Contrast-enhanced voiding ultrasonography detecting intrarenal reflux in children: comparison with 99mTc-DMSA renal scan
Saelin Oh2 , Ji Young Ha1 , Yeon Jin Cho3
1Gyeongsang National University Changwon Hospital, Changwon, Korea
2Department of Radiology, Korea University Anam Hospital, Seoul, Korea
3Department of Radiology, Seoul National University Hospital, Seoul, Korea
Corresponding Author: Ji Young Ha ,Tel: 0552143142, Fax: 0552143134, Email: wonpiece@gmail.com
Received: July 1, 2021;  Accepted: December 22, 2021.  Published online: December 22, 2021.
ABSTRACT
Purpose:
To evaluate the diagnostic performance of CeVUS detecting IRR and propose the correlation between sites of IRR detected by CeVUS and photon defect sites in acute DMSA renal scan in pediatric patients.
Methods:
54 kidneys from 27 patients (20 males and 7 females; mean age, 5.6±4.1 months) who underwent CeVUS and acute DMSA renal scan for recurrent UTI or pyelonephritis were included. Pediatric experts compared the results of CeVUS with acute DMSA renal scan, including the grade of VUR and the presence and location of IRR.
Results:
13 renal units (13/54, 24.1%) of 10 patients (mean age, 6.3±3.7 months) showed VUR and 8 renal units (8/54, 14.8%) demonstrated IRR on CeVUS. 10 renal units of 8 patients (mean age, 6.9±1.4 months) showed 19 photon defects on acute DMSA renal scan. Among 54 renal units, 52 (96.3%) showed concordant results, and 2 renal units (3.7%) showed discordant results between CeVUS and acute DMSA renal scan. IRR accounted for 15/19 (78.9%) photon defects in 8 renal units of 7 patients, on using CeVUS. In the per-renal unit-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CeVUS were 80%, 100%, 100%, 95.7%, and 96.3%, respectively.
Conclusion:
CeVUS showed good performance in detecting IRR, and the IRR sites detected by CeVUS showed a high correlation with photon defect sites in acute DMSA scan. Therefore, CeVUS may play an important role in managing patients with recurrent UTI or pyelonephritis with reduced radiation exposure.
Keywords: Contrast-enhanced voiding ultrasonography; Technetium Tc 99m Dimercaptosuccinic Acid; Vesicoureteral reflux; Intrarenal reflux; Ultrasonography
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