DESIGN Patients with unilateral hydronephrosis who underwent surgery after an fMRU were included in the sample. Surgical data regarding the etiology of UPJO were compared with radiological results. The etiology was divided into intrinsic, extrinsic due to CV, extrinsic due to adhesions, and mixed or cicatricial (postoperative). The concordance was calculated by means of the Cohen's kappa coefficient. RESULTS The observed agreement between fMRU and surgical findings regarding the etiology and the presence of CV were 83.2% and 89.4%, respectively (with substantial Cohen's kappa coefficient). The sensitivity and specificity of fMRU were 0.84 and 0.93, respectively; the positive predictive value (PPV) and negative predictive value (NPV) were 0.889 and 0.897, respectively. The observed agreement regarding the type of vessel was 88.3% with a Cohen's kappa coefficient of 0.787 (substantial). DISCUSSION In children with hydronephrosis, it is very important for the surgeon to quantify the extent of dilation, define the etiology of the obstruction, and the presence or absence of CVs. fMRU is a 'one-stop-shop' technique which provides both anatomical and functional information showing a high concordance with surgical findings, avoiding radiation exposure. CONCLUSIONS fMRU should be considered a valid imaging technique in the study of pediatric UPJO, as it provides the surgeon with important information regarding the etiology of the obstruction for the preoperative planning.
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Affiliation(s)
- M C Y Wong
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
| | - F Sertorio
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; University of Genoa, Via Balbi 5, 16126, Genoa, Italy.
| | - M B Damasio
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - V Incarbone
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - F Beati
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
| | - M Bodria
- Nephrology, Dialysis and Renal Transplantation Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - A Pistorio
- Epidemiology and Biostatistics Service, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G M Ghiggeri
- Nephrology, Dialysis and Renal Transplantation Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G M Magnano
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G Mattioli
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
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