MULTIDISCIPLINARY
CONSENSUS ON THE
CLASSIFICATION OF ANTENATAL
AND POSTNATAL URINARY
TRACT DILATION
UTD CLASSIFICATION
Dr Vassil Zefov
08.12. 2015 LH
UTD CLASSIFICATION
Correlation between antenatal and postnatal US findings has been
difficult due to the lack of consensus in defining and describing urinary
tract dilation
There is variability not only among subspecialty groups, but also within
the Societies of Pediatric Radiology.
A recent survey showed that pediatric radiologists have no standard
method to describe urinary tract dilation
Some are descriptive system (e.g. , mild, moderate, or severe) while
others use standard grading system (e.g., Grade 1-4 )
UTD CLASSIFICATION
Representatives from eight societies with interest in the diagnosis
and management of fetuses and children with UTD agreed to
collaborate on the development of standard grading system for
UTD - urinary tract dilation
1) ACR - American College of Radiology
2) AIUM - American Institute of Ultrasound in Medicine
3) ASPN - American Society of Pediatric Nephrology
4) SFU - Society for Fetal Urology
5) SMFM - Society for Maternal-Fetal Medicine
6) SPU - Society of Pediatric Urology
7) SPR - Society of Pediatric Radiology
8) SRU - Society of Radiologists in Ultrasound
UTD CLASSIFICATION
The Consensus Panel proposed the UTD Classification System to describe the
appearance of the urinary tract in both - antenatally and postnatally.
The proposed UTD Classification System is based on six ultrasound findings:
1) A-P diameter of renal pelvis
2) Calyceal dilation with distinction between central and peripheral calyceal
dilation (postnatally)
3) Renal parenchyma thickness.
4) Renal parenchymal appearance
5) Bladder abnormalities
6) Ureteral abnormalities
UTD CLASSIFICATION
1) The UTD Classification System distinguishes whether the findings are
antenatal ( A ) or postnatal ( P )
P
UTD CLASSIFICATION
1) The UTD Classification System distinguishes whether the findings are
antenatal ( A ) or postnatal ( P )
A normal
A A1
A2-3
P normal
P1
P2
P P3
UTD CLASSIFICATION
1) The UTD Classification System distinguishes whether the findings are
antenatal ( A ) or postnatal ( P )
16-27 weeks
< 4mm A-P
A normal
>28 weeks
< 7 mm A-P
UTD CLASSIFICATION
1) The UTD Classification System distinguishes whether the findings are
antenatal ( A ) or postnatal ( P )
16-27 weeks
4 mm 7 mm A-P
A 1
>28 weeks
7 mm 10 mm A-P
UTD CLASSIFICATION
Transversal Sagital
A 2-3
Peripheral 16-27 weeks
Calyceal > 7 mm A-P
dilatation,
Ureteral
dilatation,
Renal
parenchyma >28 weeks
Bladder >10 mm A-P
abnormalities
UTD CLASSIFICATION
1) The UTD Classification System distinguishes whether the findings are
antenatal ( A ) or postnatal ( P )
P normal A-P
< 10 mm
UTD CLASSIFICATION
Transversal Sagital
A-P
10 15 mm
P 1
Central
calyceal
dilation
UTD CLASSIFICATION
Transversal Sagital
A-P
> 15 mm
P 2
Peripheral
calyceal
dilation
UTD CLASSIFICATION
Transversal Sagital
Additional
Regardless A-P
Ureteral
dilation
P 3 Renal
echogenic
parenchyma
Renal cysts
Bladder
abnormalities
UTD CLASSIFICATION
The Consensus Panel recommends consistent use of term
dilation and avoiding the use of non-specific terms such
as :
Hydronephrosis
Pyelectasis
Pelviectasis
Renal pelvis fullness
UTD CLASSIFICATION
When reporting urinary tract dilation, a description of the proposed six
imaging parameters should be described in the body of the report.
In the Conclusion should be included the specific UTD categories
A P
Normal Normal
UTD A1 UTD P1
UTD A 2-3 UTD P2
UTD P3
UTD CLASSIFICATION
Scenario Defensive management
Antenatal Report - Bilateral renal fullness ( A-P 4 mm )
Postnatal Report Bilateral fullness ( A-P 7 mm ) To be followed up
After 3 m Request For MCU with diagnosis :
Bilateral hydronephrosis
To R/O VUR
UTD CLASSIFICATION
Tips to avoid Defensive behaviour :
For Radiologist - Wright Normal when it is normal instead
measurements .
A normal Avoid - Fullness with A-P 5 mm
P normal Avoid A-P 5 mm . To be followed up
For Clinicians - Avoid US exam of NB in the first 48 hrs. It will be
misinterpret.
Avoid request for MCU if it is normal and no signs of UTI
UTD CLASSIFICATION
THANK YOU