Imaging of the Urinary Tract in Children

  • Jeanne S. Chow
  • J. Damien Grattan-Smith


The principle that guides imaging of the pediatric genitourinary tract is the same that guides imaging elsewhere in the body of the child: judicious use of imaging while minimizing ionizing radiation exposure [1] and unnecessary sedation. Ultrasound (US) is the main imaging modality of the genitourinary tract, providing excellent images of the kidneys and bladder. An abnormally dilated ureter is also easily imaged, especially at the levels of the kidney and bladder. Doppler provides additional information regarding vascular flow and is especially helpful in evaluating the main renal artery and veins as well as the arcuate vessels. US contrast agents are used to further evaluate vascular flow of the kidneys, intrarenal masses, and vesicoureteral reflux (VUR) [2]. The main downside of US is that it provides little functional imaging, instead mainly revealing the physical appearance of the urinary tract (UT).


Autosomal Recessive Polycystic Kidney Disease Clear Cell Sarcoma Congenital Nephrotic Syndrome Ureteropelvic Junction Obstruction Magnetic Resonance Urography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296.PubMedCrossRefGoogle Scholar
  2. 2.
    Ripolles T, Puig J (2009) Update on the use of contrast agents in ultrasonography: a review of the clinical guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). Radiologia 51:362–375.PubMedCrossRefGoogle Scholar
  3. 3.
    Grattan-Smith JD, Jones RA (2008) MR urography: technique and results for the evaluation of urinary obstruction in the pediatric population. Magn Reson Imaging Clin N Am 16:643–660, viii–ix.PubMedCrossRefGoogle Scholar
  4. 4.
    Thomsen HS (2007) ESUR guideline: gadolinium-based contrast media and nephrogenic systemic fibrosis. Eur Radiol 17:2692–2696.PubMedCrossRefGoogle Scholar
  5. 5.
    Passerotti C, Chow JS, Silva A et al (2009) Ultrasound versus computerized tomography for evaluating urolithiasis. J Urol 182:1829–1834.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    Riccabona M, Avni FE, Blickman JG et al (2009) Imaging recommendations in paediatric uroradiology. Minutes of the ESPR uroradiology task force session on childhood obstructive uropathy, high-grade fetal hydronephrosis, childhood haematuria, and urolithiasis in childhood. ESPR Annual Congress, Edinburgh, UK, June 2008. Pediatr Radiol 39:891–898.PubMedCrossRefGoogle Scholar
  8. 8.
    de Bruyn R, Marks SD (2008) Postnatal investigation of fetal renal disease. Semin Fetal Neonatal Med 13:133–141.PubMedCrossRefGoogle Scholar
  9. 9.
    Lee RS, Cendron M, Kinnamon DD et al (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118:586–593.PubMedCrossRefGoogle Scholar
  10. 10.
    Hildebrandt F, Benzing T, Katsanis N (2011) Ciliopathies. N Engl J Med 364:1533–1543.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Carrico C, Lebowitz RL (1998) Incontinence due to an infrasphincteric ectopic ureter: why the delay in diagnosis and what the radiologist can do about it. Pediatr Radiol 28:942–949.PubMedCrossRefGoogle Scholar
  12. 12.
    Gill RD (1952) Triplication of the ureter and renal pelvis. J Urol 68:140–147.PubMedGoogle Scholar
  13. 13.
    Wyly JB, Lebowitz RL (1984) Refluxing urethral ectopic ureters: recognition by the cyclic voiding cystourethrogram. AJR Am J Roentgenol 142:1263–1267.PubMedCrossRefGoogle Scholar
  14. 14.
    Prewitt LH, Jr., Lebowitz RL (1976) The single ectopic ureter. AJR Am J Roentgenol 127:941–948.PubMedCrossRefGoogle Scholar
  15. 15.
    Rooks VJ, Lebowitz RL (2001) Extrinsic ureteropelvic junction obstruction from a crossing renal vessel: demography and imaging. Pediatr Radiol 31:120–124.PubMedCrossRefGoogle Scholar
  16. 16.
    Shukla AR, Cooper J, Patel RP et al (2005) Prenatally detected primary megaureter: a role for extended followup. J Urol 173:1353–1356.PubMedCrossRefGoogle Scholar
  17. 17.
    Chaudry G, Perez-Atayde AR, Ngan BY et al (2009) Imaging of congenital mesoblastic nephroma with pathological correlation. Pediatr Radiol 39:1080–1086.PubMedCrossRefGoogle Scholar
  18. 18.
    Ko SM, Kim MJ, Im YJ et al (2013) Cellular mesoblastic nephroma with liver metastasis in a neonate: prenatal and postnatal diffusion-weighted MR imaging. Korean J Radiol 14:361–365.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Eftekhari F, Erly WK, Jaffe N (1990) Malignant rhabdoid tumor of the kidney: imaging features in two cases. Pediatr Radiol 21:39–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Boggs LK, Kimmelstiel P (1956) Benign multilocular cystic nephroma: report of two cases of so-called multilocular cyst of the kidney. J Urol 76:530–541.PubMedGoogle Scholar
  21. 21.
    Estrada CR, Suthar AM, Eaton SH et al (2005) Renal cell carcinoma: Children’s Hospital Boston experience. Urology 66:1296–1300.PubMedCrossRefGoogle Scholar
  22. 22.
    Wedekin M, Ehrich JH, Offner G et al (2008) Aetiology and outcome of acute and chronic renal failure in infants. Nephrol Dial Transplant 23:1575–1580.PubMedCrossRefGoogle Scholar
  23. 23.
    Ardissino G, Dacco V, Testa S et al (2003) Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics 111:e382–387.PubMedCrossRefGoogle Scholar
  24. 24.
    Mercado-Deane MG, Beeson JE, John SD (2002) US of renal insufficiency in neonates. Radiographics 22:1429–1438.PubMedCrossRefGoogle Scholar
  25. 25.
    Lim R (2009) Vesicoureteral reflux and urinary tract infection: evolving practices and current controversies in pediatric imaging. AJR Am J Roentgenol 192:1197–1208.PubMedCrossRefGoogle Scholar
  26. 26.
    Lee MD, Lin CC, Huang FY et al (2009) Screening young children with a first febrile urinary tract infection for high-grade vesicoureteral reflux with renal ultrasound scanning and technetium-99m-labeled dimercaptosuccinic acid scanning. J Pediatr 154:797–802.PubMedCrossRefGoogle Scholar
  27. 27.
    Ajdinovic B, Jaukovic L, Krstic Z et al (2008) Impact of micturating cystourethrography and DMSA renal scintigraphy on the investigation scheme in children with urinary tract infection. Ann Nucl Med 22:661–665.PubMedCrossRefGoogle Scholar
  28. 28.
    Hoppe B, Kemper MJ (2010) Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr Nephrol 25:403–413.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Jeanne S. Chow
    • 1
  • J. Damien Grattan-Smith
    • 2
  1. 1.Departments of Urology and RadiologyBoston Children’s HospitalBostonUSA
  2. 2.Department of RadiologyChildren’s Healthcare of Atlanta at Scottish RiteAtlantaUSA

Personalised recommendations