Journal of Pediatric Urology
Volume 5, Issue 2 , Pages 114-118, April 2009

Appearance of Deflux® implants with magnetic resonance imaging after endoscopic treatment of vesicoureteral reflux in children

  • Wolfgang H. Cerwinka

      Affiliations

    • Pediatric Urology at Children's Healthcare of Atlanta, Atlanta, GA, USA
    • Corresponding Author InformationCorrespondence at: Georgia Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, 5445 Meridian Mark Road, Suite 420, Atlanta, GA 30342, USA. Tel.: +1 (404) 252 5206; fax: +1 (404) 252 1268.
    • ,
  • J. Damien Grattan-Smith

      Affiliations

    • Pediatric Radiology at Children's Healthcare of Atlanta, Atlanta, GA, USA
    • ,
  • Hal C. Scherz

      Affiliations

    • Pediatric Urology at Children's Healthcare of Atlanta, Atlanta, GA, USA
    • ,
  • Andrew J. Kirsch

      Affiliations

    • Pediatric Urology at Children's Healthcare of Atlanta, Atlanta, GA, USA

Received 27 August 2008; accepted 7 October 2008. published online 19 November 2008.

Abstract 

Objective

With the increasing popularity of endoscopic treatment for vesicoureteral reflux (VUR) in children, dextranomer/hyaluronic acid copolymer (Deflux®) implants are more frequently detected by magnetic resonance imaging (MRI). Such findings on MRI may be misinterpreted and lead to unnecessary intervention. The objective of this study was to characterize the appearance of Deflux® implants on MRI.

Materials and methods

Between July 2001 and November 2007, hospital charts of patients with a history of Deflux® injection for VUR were evaluated to identify those who had subsequent MRI studies. The indications were determined, and the appearance of Deflux® implants analyzed and compared to findings on ultrasound, voiding cystourethrography and kidney ureter bladder radiography.

Results

Of 893 patients who underwent endoscopic treatment for VUR, subsequently 16 patients (1.8%) had MRI scans. Twenty-seven Deflux® implants were identified on MRI as bright structures on T2-weighted sequences only. Neither T1-weighted images nor excretory MR urography visualized the Deflux® implants, which did not enhance with gadolinium. Deflux® was not detected by kidney ureter bladder radiography; however, voiding cystourethrography and more reliably ultrasound could identify implants.

Conclusions

Deflux® implants appear on MRI as bright structures on T2-weighted sequences. History of VUR/VUR treatment and the presence of a single urinary system should provide reassurance and prevent inappropriate intervention for misdiagnosed ureteroceles.

Keywords: Vesicoureteral reflux, Endoscopic injection, Magnetic resonance imaging

Abbreviations: VUR, vesicoureteral reflux, MRI, magnetic resonance imaging, UVJ, ureterovesical junction, STING, subureteric Teflon injection, HIT, hydrodistention implantion technique, MRU, magnetic resonance urography, HD, hydrodistention, US, ultrasound, VCUG, voiding cystourethrography, KUB, kidney ureter bladder radiography, CT, computed tomography

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PII: S1477-5131(08)00398-7

doi:10.1016/j.jpurol.2008.10.005

Journal of Pediatric Urology
Volume 5, Issue 2 , Pages 114-118, April 2009

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