Abstract
Background
Functional magnetic resonance (MR) urography has been well established in the diagnostic workup of congenital anomalies of kidneys and urinary tract, though long acquisition time requires sedation or general anesthesia in infants.
Objective
To evaluate the success rate of an optimized functional MR urography protocol in infants carried out in natural sleep.
Materials and methods
We retrospectively evaluated all functional MR urographies performed under general anesthesia or during natural sleep in infants younger than 1 year between 2010 and 2017 and rated image quality in both cohorts using a 3-point Likert scale. We tested the analyzability of functional sequences using a free available software. We also calculated examination time. Finally, we compared examinations in natural sleep and those with general anesthesia using independent t-test for continuous data and Mann–Whitney U test for categorical data.
Results
Functional MR urography could be performed successfully during natural sleep in 38 of 42 (90%) infants younger than 10 months. Four examinations were aborted before contrast medium was administrated. In the same period, 19 functional MR urographies were performed successfully under general anesthesia. Although image quality was significantly better in this group (P<0.0001), image quality was at least diagnostic in all finished examinations in natural sleep, and the functional analyzability was given in all completed examinations. There was a significant saving in examination time during natural sleep (P<0.001).
Conclusion
Functional MR urography can be successfully performed in natural sleep in infants younger than 10 months.
Similar content being viewed by others
References
Wiesel A, Queisser-Luft A, Clementi M et al (2005) Prenatal detection of congenital renal malformations by fetal ultrasonographic examination: an analysis of 709,030 births in 12 European countries. Eur J Med Genet 48:131–144
Riccabona M, Avni FE, Blickman JG et al (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145
Riccabona M, Avni FE, Dacher JN et al (2010) ESPR uroradiology task force and ESUR paediatric working group: imaging and procedural recommendations in paediatric uroradiology, part III. Minutes of the ESPR uroradiology task force minisymposium on intravenous urography, uro-CT and MR-urography in childhood. Pediatr Radiol 40:1315–1320
Dickerson EC, Dillman JR, Smith EA et al (2015) Pediatric MR urography: indications, techniques, and approach to review. Radiographics 35:1208–1230
Khrichenko D, Darge K (2010) Functional analysis in MR urography — made simple. Pediatr Radiol 40:182–199
Jones RA, Grattan-Smith JD, Little S (2011) Pediatric magnetic resonance urography. J Magn Reson Imaging 33:510–526
Serafini G, Zadra N (2008) Anaesthesia for MRI in the paediatric patient. Curr Opin Anaesthesiol 21:499–503
Ing C, DiMaggio C, Whitehouse A et al (2012) Long-term differences in language and cognitive function after childhood exposure to anesthesia. Pediatrics 130:e476–e485
Andropoulos DB (2018) Effect of anesthesia on the developing brain: infant and fetus. Fetal Diagn Ther 43:1–11
Delgado J, Bedoya MA, Adeb M et al (2015) Optimizing functional MR urography: prime time for a 30-minutes-or-less fMRU. Pediatr Radiol 45:1333–1343
Dean DC 3rd, Dirks H, O'Muircheartaigh J et al (2014) Pediatric neuroimaging using magnetic resonance imaging during non-sedated sleep. Pediatr Radiol 44:64–72
Windram J, Grosse-Wortmann L, Shariat M et al (2012) Cardiovascular MRI without sedation or general anesthesia using a feed-and-sleep technique in neonates and infants. Pediatr Radiol 42:183–187
Vivier PH, Dolores M, Taylor M, Dacher JN (2010) MR urography in children. Part 2: how to use ImageJ MR urography processing software. Pediatr Radiol 40:739–746
Vivier PH, Dolores M, Taylor M et al (2010) MR urography in children. Part 1: how we do the F0 technique. Pediatr Radiol 40:732–738
Grattan-Smith JD, Little SB, Jones RA (2008) MR urography in children: how we do it. Pediatr Radiol 38:S3–S17
Grattan-Smith JD, Perez-Bayfield MR, Jones RA et al (2003) MR imaging of kidneys: functional evaluation using F-15 perfusion imaging. Pediatr Radiol 33:293–304
Shariat M, Mertens L, Seed M et al (2015) Utility of feed-and-sleep cardiovascular magnetic resonance in young infants with complex cardiovascular disease. Pediatr Cardiol 36:809–812
Bai J, Harper FWK, Penner LA et al (2017) Parents' verbal and nonverbal caring behaviors and child distress during cancer-related port access procedures: a time-window sequential analysis. Oncol Nurs Forum 44:675–687
Piira T, Sugiura T, Champion GD et al (2005) The role of parental presence in the context of children's medical procedures: a systematic review. Child Care Health Dev 31:233–243
Jaimes C, Murcia DJ, Miguel K et al (2018) Identification of quality improvement areas in pediatric MRI from analysis of patient safety reports. Pediatr Radiol 48:66–73
Raper J, Alvarado MC, Murphy KL, Baxter MG (2015) Multiple anesthetic exposure in infant monkeys alters emotional reactivity to an acute stressor. Anesthesiology 123:1084–1092
Jevtovic-Todorovic V, Hartman RE, Izumi Y et al (2003) Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci 23:876–882
Davidson AJ, Disma N, de Graaff JC et al (2016) Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet 387:239–250
Chan SS, Ntoulia A, Khrichenko D et al (2017) Role of magnetic resonance urography in pediatric renal fusion anomalies. Pediatr Radiol 47:1707–1720
Figueroa VH, Chavhan GB, Oudjhane K, Farhat W (2014) Utility of MR urography in children suspected of having ectopic ureter. Pediatr Radiol 44:956–962
Boss A, Martirosian P, Fuchs J et al (2014) Dynamic MR urography in children with uropathic disease with a combined 2D and 3D acquisition protocol — comparison with MAG3 scintigraphy. Br J Radiol 87:20140426
Adeb M, Darge K, Dillman JR et al (2013) Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am 21:717–730
Khrichenko D, Saul D, Adeb M et al (2016) Intra- and inter-observer variability of functional MR urography (fMRU) assessment in children. Pediatr Radiol 46:666–673
Dillman JR, Trout AT, Smith EA (2016) MR urography in children and adolescents: techniques and clinical applications. Abdom Radiol 41:1007–1019
Avni FE, Nicaise N, Hall M et al (2001) The role of MR imaging for the assessment of complicated duplex kidneys in children: preliminary report. Pediatr Radiol 31:215–223
Arteaga MV, Caballero VM, Rengifo KM (2018) Dosimetry of (99m)Tc (DTPA, DMSA and MAG3) used in renal function studies of newborns and children. Appl Radiat Isot 138:25–28
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None
Rights and permissions
About this article
Cite this article
Tsiflikas, I., Obermayr, F., Werner, S. et al. Functional magnetic resonance urography in infants: feasibility of a feed-and-sleep technique. Pediatr Radiol 49, 351–357 (2019). https://doi.org/10.1007/s00247-018-4307-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-018-4307-5