Guideline-Driven Recommendations for Pediatric Renal Imaging: Insights from the European Society of Paediatric Radiology

The European Society of Pediatric Radiology guideline now endorses an ultrasound‑first strategy for pediatric renal imaging, shifting triage toward ultrasound with selective MRI or CT for problem‑solving.

The guidance covers cystic kidney disease, urinary tract infection, and renal trauma across the pediatric age range and signals a clear change in modality selection for frontline teams.

Where many services historically used mixed pathways or defaulted to early CT for diagnostic certainty, the guideline reframes practice: ultrasound is first‑line for most indications because it is non‑invasive and yields high diagnostic value for common presentations. Expect fewer immediate CT referrals and a streamlined, ultrasound‑based diagnostic pathway for routine cases.

Ultrasound’s practical and safety advantages are central: no ionizing radiation, bedside availability, and Doppler and functional assessment across ages. It is often sufficient for simple cystic lesions, initial evaluation of febrile urinary tract infection, and routine hydronephrosis follow‑up—reducing cumulative radiation and accelerating decision‑making at the bedside.

For complex congenital anomalies or when high‑resolution anatomic detail is needed, MRI is the recommended problem‑solving tool. MRI provides radiation‑free high‑contrast anatomy and functional sequences but requires planning for sedation in younger children and tailored protocols aimed at the surgical or urological question. Reserve MRI when ultrasound is inconclusive or when presurgical mapping will change management.

CT retains a limited but essential role for major trauma, selected complex stone disease, or other scenarios needing rapid, high‑resolution cross‑sectional detail. The guideline stresses radiation‑risk mitigation with tailored low‑dose CT protocols and strict indication thresholds.

At a systems level, general hospitals should prioritize rapid ultrasound access with selective MRI referral; specialized centers may expand advanced MRI and interventional pathways while balancing diagnostic yield against radiation exposure.

Key Takeaways:

• Emergency departments, general pediatrics and radiology should expect increased bedside sonography and fewer routine CTs; operational pathways must prioritize rapid US access.
• Use MRI when ultrasound is insufficient—plan for sedation, sequence selection and scheduling that allow for preprocedural preparation.
• Limit CT to major trauma or complex stone disease, apply strict low‑dose protocols and explicit escalation criteria; anticipate protocol updates and targeted training in ultrasound and MRI pathways.