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MR Protocol ABDOMEN Kidneys Urography

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08-05-2020 01:27

Gayathri Sreedher

Name of Protocol: MR Protocol ABDOMEN Kidneys Urography

Date Created: 2020-01-15

Non-‐sedate cases NPO 4 hours prior to scan
Sedation/anesthesia-‐ usually < 7 years of age.
Hydration-‐ 20cc/kg bolus prior to imaging
Bladder Catheterization-‐ Foley catheter without balloon connected to a bag which is placed below the level of the table to facilitate bladder emptying
Procedural meds-¬‐ Lasix 1mg/kg (max 20 mg) given 15 min before IV gadolinium injection

Coverage-‐ from diaphragm to below the bladder, A-‐P coverage through the kidneys

Positioning: Prone (unless precluded by surgery or sedation issues)

Indication: Complex renal and urinary tract anatomy, urinary tract obstruction, pre operative planning and post operative assessment. Examples: Duplex systems, ectopic ureters, degree of narrowing, Crossing vessels causing UPJ, surgical anastomoses after UPJ obstruction repair and reimplantation of ectopic ureters.

Sequence Name	Vendor Specific name	Plane	Fat suppression	Motion compensation	Other relevant parameters including slice thickness	Additional info
1. T2Single Shot (2D)	T2 HASTE, SSFSE, sSH-TSE	Sagittal and axial	No	FB or BH based on patient age		Essential for planning oblique coronals
2. T2 (2D)	BLADE, PROPELLER, MultiVane	Axial (abdomen)	Yes	FB		Depicts scarring, dysplasia well
3. T2 (3D)	T2 SPACE/CUBE/VISTA	Coronal (isotropic)	Yes	RT or navigator		Can use to reconstruct in other planes
4. T1 (3D)	VIBE/THRIVE/LAVA	Coronal	Yes	FB	Fast Scan	Pre-contrast oblique to include kidneys, ureters and bladder
5. T1 (3D) post contrast	VIBE, LAVA, THRIVE	Coronal	Yes	FB	Repeated till contrast in ureters or for 8 min	Can be repeated, same oblique plane as pre- contrast
Optional Sequences
6. DWI axial b-value ( 2-3 b values)		Axial
7. T2 SSFSE	T2 HASTE, SSFSE, sSH-TSE	Coronal	No	FB or BH based on patient age
8. T2		Axial	Yes		High resolution imaging through pelvis	Concern for ectopic ureter
9. T1 (3D)	VIBE, LAVA, THRIVE	Coronal and Sagittal	Yes	FB		Concern for calyceal diverticulum
10. Coronal cinematic balanced SSFP	TruFISP/FIESTA/balanced FFE	Coronal	Yes	RT,BH		Concern for fibroepithelial polyp

BH =Breath-hold; FB = Free Breathing; RT = Respiratory Triggered; sSH = single-shot; T/FSE = Turbo/Fast Spin-echo

C) References:
Morin CE, McBee MP, Trout AT, Reddy PP, Dillman JR. Use of MR Urography in Pediatric Patients. Curr Urol Rep. 2018;19(11):93. Published 2018 Sep 11. doi:10.1007/s11934-018-0843-7
Elliot C. Dickerson , Jonathan R. Dillman, Ethan A. Smith, Michael A. DiPietro, Robert L. Lebowitz, Kassa Darge. Pediatric MR Urography: Indications, Techniques, and Approach to Review. RadioGraphics 2015; 35:1208–1230. https://doi.org/10.1148/rg.2015140223

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