Abstract
Magnetic resonance urography (MRU) has evolved over the past three decades into a validated tool for evaluating the pediatric urinary tract. Originally developed in the early 1990s, MRU now combines high-resolution anatomic imaging with quantitative functional assessment, offering a radiation-free alternative to traditional modalities. Comparative studies have consistently demonstrated excellent agreement between MRU-derived differential renal function and radionuclide scintigraphy. Beyond functional equivalence, MRU provides superior delineation of complex anomalies such as megaureter and ectopic ureteral insertion, directly informing surgical planning. Recent innovations have enhanced feasibility in younger children, with real-time imaging and compressed sensing reducing scan times by 30–50% and improving motion robustness. Multiparametric protocols integrating diffusion and perfusion sequences, as well as emerging multi-nuclear approaches, extend MRU’s role into parenchymal and physiologic evaluation. Collectively, these advances shift MRU from a problem-solving adjunct to a central modality in pediatric urology, with future directions focused on standardization, multicenter validation, and potential integration of artificial intelligence for quantitative analysis.