Veziko üreteral reflü hastalığında ultrasonun rolünü nasıl belirleyebiliriz?

Yıl 2020, Cilt: 14 Sayı: 4, 348 - 351, 26.06.2020

Gülşah Bayram Ilıkan

https://doi.org/10.12956/tchd.733936

Öz

Amaç: Ultrasonografinin (US), veziko-üreteral reflü tanısındaki rolünü, endikasyonlarını açıklamak ve özellikli hasta grubunda, tanıda gold standart olan voiding sistoüretrografi’yle (VCUG) kıyaslamayı amaçladık.
Gereç ve Yöntemler: Nisan 2010 - Mart 2019 tarihleri arasında tek bir radyolog tarafından uygulanmış 532 VCUG ve eş zamanlı US tetkiki retrospektif olarak değerlendirildi. Demografik özellikler, US’de; pelvik staz, pelvikaliksiyel dilatasyon, hidroüreteronefroz ile VCUG’de reflü varlığı kaydedildi. İki testi kıyaslamak için ROC analizi yapıldı.
Bulgular: Yaşları 5 ay- 18 yaş arasında değişen hastaların 342’ si (% 64,3) kadın, 190 ‘ı (% 35,7) erkek idi. Hastalar 6 yaş altı (n=286) ve 6 yaş üstü (n=246) olmak üzere iki gruba ayrıldı. 6 yaş altında US ve VCUG bulgularında korelasyon saptanırken (p<0.005, OR=6,977), 6 yaş üstünde saptanmadı (p=0,539). ROC analizinde US’nin VUR saptamadaki, sensitivite, spesifite, pozitif prediktif değer (PPV), ve negatif prediktif değeri (NPV) 6 yaş altında; % 89,76 , % 47,86 %, % 65,1 ve % 81,2 (AUC= 0,688, p= 0,0001), 6 yaş üstünde % 50,49, % 53,55, % 38,0 ve % 65,8 (AUC=0,520, p= 0,5720) olarak hesaplandı.
Tartışma: US, hastalığın tanısında kolay, tekrarlanabilen, güvenli ve etkin bir yöntemdir. Yüksek sensitivite (% 89,7) ve NPV ( % 81,2) oranları ile 6 yaş altında tarama testi olarak kullanılabilir. VCUG tüm yaş gruplarında kesin tanı için gold standart incelemedir.

Anahtar Kelimeler

Vezikoüreteral reflü, Voiding sistoüreterografi, , Ultrasonografi, , Pediatri, , Tanı, , Görüntüleme

How can we specify the role of ultrasonography in the vesico – ureteral reflux disease?

Öz

Objectives: We aimed to explore the role and indication for the use of ultrasonography (US) in the vesico-ureteral reflux (VUR) disease and demonstrate the non – inferiority against the gold standard voiding cystourethrography (VCUG) for the screening in a certain group of patients.
Material and Methods: This is a retrospective analysis of 532 simultaneous VCUG and US examinations between April 2010 and March 2019, by a single radiologist in our hospital. Demographic characteristics, pelvic stasis, pelvi – calyxeal dilatation and hydro – uretero – nephrosis in the US, and reflux in the VCUG were recorded. ROC analysis was done for comparing the two tests.
Results: Among the cases between 5 months to 18 years of age, 342 (64.3 %) were female, and 190 (35.7 %) were male. The cases were divided into two groups below and after 6 years of age (N = 246 (46.2 %), and 286 (43.8%) respectively. There was a correlation between US and VCUG findings below the age of 6 (p<0.005, OR=6,977), but not in the cases over (p=0,539). In the ROC analysis of US in detection of VUR, compared to VCUG, sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) below 6 years age is 89,76 %, 47,86 %, 65,1 %, and 81,2 % (AUC= 0,688, p= 0,0001) respectively, and those above 6 years of age are 50,49 %, 53,55 %, 38,0 %, and 65,8 % (AUC=0,520, p= 0,5720).
Conclusion: US is easy, reproducible, safe and effective for diagnosis, and staging of the disease. Its high sensitivity (89.7 %), and negative predictive value (81.2 %), can make it an initial screening test in the patients below 6 years of age. VCUG as a gold standard modality can be reserved for definitive diagnosis in the suspected cases below the age of 6 and all of the cases after the age of 6.

Anahtar Kelimeler

Vesicoureteral reflux, , Voiding cysto-urethrography, Ultrasonography, Pediatrics, Diagnosis, Screening

Kaynakça

• 1. Adibi A, Gheysari A, Azhir A, Merikhi A, Khami S, Tayari N. Value of Sonography in the Diagnosis of Mild, Moderate and Severe Vesicoureteral Reflux in Children. Saudi J Kidney Dis Transpl 2013; 24: 297-302.
• 2. Lim R. Vesicoureteral reflux and urinary tract infection: Evolving practices and current controversies in pediatric imaging. Am J Roentgenol 2009; 192: 1197-208.
• 3. Nafisi-Moghadam R, Malek M, Najafi F, Shishehsaz B. The Value of Ultrasound in Diagnosing Vesicoureteral Reflux in Young Children with Urinary Tract Infection. Acta Med Iran 2011; 49: 588-591.
• 4. Lebowitz RL, Olbing H, Parkkuleinen KV, Smellie JM, Tamminen-Möbius TE. International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 1985; 15: 105–109.
• 5. Fallah MM, Falahati M, Mohammadi A, Alizadeh M, Mladkova-Suchy N, Ghasemi-Rad M. Comparative study of color doppler voiding urosonography without contrast enhancement and direct radionuclide voiding cystography for diagnosis of vesicoureteric reflux in children. J Ultrasound Med 2012; 31: 55–61.
• 6. Shaikh N, Spingarn RB, Hum SW. Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections. Cochrane Database Syst Rev. 2016 Jul 5;7:CD010657. doi: 10.1002/14651858. CD010657.
• 7. Kenney IJ, Negus AS, Miller FN. Is sonographically demonstrated mild distal ureteric dilatation predictive of vesicoureteric reflux as seen on micturating cystoureterography. Pediatr Radiol 2002; 32:175-8.
• 8. Muensterer OJ. Comprehensive ultrasound versus voiding cysturethrographyin the diagnosis of vesicoureteral reflux. Eur J Pediatr 2002; 161: 435–437.
• 9. Otukesh H, Hoseini R, Behzadi AH, Mehran M, Tabbaroki A, Khamesan B, et al. Accuracy of cystosonography in the diagnosis of vesicourethral reflux in children. Saudi J Kidney Dis Transpl 2011; 22: 488-491.
• 10. Thompson M, Simon SD, Sharma V, Alon US. Timing of Follow-up Voiding Cystourethrogram in Children With Primary Vesicoureteral Reflux: Development and Application of a Clinical Algorithm. Pediatrics 2005; 115:426-34.
• 11. Darge K. Diagnosis of vesicoureteral reflux with ultrasonography. Pediatr Nephrol 2002; 17:52–60.
• 12. Ji LN, Cao L, Chen DK,Cui YC, Zhang YL, Ye H, et al. Evaluation of the clinical and imaging examination in high-risk children with vesicoureteral reflux. Zhonghua Er Ke Za Zhi 2011; 49: 282-6.
• 13. Haberlik A. Detection of low-grade vesicoureteral reflux in children by color Doppler imaging mode. PediatrSurg Int 1997; 12:38-43.
• 14. Darge K, Riedmiller H. Current status of vesicoureteral reflux diagnosis. World J Urol 2004; 22: 88–95.
• 15. Lee LC, Lorenzo AJ, Koyle MA. The role of voiding cystourethrography in the investigation of children with urinary tract infections. Can Urol Assoc J. 2016; 10: 210-214.
• 16. Schaeffer AJ, Greenfield SP, Ivanova A, Cui G, Zerin JM, Chow JS, et al. Reliability of grading of vesicoureteral reflux and other findings on voiding cystourethrography. J Pediatr Urol. 2017; 13: 192-198.