Magnetic resonance imaging diagnosis of renal infection in children

Huihui Lin, Xu Li, Xiaoyun Wang, Jun‐tao Hu, Chang Wang, Weimin Fei, Kaixuan Wang, Gengwu Li
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Abstract

OBJECTIVE: To analyze the magnetic resonance imaging (MRI) manifestations of renal infection in children, evaluate the reliability of diffusion-weighted imaging (DWI) in detecting renal infections, and the difference in apparent diffusion coefficient (ADC) values between acute renal pelvis nephritis (APN), acute focal bacterial nephritis (AFBN) and renal abscess (RA). METHODS: Data for 513 children with a clinical orpathological diagnosis of acute kidney infection. Both MRI and voiding cystourethrography were performed in 28 cases. Group A comprised 17 cases of retrograde infection; Group B comprised 11 cases of blood–borne infection. The Kappa test was used to analyze differences in lesion DWI distribution between the groups, and the t-test was used to compare the ADC values. RESULTS: The MRI manifestations of pediatric renal infection were characteristic. The lesions had high-signal intensity on DWI and were located mainly in the renal cortex blood–borne infections versus the renal cortex and medulla in retrograde infections. The sensitivity and specificity of DWI for detecting lesions were 100% and 96%. The average ADC values of APN, AFBN, and RA lesions were lower than that of normal kidney tissue, with statistically significant differences between the three conditions; the ADC value of RA was the lowest, and that of APN was the highest. CONCLUSION: There were differences in the lesion distributions between renal retrograde and blood–borne infections. The quantitative decrease in ADC value may be related to the duration of the disease and the degree of renal damage.
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儿童肾脏感染的磁共振成像诊断
目的:分析儿童肾脏感染的磁共振成像(MRI)表现,评价弥散加权成像(DWI)检测肾脏感染的可靠性,以及急性肾盂肾炎(APN)、急性局灶性细菌性肾炎(AFBN)和肾脓肿(RA)的表观弥散系数(ADC)值差异。方法:513例临床或病理诊断为急性肾脏感染的儿童的资料。28例均行MRI和排尿膀胱尿道造影检查。A组逆行感染17例;B组血源性感染11例。采用Kappa检验分析两组间病变DWI分布差异,采用t检验比较ADC值。结果:小儿肾脏感染的MRI表现具有特征性。DWI显示病变高信号强度,主要位于肾皮质血源性感染,而逆行性感染则位于肾皮质和髓质。DWI检测病变的敏感性为100%,特异性为96%。APN、AFBN、RA病变的平均ADC值均低于正常肾组织,三者间差异有统计学意义;RA的ADC值最低,APN的ADC值最高。结论:肾逆行性感染与血源性感染在病变分布上存在差异。ADC值的定量下降可能与病程和肾脏损害程度有关。
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