| Objective:To investigate the imaging features of urinary congenital abnormity with conventional magnetic resonance imaging , MR urography and liver acquisition with volume acceleration,and to estimate the clinical application value of them.Methods: 43 patients were recruited from our hospital and a local Children's Hospital from August 2008 to February 2010. Conventional MRI and MR urography were performed for all patients in our hospital who were suspected of complex urinary congenital abnormity by ultrasonography (US), intravenous pyelogram (IVP) or computed tomography (CT) in our hospital or Children's Hospital. LAVA was performed if the former could't make a full diagnosis (n=8). All of them were confirmed by surgical treatment after a week in our hospital or Children's Hospital. 2 patients who had surgical history in abdominal and pelvis regions, 1 neuropathic bladder, and 1 distal ureteral silt stone combined with hydronephrosis and ureterectasis were excluded. 19 men and 22 women were included in our study ( age range 4 months to 40 years, median age 3 years, under the age of 14 patients 34 cases, more than 14 years old patients 7 cases). 36 cases of them diagnosed by ultrasonography, 10 cases by IVP, and 18 cases by CT. To read imaging in a double-blind manner, operation as reference standard. To analyze all the data by Chispuare test using SPSS13.0. To investigate the sensitivity, specificity, and accuracy of conventional MRI, MRU combined with LAVA in diagnosis of complex urinary congenital abnormity. To compare the difference of MRU and LAVA with US, IVP and CT.Results: These malformations included 10 vesicoureteral junction obstruction, 1 renal dysplasia combined with vesicoureteral junction obstruction, 1 duplex kidney and ureter combined with vesicoureteral junction obstruction, 2 bilateral ureterovesical junction stenosis, 2 ureterocele, 2 ectopic kidneys, 2 bladder malformation(1 duplex bladder and 1 bladder diverticulum), and 21 ectopic extravesical ureteric insertions. 3 of 41 cases was misdiagnosed by MRI before the operation (7.3%). insufficient 2 cases(4.9%), Other cases were made comprehensively and correctly diagnose by MRI (87.7%). US diagnosed correctly 2 cases (5.6%), insufficient 17 cases (47.2%), and misdiagnosed 17 cases (47.2%). IVP diagnosed correctly 1 case (10.0%), insufficiently 4 cases (40.0%), and misdiagnosed 5 cases (50%). CT diagnosed correctly 3 cases (16. 7%), insufficiently 9 cases (50.0%), and misdiagnosed 6 cases (33.3%).1. The diagnosis ratio of conventional MR, MRU combined with LAVA to renal abnormality was 93.0%, and that of US, IVP and CT were 61.5%,33.3%,60.9%,respectivly.Compared with the latter ,theχ~2 value was 19.408,28.537,15.406,respectively, P<0.001.2. The diagnosis ratio of conventional MR, MRU combined with LAVA , US, IVP, and CT to ectopic ureter were 90.5%, 5.9%, 14.3%, 23.1%, respectively. MR compared with US, IVP, and CT, theχ~2 value was 26.967,15.972,14.933,respectively, P<0.001。3. The diagnosis sensitivity and accuracy of MRI to complicated urinary congenital abnormity were 92.3% and 88.4%. The missed diagnosis rate were 0.1%. Conclusions: Conventional MR imaging, static MRU and LAVA have more help to depict continuously and completely the morphological changes of the complex urinary congenital malformations than that of the traditional modalities, but also provide the preliminary function of information, and make a comprehensive and correct diagnosis. |
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