24 Outcome of updated static/dynamic MRU protocols in the diagnosis of PUJ and ectopic ureter
Andrew Ross, Simona Rusu, Katherine Burnand, Marie-Klaire Farrugia, Nisha Rahman, Kathryn Wessely, Diane De Caluwe
Chelsea and Westminster Hospital, London, United Kingdom

Abstract

Aim of the Study
MRU is a modality that provides detailed anatomical and functional information when investigating urological disease. Following evaluation of exisiting Magnetic Resonance Urography (MRU) protocols in our institution, we introduced modified protocols intended to enhance our detection of these anomalies in equivicol diagnostic scenarios and evaluated the impact on the rate of definitive diagnosis of these conditions.  

Methods
Data were collected retrospectively on all infants and children undergoing MRU at a single institution over an eight year period (2010-2018).  MRU performed for non-urological purposes were excluded. Demographic and clinical data were recorded. Data from Phase 1, (pre-existing protocols) and Phase 2, (updated static / dynamic protocols) were compared.

Main Results
Fifty-eight patients (32 male, 26 female) underwent MRU during this period. Median age at MRU was 5.3 years (range 8m – 10 years).

Investigation of suspected pelvi-ureteric junction obstruction (PUJO) was the commonest indication for MRU (33 studies 56%).

During Phase 1 (2010-2014) 10 studies were performed for possible PUJO, 8 were definitive in confirming or excluding diagnosis (80%). During Phase 2 (2014-2018) 23 studies were performed to investigate PUJO, 22 were definitive (96%). For confirmation of ectopic ureter insertion definitive clinical answers were obtained in 66% (2/3) of studies during phase 1 and 83% (4/5) in phase 2. Overall definitive diagnosis was achieved in 67% of cases (18/27) during phase 1 and in 93.8% (30/32) in phase 2.

Conclusion
MRU has been previously shown to be beneficial in diagnosing complex urological pathology. The introduction of modified protocols increased the rate of definitive diagnosis in this institution. This was particularly evident when assessing for PUJO and ectopic ureter insertion where the new protocols enhanced assessment of drainage and structure.  We would encourage other institutions to consider this process in order to assist the diagnosis of aberrant functional anatomy.


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