Journal Reading

Choosing the Appropriate

Imaging Modality for
Pediatric
Urologic Disorders

Fahruni Dian Iramani
1110070100129

Perceptor : dr. Dessy Wimelda, Sp.Rad

Today various conventional:
 ULTRASOUND (US)
Ultrasound is almost universally the modality of choice
because
a.inexpensive,
b.immediate,
c.painless,
d.radiation free,
e.widely available
f.requires no sedation or anesthetic
g.important role in assessment of thickness and length of
bulbar urethral stricture.
 In children, due to less body fat and
relatively superficial location of kidneys and
bladder the urinary tract is easily visualized
by ultrasound.
Ultrasound allows for repeated followup
investigations that enable a close
monitoring of the course of any diseases.
 IMPORTANT TO KNOW

Multifrequency curveted and linear

array transducers
(18-2 MHz) are needed for scanning
pediatric patients
 The limitations :

a. operator dependent (high level of skill and knowledge is

needed)
b. Convesional sonografi poor in anatomical evaluation of
the urethra and the ureters and in detecting/excluding of
vesicoureteral reflux (VUR)

But its all can overcome with contrast-enhanced

voiding urosonography (ceVUS)
 MAGNETIC RESONANCE
IMAGING (MRI)
the second imaging option after
Ultrasound in children.
The provfit :
1.comprehensive morphologic and
functional information
2.no exposure to radiation
 The limitations :

need for sedation in infants and small

children
availability of MR scanners
cost are ancillary factors that restrict the
widespread use of MR in pediatric
uroradiology
 The primary indications:
congenital anomalies and renal and
bladder tumors.

Less frequent indications for MR imaging :

Infections and vascular anomalies of the
urinary tract
 COMPUTERIZED
TOMOGRAPHY (CT) SCANS
The provfit :

a. When following an US study, additional diagnostic

imaging for urolithiasis is needed.
b. In the case of severe poly trauma including blunt
abdominal trauma
c. higher diagnostic
d. CT is much more available and takes short duration
of examination
e. evaluation of bladder rupture
The limitations :
a.High radiation dose
b.Thus is less suitable
Plain radiography
 t..
u n
Co
Intravenous urography (IVU) or
Intravenous pyelography (IVP)
The indications for IVU can be:
Contraindications for IVU.
Voiding cystourethrography (VCUG) or
Micturating cystourethrography (MCUG)

gold standard
for detection of vesico-ureteric reflux (VUR) and
evaluation of urethra
 Retrograde urethrogram
(RUG) and Cystogram

indicated in the evaluation of urogenital trauma

However most cystograms in trauma patients
are now CT cystograms.
CATHETER DIRECTED
ANGIOGRAPHY
NUCLEAR MEDICINE
IMAGING
 Radionuclide cystography
(RNC):
Indications

Family Follow-up of
screening for
Follow-up of patients after
vesicoureteral known VUR anti-reflux
reflux surgery
 Renal cortical scanning
Indications :

a. Identify anomalies of the upper urinary

tract that affect renal function e.g.
multicystic dysplasia and pyelonephritic
scarring.

b. Diagnosis of acute pyelonephritis.

Diuretic Renography
 POSITRON EMITTED
TOMOGRAPHY (PET) SCAN
The provfit :
1.detect cancer and to examine the effects
of cancer therapy
2.Evaluation of retroperitoneal tumors and
renal tumors in the pediatric GU patient.
4 years old boy with bilateral grade V vesico-ureteric reflux
and evidence of chronic
cystitis
MR- T2WI: bilateral Pelvi ureteric junction
obstruction with normal ureters and
bladder.
CT Angiography, Coronal 3D VRT image: Right
renal artery short-segment highgrade
stenosis
Sagittal harmonic US image of
bladder and megaureter
Patient with renal colic. abdominal plain film (KUB)
demonstrates a small calculus
in the coarse of left ureter
VCUG: A neonate with posterior urethral valve.
Huge diverticulum of the urachus
is visible on this lateral view (arrow)
 Conclusion
Ultrasound is universally the modality of choice in pediatric
uroradiology. It is inexpensive, immediate, painless, radiation
free, widely available and requires no sedation.
Magnetic resonance imaging is the second imaging option
after Ultrasound in children. It is radiation free modality and
provides both morphologic and functional information.
Computerized tomography it is less suitable for routine
imaging in pediatrics due to its high radiation dose but it is the
modality of choice in the context of blunt abdominal trauma
and inadequate ultrasound result for urolithiasis.
Plain radiography is used to visualize any radio-opaque
objects in the urinary tract and to evaluate the position of
stents or drains.
 Voiding cysto-urethrography provides anatomic and
functional information about the urinary bladder and the
urethra and is the gold standard for detection of vesico-
ureteric reflux.
Usage of Intravenous Urography is now in universal
decline but can still be used as an alternative in the
absence of cross sectional imaging facility.
Catheter directed angiography has very limited application
in pediatric uroradiology due to the invasive nature and is
largely replaced by MR Angiography and CT Angiography.
 Retrograde urethrography and cystogram are essential
for evaluation of urethral abnormalities and are
replaced by CT cystography in the context of trauma.
Nuclear medicine imaging offers functional information
about urinary tract.
Positron emitted tomography permits the study of
organ function by detecting alterations in biochemical
processes that suggest disease before changes in
anatomy are apparent therefor important in early
detection of cancer and evaluation of effects of cancer
therapy.
Appropriate imaging modalities
for specific conditions.
 References
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