Identification and characterization of calyceal diverticula with MR urography (MRU) in children

Abstract

Purpose

To determine the MRU imaging findings of calyceal diverticula in a large cohort of children and to compare the frequency of calyceal diverticula in our cohort with what has been previously reported.

Methods

This was a HIPAA-compliant, IRB-approved retrospective study of all patients with suspected CD based on their medical records. All patients in this study underwent MRU at our institution between 2010 and 2017. Two pediatric radiologists reviewed each MRU blinded to clinical information and other urologic imaging regarding the presence, size, location, and morphology of the cyst and presence/absence of contrast within it. The time when contrast first appeared within the cystic mass was recorded, and a χ2 test was used to determine significance on differences between the different characteristics of renal cysts and diverticula.

Results

Fifty children (29 girls and 21 boys; median age of 11.5 years, IQR 7–16) with a total of 66 individual cystic masses were included. 21 (21/66, 31.8%) Cystic masses demonstrated contrast filling and were characterized as diverticula, resulting in a frequency of 26.6 cases per 1000 patients (21/787). The remaining 45 cystic masses (45/66, 68.1%) were cysts. The median diameter of CD was 2.5 cm (IQR 1.5–3.7). Contrast was observed within the cystic mass on average at 4.6 min (SD ± 2.4; range 1.5–13 min). The agreement between both radiologists was 91% (k = 0.78). 6 Cysts and 18 CD were confirmed surgically, MRU demonstrated accurate diagnosis in 100% of those cases.

Conclusion

Magnetic resonance urography is reliable in differentiating calyceal diverticula from renal cysts. On MRU, all diverticula were identified within 15 min of contrast administration; hence longer delays in imaging are unnecessary.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Waingankar N, Hayek S, Smith AD, Okeke Z. Calyceal diverticula: a comprehensive review. Rev Urol 2014;16:29–43.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Michel W, Funke PJ, Tunn UW, Senge T. Pyelocalyceal diverticula. Int Urol Nephrol 1985;17:225–30. https://doi.org/10.1007/BF02085408.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Ito H, Aboumarzouk OM, Abushamma F, Keeley FX. Systematic Review of Caliceal Diverticulum. J Endourol 2018;32:961–72. https://doi.org/10.1089/end.2018.0332.

    Article  PubMed  Google Scholar 

  4. 4.

    Karmazyn B, Kaefer M, Jennings SG, Nirmala R, Raske ME. Caliceal diverticulum in pediatric patients: The spectrum of imaging findings. Pediatr Radiol 2011;41:1369–73. https://doi.org/10.1007/s00247-011-2113-4.

    Article  PubMed  Google Scholar 

  5. 5.

    Estrada CR, Datta S, Schneck FX, Bauer SB, Peters CA, Retik AB. Caliceal Diverticula in Children: Natural History and Management. J Urol 2009;181:1306–11. https://doi.org/10.1016/j.juro.2008.10.043.

    Article  PubMed  Google Scholar 

  6. 6.

    Timmons JW, Malek RS, Hattery RR, Deweerd JH. Caliceal diverticulum. J Urol 1975;114:6–9. https://doi.org/10.1016/S0022-5347(17)66930-1.

    Article  PubMed  Google Scholar 

  7. 7.

    Wood CG, Stromberg LJ, Harmath CB, Horowitz JM, Feng C, Hammond NA, et al. CT and MR imaging for evaluation of cystic renal lesions and diseases. Radiographics 2015;35:125–41. https://doi.org/10.1148/rg.351130016.

    Article  PubMed  Google Scholar 

  8. 8.

    Mullett R, Belfield JC, Vinjamuri S. Calyceal diverticulum - A mimic of different pathologies on multiple imaging modalities. J Radiol Case Rep 2012;6:10–7. https://doi.org/10.3941/jrcr.v6i9.1123.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Stunell H, McNeill G, Browne RFJ, Grainger R, Torreggiani WC. The imaging appearances of calyceal diverticula complicated by uroliathasis. Br J Radiol 2010;83:888–94. https://doi.org/10.1259/bjr/22591022.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Terada N, Arai Y, Kinukawa N, Terai A. The 10-Year Natural History of Simple Renal Cysts. Urology 2008;71:7–11. https://doi.org/10.1016/j.urology.2007.07.075.

    Article  PubMed  Google Scholar 

  11. 11.

    Bombiński P, Warchoł S, Brzewski M, Biejat A, Warchoł TD, Krzemień G, et al. Calyceal diverticulum of the kidney – diagnostic imaging dilemma in pediatric patients – case report. Polish J Radiol 2015;80:27–30. https://doi.org/10.12659/PJR.892053.

  12. 12.

    Rodigas J, Kirsch H, John U, Seifert P, Winkens T, Stenzel M, et al. Static and functional mr urography to assess congenital anomalies of the kidney and urinary tract in infants and children: Comparison with mag3 renal scintigraphy and sonography. Am J Roentgenol 2018;211:193–203. https://doi.org/10.2214/AJR.17.17891.

    Article  Google Scholar 

  13. 13.

    Dillman JR, Trout AT, Smith EA. MR urography in children and adolescents: techniques and clinical applications. Abdom Radiol 2016;41:1007–19. https://doi.org/10.1007/s00261-016-0669-z.

    Article  Google Scholar 

  14. 14.

    Dickerson EC, Dillman JR, Smith EA, Dipietro MA, Lebowitz RL, Darge K. Pediatric MR urography: Indications, techniques, and approach to review. Radiographics 2015;35:1208–30. https://doi.org/10.1148/rg.2015140223.

    Article  PubMed  Google Scholar 

  15. 15.

    Grattan-Smith JD, Jones RA. Magnetic Resonance Urography in Children. Magn Reson Imaging Clin N Am 2008;16:515–31. https://doi.org/10.1016/j.mric.2008.04.002.

    Article  PubMed  Google Scholar 

  16. 16.

    Chua ME, Ming JM, Farhat WA. Magnetic resonance urography in the pediatric population: a clinical perspective. Pediatr Radiol 2016;46:791–5. https://doi.org/10.1007/s00247-016-3577-z.

    Article  PubMed  Google Scholar 

  17. 17.

    Leyendecker JR, Clingan MJ. Magnetic Resonance Urography Update-Are We There Yet? Semin Ultrasound, CT MRI 2009;30:246–57. https://doi.org/10.1053/j.sult.2009.03.004.

    Article  Google Scholar 

  18. 18.

    Borthne A, Nordshus T, Reiseter T, Geitung JT, Gjesdal KI, Babovic A, et al. MR urography: The future gold standard in paediatric urogenital imaging? Pediatr Radiol 1999;29:694–701. https://doi.org/10.1007/s002470050677.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Sahin H, Sarioglu FC, Alaygut D, Akdogan AI, Pekcevik Y. Differentiation of simple renal parenchymal cyst and calyceal diverticulum. Pediatr Int 2019:ped.14127. https://doi.org/10.1111/ped.14127.

  20. 20.

    Grattan-Smith JD, Little SB, Jones RA. MR urography evaluation of obstructive uropathy. Pediatr. Radiol., vol. 38, 2008. https://doi.org/10.1007/s00247-007-0667-y.

  21. 21.

    de Bruyn R, Marks SD. Postnatal investigation of fetal renal disease. Semin Fetal Neonatal Med 2008;13:133–41. https://doi.org/10.1016/j.siny.2007.10.008.

    Article  PubMed  Google Scholar 

  22. 22.

    Middleton AW, Pfister RC. Stone containing pyelocaliceal diverticulum: embryogenic, anatomic, radiologic and clinical characteristics. J Urol 1974;111:2–6. https://doi.org/10.1016/S0022-5347(17)59872-9.

    Article  PubMed  Google Scholar 

  23. 23.

    Wulfsohn MA. Pyelocaliceal diverticula. J Urol 1980;123:1–8. https://doi.org/10.1016/S0022-5347(17)55748-1.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Kavukcu S, Cakmakci H, Babayigit A. Diagnosis of caliceal diverticulum in two pediatric patients: A comparison of sonography, CT, and urography. J Clin Ultrasound 2003;31:218–21. https://doi.org/10.1002/jcu.10154.

    Article  PubMed  Google Scholar 

  25. 25.

    Rohrer M, Bauer H, Mintorovitch J, Requardt M, Weinmann HJ. Comparison of magnetic properties of MRI contrast media solutions at different magnetic field strengths. Invest Radiol 2005;40:715–24. https://doi.org/10.1097/01.rli.0000184756.66360.d3.

    Article  PubMed  Google Scholar 

  26. 26.

    Elster AD. How much contrast is enough? Dependence of enhancement on field strength and MR pulse sequence. vol. 7. Springer-Verlag; 1997. https://doi.org/10.1007/pl00006908.

  27. 27.

    Davenport, Matthew S. Daniella AJC et al. ACR Manual On Contrast Media 2020 ACR Committee on Drugs and Contrast Media. 2020.

  28. 28.

    Blumfield E, Moore MM, Drake MK, Goodman TR, Lewis KN, Meyer LT, et al. Survey of gadolinium-based contrast agent utilization among the members of the Society for Pediatric Radiology: a Quality and Safety Committee report. Pediatr Radiol 2017;47:665–73. https://doi.org/10.1007/s00247-017-3807-z.

    Article  PubMed  Google Scholar 

  29. 29.

    Woolen SA, Shankar PR, Gagnier JJ, MacEachern MP, Singer L, Davenport MS. Risk of Nephrogenic Systemic Fibrosis in Patients with Stage 4 or 5 Chronic Kidney Disease Receiving a Group II Gadolinium-Based Contrast Agent: A Systematic Review and Meta-analysis. JAMA Intern Med 2020;180:223–30. https://doi.org/10.1001/jamainternmed.2019.5284.

    CAS  Article  Google Scholar 

  30. 30.

    Exhibit E, Ochoa Y, Pacheco A. Radiological and clinical findings of calyceal diverticula in children. Electron Poster Present Eur Soc Radiol ECR Conf Meet 2016:1–19. https://doi.org/10.1594/ecr2016/C-1982.

  31. 31.

    Abeshouse BS, Abeshouse GA. Calyceal Diverticulum: A Report of Sixteen Cases and Review of the Literature. Urol Int 1963;15:329–57. https://doi.org/10.1159/000279027.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    McGarry L, Sahadev R, Hogan G, Long C, Otero H, Srinivasan AK, et al. Calyceal diverticula in children: laparoscopic marsupialization is the optimal intervention. J Pediatr Urol 2020. https://doi.org/10.1016/j.jpurol.2020.01.014.

    Article  PubMed  Google Scholar 

  33. 33.

    Gross AJ, Herrmann TRW. Management of stones in calyceal diverticulum. Curr Opin Urol 2007;17:136–40. https://doi.org/10.1097/MOU.0b013e328011bcd3.

    Article  PubMed  Google Scholar 

  34. 34.

    Long CJ, Weiss DA, Kolon TF, Srinivasan AK, Shukla AR. Pediatric calyceal diverticulum treatment: An experience with endoscopic and laparoscopic approaches. J Pediatr Urol 2015;11:172.e1–172.e6. https://doi.org/10.1016/j.jpurol.2015.04.013.

    CAS  Article  Google Scholar 

  35. 35.

    Sahin H, Pekcevik Y, Alaygut DE. The utility of static fluid magnetic resonance urography in differentiation of renal parenchymal cyst and calyceal diverticulum in children. Esr 2017:1–13.

Download references

Funding

No financial grants were applied to this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hansel J. Otero.

Ethics declarations

Conflict of interest

Authors declare no conflict.

Ethical approval

This study was approved by our Institutional Review Board.

Informed consent

Informed consent waiver was obtained.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Calle-Toro, J.S., Back, S.J., Maya, C. et al. Identification and characterization of calyceal diverticula with MR urography (MRU) in children. Abdom Radiol (2020). https://doi.org/10.1007/s00261-020-02623-2

Download citation

Keywords

  • Calyceal diverticula
  • Diagnosis
  • Magnetic resonance urography (MRU)
  • Children