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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
Lorenzo Anfigeno* Lorenzo Anfigeno* 1*Alberto La Valle Alberto La Valle 2Elio Castagnola Elio Castagnola 2Enrico E. Verrina Enrico E. Verrina 3GIORGIO PIAGGIO GIORGIO PIAGGIO 3Maria Ludovica Degl'Innocenti Maria Ludovica Degl'Innocenti 3Emanuela Piccotti Emanuela Piccotti 4Andrea Wolfler Andrea Wolfler 5Francesca M. Lembo Francesca M. Lembo 5Monica Bodria Monica Bodria 6Clelia Formigoni Clelia Formigoni 7Alice Boetto Alice Boetto 7Lucia Santini Lucia Santini 7Maria Beatrice Damasio Maria Beatrice Damasio 1
  • 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

The final, formatted version of the article will be published soon.

    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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