Skip to main content

Table 1 Different clinical scenarios and imaging guideline

From: Imaging of urinary tract in children in different clinical scenarios: a guide for general radiologists

Clinical scenarios Imaging guideline
Perinatal urinary tract dilatation Ultrasound
After sonographic detection of UTD, MCUG may be required for detection of VUR or PUV
If reflux is found, Tc-99m-DMSA scintigraphy is the investigation of choice for functional
If VUR is not encountered, so obstruction is the probable cause of UTD for dynamic renal scintigraphy
MRI also can be requested especially in complex renal anomalies (robust anatomical and functional capabilities)
Recurrent urinary tract infection Ultrasound in infants below two years or present with atypical or recurrent UTI
MCUG in all children with abnormal ultrasound or atypical or recurrent UTI
MCUG, and if positive, DMSA scintigraphy; Or DMSA scintigraphy and if positive MCUG
Enuresis and daytime urinary incontinence Screening ultrasound (pre-void and post-void scan)
MRI of the spine is reserved for children with suspected abnormalities of the lumbosacral spine
MR urography can be of value in detection of structural anomalies particularly ectopic ureter
IVP may be of value if the access to MRI is limited
Abdominal masses Following ultrasound, cross-sectional imaging with CT or MRI is mandatory for further evaluation and initial staging
CT enables simultaneous evaluation of both lungs
MRI is more sensitive in detecting contralateral synchronous masses
Flank pain Ultrasound and radiography
Low-dose non-contrast CT should be reserved when ultrasound is non-diagnostic or further anatomical details are needed for surgical intervention
Hematuria Ultrasound
Subsequent imaging depends on the initial ultrasound findings
Trauma Ultrasound is the first modality for trauma surveillance especially in patients with minimal symptoms
Four-phase post-contrast CT of the urinary tract (Pre- and post-contrast phases in arterial, nephrographic and pyelographic phases)
Nonpalpable testis, ambiguous genitalia and common urogenital sinus anomalies General guidelines recommend against preoperative imaging of nonpalpable testis
Ultrasound and or MRI in cases of ambiguous genitalia
Genitogram represents the main preoperative radiological assessment in urogenital sinus anomalies, some centres may add pelvic MRI
Renovascular hypertension Ultrasound with Doppler is the initial imaging modality
CT or MR angiography are the recommended further imaging modalities
Catheter angiography after failure of medical therapy for hypertension or when ultrasound reveals size discrepancy between both kidneys, or in children with neurofibromatosis