Yang Xiuzhen,Fu Junfen,Ye Jingjing,et al.Value of contrast-enhanced voiding urosonography in the diagnosis of vesicoureteral reflux and urethrovaginal diseases in children[J].Journal of Clinical Pediatric Surgery,2023,22(10):924-929.[doi:10.3760/cma.j.cn101785-202204058-005]
排泄性尿路超声造影在儿童膀胱输尿管反流与尿道阴道疾病诊断中的应用
- Title:
- Value of contrast-enhanced voiding urosonography in the diagnosis of vesicoureteral reflux and urethrovaginal diseases in children
- Keywords:
- Vesico-Ureteral Reflux; Diagnosis; Contrast-Enhanced Voiding Urosonography; Intrarenal reflux; Urethra; Vagina; Child
- 摘要:
- 目的 探讨排泄性尿路超声造影(contrast-enhanced voiding urosonography,CeVUS)在儿童膀胱输尿管反流(vesicoureteral reflux,VUR)及尿道阴道疾病诊断中的应用价值。方法 回顾性收集浙江大学医学院附属儿童医院自2020年9月至2021年12月行CeVUS检查的207例临床可疑VUR患儿临床资料,均使用超声造影剂六氟化硫微泡(SonoVue,Bracco,Italy)经导尿管膀胱内给药行CeVUS 检查,同时检查尿道和女童阴道。根据国际VUR分级标准,将VUR分为五级。记录VUR级别、有无肾内反流(intrarenal reflux,IRR)以及尿道阴道的异常发现。对其中18例同期行排泄性尿路造影(voiding cystourethrogram,VCUG)者应用加权Kappa检验比较CeVUS和VCUG诊断VUR和IRR的一致性。结果 共检查207例患儿416个肾盂-输尿管单位(pelvi-ureter units,PUUs),其中3例重复肾双输尿管,1例单侧肾缺如。207例中诊断VUR 97例(97/207,46.86%);416个PUUs中诊断VUR 145 个(145/416,34.86％)。发现IRR 24个,均发生在Ⅲ级及以上反流患儿。同期行CeVUS和VCUG检查的18例患儿(2例重复肾双输尿管,1例单侧肾缺如,共37个PUUs)中,诊断VUR一致性的加权Kappa值0.747,P<0.01,95%CI:0.554~0.941。上述37个PUUs中CeVUS发现IRR 12个,重复肾下极反流1例,而VCUG无一例发现。另外,CeVUS发现尿道阴道异常5例,重复肾Y形输尿管1例,反流侧肾脏形态偏小6例。结论 CeVUS检查安全,与VCUG检查结果一致性高,较VCUG在诊断IRR和重复肾合并VUR上有一定优势。CeVUS也能发现尿道阴道异常。CeVUS可以作为儿童VUR的首选影像学检查方法。
- Abstract:
- Objective To explore the value of contrast-enhanced voiding urosonography (CeVUS) in the diagnosis of vesicoureteral reflux (VUR) and urethrovaginal diseases in children.Methods From September 2020 to December 2021,the relevant clinical data were retrospectively reviewed for 207 children with suspected VUR examined by CeVUS.And CeVUS was performed by SonoVue (Bracco,Italy) and intravesical administration via catheter while urethrovaginal examinations were performed in girls.According to the international VUR grading system,VUR was divided into five grades.Grade of VUR,presence of intrarenal reflux (IRR) and abnormal findings of urethrovaginal tract were recorded,.And the diagnostic value of CeVUS was examined in children with VUR and urethrovaginal abnormalities.Eighteen patients were examined by voiding cystourethrogram (VCUG) during the same period.Weighted Kappa test was utilized for comparing the consistency of CeVUS and VCUG in diagnosis of VUR.Results A total of 416 pyeloureteral units (PUUs) were examined in 207 children,including duplicate kidney (n=3) and unilateral renal absence (n=1).No adverse events related to contrast agent were reported.Among them,97 (97/207,46.86%) were diagnosed with VUR.Among 416 PUUs,145(145/416,34.86%) were diagnosed as VUR.Twenty-four IRR occurred in grade Ⅲ and above.Among 18 children examined by CeVUS and VCUG at the same time (2 duplicate kidneys & 1 unilateral kidney absence,a total of 37 PUUs),Weighted Kappa value of VUR consistency was 0.747 (P<0.01,95%CI:0.554-0.941).Among 37 PUUs,12 PUUs had IRR on CeVUS,one VUR in lower pole of duplex kidney missed a diagnosis by VCUG.Also there were urethrovaginal abnormalities (n=5),Y-shaped ureter (n=1) and miniature kidney at reflux side (n=6).Conclusion CeVUS is safe and has high consistency with VCUG. CeVUS has advantages over VCUG in the diagnosis of IRR and duplicate kidney with VUR. CeVUS can also detect urethrovaginal abnormalities. CeVUS can be used as the preferred imaging method for VUR in children.
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备注/Memo
收稿日期:2023-4-19。
通讯作者:傅君芬,Email:fjf68@zju.edu.cn