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ORIGINAL RESEARCH article
Front. Radiol.
Sec. Emergency Radiology
Volume 4 - 2024 |
doi: 10.3389/fradi.2024.1452902
Diffusion-weighted MRI in the Identification of Renal Parenchymal Involvement in Children with a First Episode of Febrile Urinary Tract Infection
Provisionally accepted- 1 Department of Radiology, Giannina Gaslini Institute (IRCCS), Genoa, Italy
- 2 Infectious Disease Unit, Giannina Gaslini Institute (IRCCS), Genoa, Italy
- 3 Department of Nephrology and Kidney Transplantation, Giannina Gaslini Institute (IRCCS), Genoa, Italy
- 4 Department of Emergency Pediatrics and First Aid, Giannina Gaslini Institute (IRCCS), Genoa, Italy
- 5 Department of Anesthesiology and Acute and Procedural Pain Therapy, Giannina Gaslini Institute (IRCCS), Genoa, Italy
- 6 Other, Parma, Italy
- 7 Department of Health Sciences, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
This study aims to assess the diagnostic accuracy of diffusion-weighted Magnetic Resonance Imaging (DW-MRI) and determine the inter-reader agreement between two expert radiologists in detecting pyelonephritic foci during the initial episode of febrile urinary tract infection (fUTI) in children aged 0 to 5 years. Also, we aim to establish the correlation between clinical data and DW-MRI findings.Children aged 0 to 5 years presenting with their first episode of fUTI were included in the study and underwent DW-MRI and Ultrasound (US) examinations within 72 hours of admission. Inter-observer agreement between the two expert radiologists in assessing DW-MRI scans was evaluated using Cohen's kappa statistic. Clinical and laboratory data were subjected to statistical analysis.84 children (40 male, 44 female) with a mean age of 7.3 (SD 6.2) months were enrolled. DW-MRI detected pyelonephritis in 78 out of 84 cases (92.9%), with multiple foci observed in 73 out of 78 cases (93.6%). There was a "substantial" level of agreement between the two expert radiologists (κ = 0.725; observed agreement 95.2%).Renal US revealed pyelonephritis in 36 out of 78 cases (46.2%). White blood cell (WBC) count (p = 0.04) and lymphocyte count (p = 0.01) were significantly higher in patients with positive DW-MRI. Although not statistically significant, patients with positive DW-MRI had higher mean values of C-Reactive Protein, Procalcitonin, and neutrophil WBC count (7.72 mg/dL, 4.25 ng/dL, and 9271/μL, respectively).DW-MRI exhibited excellent diagnostic performance in detecting pyelonephritic foci, with substantial inter-reader agreement among expert radiologists, indicating the reliability of the technique. However, a weak correlation was observed between laboratory parameters and DW-MRI results, potentially because of the low rate of negative DW-MRI findings.
Keywords: UTI - Urinary tract infection, Pyelonephritis, pediatric, DWI (diffusion weighted imaging), MRI
Received: 21 Jun 2024; Accepted: 31 Oct 2024.
Copyright: © 2024 Anfigeno*, La Valle, Castagnola, Verrina, PIAGGIO, Degl'Innocenti, Piccotti, Wolfler, Lembo, Bodria, Formigoni, Boetto, Santini and Damasio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lorenzo Anfigeno*, Department of Radiology, Giannina Gaslini Institute (IRCCS), Genoa, 16147, Italy
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