Interactive magnetic resonance imaging for paediatric vesicoureteric reflux (VUR)

Objectives

The current gold standard for diagnosing vesicoureteric reflux in unsedated infants is the X-ray-based Micturating CystoUrethroGram (MCUG). The aim of this study was to assess the diagnostic performance of interactive MRI for voiding cysto-urethrography (iMRVC).

Methods

25 infants underwent conventional MCUG followed by iMRVC. In iMRVC, patients were examined using a real-time MR technique, which allows interactive control of image contrast and imaging plane location, before, during and after micturition. Images were assessed for presence and grade of VUR. Parental feedback on both procedures was evaluated.

Results

iMRVC gave a sensitivity of 100%, specificity of 90.5% (95% CI: 81.6–99.4%), PPV of 66.7% and NPV of 100% in this population. There was 88% concordance (44/50 renal units) according to the presence of VUR between the two methods, with iMRVC up-grading VUR in 6 units (12%). There was very good agreement regarding VUR grade: Kappa = 0.66 ± 0.11 (95% CI 0.43–0.88). 60% of parents preferred the MRI, but did not score the two tests differently.

Conclusion

Interactive MRI allows dynamic imaging of the whole urinary tract without ionising radiation exposure. iMRVC gives comparable results to the MCUG, and is acceptable to parents.