ArticlePediatric radiology2026
Comparison of dynamic contrast-enhanced MRI versus MAG-3 scintigraphy for differential renal function assessment in pediatric patients.
Article in Pediatric radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMeasuring 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.
objectiveTo evaluate the agreement between DRF values derived from DCE-MRI and MAG-3 scintigraphy-derived DRF in pediatric patients. MATERIALS AND
methodsThis 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.
resultsWith 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.
conclusionDCE-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.
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