Adherence to standardized reporting models is not well adopted according to a recent survey of pediatric radiologists [13,14], In order to increase standardization of reporting and care, a consensus group from many separate organizations recommended adoption of the urinary tract dilation (UTD) classification system which incorporates prenatal and postnatal imaging findings based on: 1) anterior-posterior renal pelvic diameter (APRPD); 2) calyceal dilation with distinction between central and peripheral calyceal dilation postnatally; 3) renal parenchymal thickness; 4) renal parenchymal appearance; 5) bladder abnormalities; and 6) ureteral abnormalities. For antenatal studies, the seventh US finding to report is the quantity of amniotic fluid [3]. This recently proposed grading classification system, as with any system, will require extensive evaluation to assess and confirm its usefulness in predicting clinical outcomes [3]. For the purposes of the current evaluation, degree of hydronephrosis is based on the SFU grading. The SFU system has been in use for a longer period of time and has good inter-rater reliability [3,15,16]. There are studies that have shown increased accuracy of hydronephrosis grading system if APRPD is measured [17,18]. We therefore have included an APRPD of >15 mm on postnatal imaging as a sign of severe hydronephrosis. Over time, the UTD classification system may predominate, but at present, familiarity with the SFU system is more widespread. Inclusion of the APRPD >15 mm conforms to the intermediate- to high-risk urinary tract dilation stratification [3]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org
Antenatal Hydronephrosis Infant. Adherence to standardized reporting models is not well adopted according to a recent survey of pediatric radiologists [13,14], In order to increase standardization of reporting and care, a consensus group from many separate organizations recommended adoption of the urinary tract dilation (UTD) classification system which incorporates prenatal and postnatal imaging findings based on: 1) anterior-posterior renal pelvic diameter (APRPD); 2) calyceal dilation with distinction between central and peripheral calyceal dilation postnatally; 3) renal parenchymal thickness; 4) renal parenchymal appearance; 5) bladder abnormalities; and 6) ureteral abnormalities. For antenatal studies, the seventh US finding to report is the quantity of amniotic fluid [3]. This recently proposed grading classification system, as with any system, will require extensive evaluation to assess and confirm its usefulness in predicting clinical outcomes [3]. For the purposes of the current evaluation, degree of hydronephrosis is based on the SFU grading. The SFU system has been in use for a longer period of time and has good inter-rater reliability [3,15,16]. There are studies that have shown increased accuracy of hydronephrosis grading system if APRPD is measured [17,18]. We therefore have included an APRPD of >15 mm on postnatal imaging as a sign of severe hydronephrosis. Over time, the UTD classification system may predominate, but at present, familiarity with the SFU system is more widespread. Inclusion of the APRPD >15 mm conforms to the intermediate- to high-risk urinary tract dilation stratification [3]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org