Zou Xiangyu,Sun Peixuan,Shi Jing,et al.Role of contrast-enhanced voiding urosonography in the diagnosis of pediatric vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2022,21(02):151-155.[doi:10.3760/cma.j.cn.101785-202006044-010]
排尿性尿路超声造影对儿童原发性膀胱输尿管反流的诊断价值
- Title:
- Role of contrast-enhanced voiding urosonography in the diagnosis of pediatric vesicoureteral reflux
- 关键词:
- 膀胱输尿管返流/诊断; 尿路造影术; 超声增强造影剂; 儿童
- Keywords:
- Vesico-Ureteral Reflux/DI; Urography; Enhanced Contrast Agent; Child
- 摘要:
- 目的 探讨排尿性尿路超声造影（contrast-enhanced voiding urosonography，CeVUS）对儿童原发性膀胱输尿管反流（vesicoureteral reflux，VUR）的诊断价值。方法 回顾性分析上海儿童医学中心2018年12月至2020年6月116例[232个肾盂-输尿管单位（pyelo-ureter units，PUUs）]因临床疑为VUR而行初筛的患儿以及VUR术后随访资料，116例均行CeVUS，分析CeVUS的应用安全性以及诊断阳性率。同时收集24例患儿（共48个PUUs）的排尿性X线膀胱尿路造影（voiding cystourethrography，VCUG）数据进行结果比对，分析其诊断灵敏度、特异度以及一致性。结果 116例均成功行CeVUS检查，无一例发生不良反应。CeVUS诊断阳性69例，诊断阳性率为59.5%。232个PUUs中，反流阳性103个，诊断阳性率为44.4%。24例（48个PUUs）行VCUG检测患儿中，VCUG检测反流阳性PUUs 23个，CeVUS检测反流阳性PUUs25个，共同阳性诊断21个。以VCUG结果为金标准，CeVUS诊断VUR的灵敏度为91.3%，特异度为84%，阳性预测值为84%，阴性预测值为91.3%。CeVUS和VCUG对VUR的诊断有较高的一致性（Kappa值=0.75）。48个PUUs中，VCUG诊断为无反流25个，其中CeVUS诊断无反流21个；同时CeVUS检测到Ⅱ级反流4个，CeVUS与VCUG检查总体一致性为72.9%。另外，对于高级别反流，VCUG诊断为Ⅳ~Ⅴ级VUR 15个中，CeVUS诊断为Ⅲ级1个，其余均为Ⅳ~Ⅴ级；两项检查均诊断为Ⅳ级7个、Ⅴ级3个，Ⅳ~Ⅴ级诊断一致性为66.7%。结论 CeVUS对检测和分级原发性膀胱输尿管反流具有一定的诊断意义，且安全、无放射性，可作为膀胱输尿管反流的筛查手段以及术后随访工具。
- Abstract:
- Objective To determine the value of contrast-enhanced voiding urosonography (CeVUS) for diagnosing vesicoureteral reflux (VUR) in children.Methods A total of 116 cases (232 pyelo-ureter units, PUUs) of suspicious VUR and postoperative children were admitted from December 2018 to June 2020.The safety and positive rate were analyzed.Twenty-four children (48 PUUs) were compared with voiding cystourethrography (VCUG) for its sensitivity, specificity, and consistency.Results All of them were examined successfully and no adverse reactions occurred.The diagnosis was positive for CeVUS (n=69) with a positive rate of 59.5%.Among 232 PUUs, 103 were positive for VUR with a positive diagnostic rate of 44.4%.Moreover, among 24 patients (48 PUUs) 23 were detected by VCUG, 25 by CeVUS and 21 were all positive.As compared with VCUG, CeVUS had a sensitivity of 91.3%, a specificity of 84.0%, a positive predictive value of 84% and a negative predictive value of 91.3%.Contrast-enhanced ultrasound and VCUG had a high consistency in the examination of VUR (Kappa=0.75).Among them, VCUG diagnosed no reflux in 25 PUUs and CeVUS in 21 PUUs with 4 grade Ⅱ VUR.The overall consistency rate was 72.9%.Moreover, VCUG diagnosed 15 grade Ⅳ-Ⅴ VUR, except CeVUS Ⅲ diagnosed 1 with a consistency rate of 66.7% in grade Ⅳ-Ⅴ VUR.Conclusion CeVUS has certain diagnostic significance in detecting and grading VUR with its safety and non-radioactive characteristics.It is considered as a first choice for suspected or post-operated VUR in children.
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备注/Memo
收稿日期:2020-06-18。
基金项目:国家自然科学基金（81900618）；上海"科技创新行动计划"扬帆计划（18YF1415000）
通讯作者:孙杰,Email:sunjie@scmc.com.cn