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Potential Impact of Pediatric MR Urography on the Imaging Algorithm in Patients with a Functional Single Kidney

Michael Riccabona1, Andrea Ruppert-Kohlmayr1, Ekkehard Ring2, Cornelia Maier1, Lukas Lusuardi3 and Marcus Riccabona3

1 Department of Radiology, Division of Pediatric Radiology, LKH-University Hospital, Auenbruggerplatz, Graz A-8036, Austria.
2 Department of Pediatrics, University Hospital Graz, Graz, Austria.
3 Department of Pediatric Urology, Barmherzige Schwestern, Linz, Austria.



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  		Fig. 1A. —Sonography and MR urography of 9.5-month-old boy show cystic dysplasia of seminal vesicle. Sonogram of lower abdomen in patient with functional single kidney depicts complex liquid structure (between cursors) behind urinary bladder in region of right seminal vesicle, without visible connection to bladder or ureter.

 


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  		Fig. 1B. —Sonography and MR urography of 9.5-month-old boy show cystic dysplasia of seminal vesicle. Coronal T2-weighted MR image shows hypertrophic single kidney and confirms cystic dysplasia of seminal vesicle (arrow), with fluid signal different from urine.

 


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  		Fig. 2A. —Sonography and MR urography of renal bud of 2-month-old boy. Longitudinal sonogram through liver depicts small, dysplastic, but orthotopically positioned renal bud (between cursors) with some liquid areas resembling residual collecting system.

 


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  		Fig. 2B. —Sonography and MR urography of renal bud of 2-month-old boy. Corresponding T2-weighted coronal MR urogram (true fast imaging with steady-state free precession) shows liquid areas (arrows) within longitudinal parenchymal structure in right renal bed indicating residual renal bud, with contralateral hypertrophic kidney that exhibits dilated collecting system.

 


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  		Fig. 3A. —Sonography and MR urography of renal bud with residual function in 5.5-month-old boy. Longitudinal sonogram of left upper quadrant depicts renal bud (between cursors).

 


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  		Fig. 3B. —Sonography and MR urography of renal bud with residual function in 5.5-month-old boy. Corresponding axial sonogram of urinary bladder shows ureterocele (arrows) at ostium of left-sided megaureter and normal ostial ureteral jet on right side.

 


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  		Fig. 3C. —Sonography and MR urography of renal bud with residual function in 5.5-month-old boy. Initial T2-weighted coronal MR urogram (true fast imaging with steady-state free precession) depicts megaureter leading to left-sided kidney region.

 


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  		Fig. 3D. —Sonography and MR urography of renal bud with residual function in 5.5-month-old boy. Delayed contrast-enhanced coronal T1-weighted 3D gradient-refocused echo MR urogram shows contrast filling indicating residual function of left-sided renal bud or vesicoureteral reflux.

 


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  		Fig. 3E. —Sonography and MR urography of renal bud with residual function in 5.5-month-old boy. Corresponding contrast-enhanced axial T1-weighted MR image shows residual diffusely enhancing renal tissue (arrows) on left side thus proving residual function, with hypertrophy of contralateral right kidney.

 

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