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Aktuelle Urol 2002; 33(5): 341-350
DOI: 10.1055/s-2002-33606
Klinische Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Kombinierte statisch-dynamische MR-Urographie zur morphologisch-funktionellen Diagnostik angeborener Harntransportstörungen

Combined Static-Dynamic MR Urography for Simultaneous Morphological and Functional Diagnosis of Congenital Urinary Tract ObstructionW.  K.  Rohrschneider1 , S.  Haufe2 , K.  Möhring3 , M.  Wiesel3 , B.  Tönshoff4 , J.  H.  Clorius5 , J.  Tröger1
  • 1Abteilung für Pädiatrische Radiologie, Radiologische Klinik, Universität Heidelberg
  • 2Abteilung für Nuklearmedizin, Radiologische Klinik, Universität Heidelberg
  • 3Abteilung für Pädiatrische Urologie, Urologische Klinik, Universität Heidelberg
  • 4Abteilung für Pädiatrische Nephrologie, Universitäts-Kinderklinik Heidelberg
  • 5Abteilung für Nuklearmedizin, Deutsches Krebsforschungszentrum Heidelberg
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Publication History

Publication Date:
25 September 2002 (online)

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Zusammenfassung

Einleitung: In dieser Arbeit beschreiben wir eine neuartige Technik - die kombinierte statisch-dynamische MR-Urographie (MRU) - die eine komplexe morphologisch-funktionelle Diagnostik angeborener Harntransportstörungen erlaubt. Material und Methode: Bislang wurden insgesamt 117 pädiatrische Patienten im Alter von 4 Tagen bis 17 Jahren (Median 12 Monate) mit 148 pathologischen und 84 normalen Nieren-Ureter-Einheiten untersucht. Eine stark T2-gewichtete IR-TSE-Sequenz liefert die dreidimensionale morphologische Darstellung der Harnwege, eine dynamische T1-gewichtete FFE-Sequenz dient der Bestimmung von seitengetrennter Nierenfunktion und Harnabfluss. Ergebnisse: Die Bildqualität wurde in 97 % als exzellent oder gut beurteilt und wurde nicht beeinträchtigt durch eine reduzierte Nierenfunktion. In insgesamt 80 % gelang die vollständige Darstellung des Harntraktes, sonst wurde meist lediglich der poststenotische Ureterabschnitt nicht abgebildet. Zwischen MRU und Szintigraphie ergab sich eine hochsignifikante Korrelation bezüglich der seitengetrennten Nierenfunktion und eine starke Übereinstimmung bezüglich des Harnabflusses. Bei Doppelnieren und dystopen Nieren war die MRU der Szintigraphie deutlich überlegen. Schlussfolgerung: Die wesentlichen Vorteile der statisch-dynamischen MR-Urographie zur Diagnostik angeborener Harntransportstörungen liegen in der fehlenden Strahlenbelastung sowie der simultanen funktionell-morphologischen Diagnostik. Besondere Vorteile bietet die Methode zur Abklärung von Doppelnieren und dystopen Nieren.

Abstract

Introduction: We describe a novel technique - combined static-dynamic MR urography (MRU) - which allows comprehensive morphological and functional diagnostic work-up of congenital urinary tract obstruction. Materials and Methods: Up to now, 117 pediatric patients ranging in age from 4 days up to 17 years (median 12 months) with 148 pathological and 84 normal kidney-ureter-units were examined. A heavily T2-weighted IR-TSE-sequence provides three-dimensional morphologic depiction of the urinary tract; a dynamic, T1-weighted FFE-sequence is used for the determination of split renal function and urinary excretion. Results: The image quality was judged excellent or good in 97 % and was not compromised by reduced kidney function. The entire urinary tract was depicted in 80 %, while, in the remaining, only the poststenotic ureter was generally lacking. MRU and scintigraphy showed a highly significant correlation regarding split renal function, and a strong agreement regarding urinary excretion. In kidneys and dystopic kidneys, MRU was clearly superior to scintigraphy. Conclusions: The essential advantages of static-dynamic MRU for the diagnosis of congenital urinary tract obstruction are the lack of radiation exposure and simultaneous functional-morphologic diagnosis. The method offers particular advantages in the evaluation of duplex and dystopic kidneys.

Schlüsselwörter

Harntrakt - Harnleiterobstruktion - Hydronephrose - Urodynamik - Magnetresonanztomographie - Urographie - Szintigraphie

Key words

urinary tract - ureteral obstruction - hydronephrosis - urodynamics - magnetic resonance imaging - urography - radioisotope renography

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W. K. Rohrschneider

Abteilung für Pädiatrische Radiologie, Radiologische Klinik, Universität Heidelberg

Im Neuenheimer Feld 153

69120 Heidelberg

Phone: +49-6221/56 2329

Fax: +49-6221/56 2998

Email: wiltrud_rohrschneider@med.uni-heidelberg.de

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