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Background <p>Measuring differential renal function (DRF) is critical for managing children with congenital and acquired urological diseases. MAG-3 renal scintigraphy is the most widely used clinical technique; dynamic contrast-enhanced MRI (DCE-MRI) provides a radiation-free and high-resolution&#xa0;alternative&#xa0;method&#xa0;for&#xa0;assessing&#xa0;DRF.</p> Objective <p>To evaluate the agreement between DRF values derived from DCE-MRI and MAG-3 scintigraphy-derived&#xa0;DRF&#xa0;in&#xa0;pediatric&#xa0;patients.</p> Materials and methods <p>This retrospective study included 23 pediatric patients (age range, 3&#xa0;months-20&#xa0;years; mean±SD, 8.3±7.4&#xa0;years) who underwent DCE-MRI embedded in MR urography (MRU) protocol and MAG-3 studies within 6&#xa0;months. DCE-MRI was performed using a golden-angle radial dynamic stack-of-stars acquisition with golden-angle sparse parallel (GRASP) reconstruction, and analyzed the renal filtration rate with a two-compartment tracer kinetic model. DRF values from DCE-MRI were compared with those from MAG-3, using both default (<i>n</i>=23) and C-shaped background regions for MAG-3 analysis, where raw data were available (<i>n</i>=16). Agreement was evaluated using Bland–Altman analysis, Pearson and concordance correlations,&#xa0;and&#xa0;paired&#xa0;statistical&#xa0;tests.</p> Results <p>With default MAG-3 background analysis (<i>n</i>=23), mean DRF difference (MAG-3 minus DCE-MRI) was 0.4% (95% CI, -3.3% to 4.2%), with 95% limits of agreement of -16.7% to +17.5%. Concordance correlation coefficient (CCC) was 0.870 (95% CI, 0.718–0.942). Within the pre-defined clinically acceptable margin of ±10%, 78.3% (18/23) of cases fell, with a mean absolute difference of 6.1%. With C-shaped background subtraction in the subset with available raw MAG-3 data (<i>n</i>=16), mean difference was -2.3% (95% CI, -6.7% to 2.0%), limits of agreement -18.3% to +13.6%, and CCC 0.845 (95% CI, 0.614–0.943). Pearson correlation was strong in both analyses (<i>n</i>=23: <i>r</i>=0.872, 95% CI, 0.719–0.945; <i>n</i>=16: <i>r</i>=0.866, 95% CI, 0.648–0.953; both <i>P</i>&lt;0.001). No clinically significant systematic or proportional bias was detected in either analysis.</p> Conclusion <p>DCE-MRI demonstrates strong linear association and concordance with MAG-3 scintigraphy for pediatric differential renal function assessment with no clinically significant systematic bias, though the observed measurement variability indicates caution is warranted when comparing values near surgical decision thresholds. C-shaped background correction is recommended for MAG-3 in hydronephrotic kidneys to optimize inter-modality agreement.</p> Graphical Abstract <p></p>

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Comparison of dynamic contrast-enhanced MRI versus MAG-3 scintigraphy for differential renal function assessment in pediatric patients

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Cemre Ariyurek,
  • Liam Timms,
  • Xinhua Cao,
  • Karen Sarao,
  • Onur Afacan,
  • Neha Kwatra,
  • Jeanne S. Chow,
  • Sila Kurugol

摘要

Background

Measuring differential renal function (DRF) is critical for managing children with congenital and acquired urological diseases. MAG-3 renal scintigraphy is the most widely used clinical technique; dynamic contrast-enhanced MRI (DCE-MRI) provides a radiation-free and high-resolution alternative method for assessing DRF.

Objective

To evaluate the agreement between DRF values derived from DCE-MRI and MAG-3 scintigraphy-derived DRF in pediatric patients.

Materials and methods

This retrospective study included 23 pediatric patients (age range, 3 months-20 years; mean±SD, 8.3±7.4 years) who underwent DCE-MRI embedded in MR urography (MRU) protocol and MAG-3 studies within 6 months. DCE-MRI was performed using a golden-angle radial dynamic stack-of-stars acquisition with golden-angle sparse parallel (GRASP) reconstruction, and analyzed the renal filtration rate with a two-compartment tracer kinetic model. DRF values from DCE-MRI were compared with those from MAG-3, using both default (n=23) and C-shaped background regions for MAG-3 analysis, where raw data were available (n=16). Agreement was evaluated using Bland–Altman analysis, Pearson and concordance correlations, and paired statistical tests.

Results

With default MAG-3 background analysis (n=23), mean DRF difference (MAG-3 minus DCE-MRI) was 0.4% (95% CI, -3.3% to 4.2%), with 95% limits of agreement of -16.7% to +17.5%. Concordance correlation coefficient (CCC) was 0.870 (95% CI, 0.718–0.942). Within the pre-defined clinically acceptable margin of ±10%, 78.3% (18/23) of cases fell, with a mean absolute difference of 6.1%. With C-shaped background subtraction in the subset with available raw MAG-3 data (n=16), mean difference was -2.3% (95% CI, -6.7% to 2.0%), limits of agreement -18.3% to +13.6%, and CCC 0.845 (95% CI, 0.614–0.943). Pearson correlation was strong in both analyses (n=23: r=0.872, 95% CI, 0.719–0.945; n=16: r=0.866, 95% CI, 0.648–0.953; both P<0.001). No clinically significant systematic or proportional bias was detected in either analysis.

Conclusion

DCE-MRI demonstrates strong linear association and concordance with MAG-3 scintigraphy for pediatric differential renal function assessment with no clinically significant systematic bias, though the observed measurement variability indicates caution is warranted when comparing values near surgical decision thresholds. C-shaped background correction is recommended for MAG-3 in hydronephrotic kidneys to optimize inter-modality agreement.

Graphical Abstract