Maizels M, Reisman M E, Flom L S, Nelson J, Fernbach S, Firlit C F, Conway J J
Department of Radiology, Children's Memorial Hospital, Chicago, Illinois.
J Urol. 1992 Aug;148(2 Pt 2):609-14; discussion 615-6. doi: 10.1016/s0022-5347(17)36668-5.
To understand better the significance of pediatric idiopathic nephroureteral dilatation the renal ultrasound images of patients less than 1 year old with hydronephrosis or hydroureteronephrosis were graded and compared to the radiological diagnosis of obstruction as determined by diuresis renography and/or urography. The study included 73 boys and 30 girls with hydronephrosis (76 patients) or hydroureteronephrosis (27). For hydronephrosis obstruction was diagnosed in 56 children (74%) and involved 61 of 97 kidneys (63%). For obstructed kidneys the mean grade of hydronephrosis (3.4 +/- 0.7 standard deviation) was statistically different from that of nonobstructed kidneys (1.6 +/- 0.8 standard deviation) (p less than 0.05). When the value to predict obstruction was set at grade 3 hydronephrosis or greater there was an 88% sensitivity and 95% specificity. For hydroureteronephrosis obstruction was diagnosed in 15 of 27 children (56%) and involved 17 of 34 kidneys (50%). The degree of dilatation was weighted as a score to assess the grades of hydronephrosis and ureteral dilatation, namely hydroureteronephrosis score equals grade of hydronephrosis plus grade of ureteral dilatation. In obstructed megaureters the mean hydroureteronephrosis score (5.8 +/- 1.0) was statistically different from that for nonobstructed megaureters (mean hydroureteronephrosis score 2.7 +/- 1.9) (p less than 0.001). When the value to predict obstruction was set at hydroureteronephrosis score of 5 or greater there was a 94% sensitivity and 80% specificity. Although ultrasound examination alone cannot be used to diagnose urinary obstruction, the radiological diagnosis of obstruction is linked with the grade of hydronephrosis or score of hydroureteronephrosis.
为了更好地理解小儿特发性肾盂输尿管扩张的意义，对1岁以下患有肾积水或肾盂输尿管积水的患者的肾脏超声图像进行分级，并与利尿肾图和/或尿路造影确定的梗阻放射学诊断结果进行比较。该研究纳入了73名男孩和30名女孩，其中76例患有肾积水，27例患有肾盂输尿管积水。对于肾积水，56名儿童（74%）被诊断为梗阻，97个肾脏中的61个（63%）受累。对于梗阻性肾脏，肾积水的平均分级（3.4±0.7标准差）与非梗阻性肾脏（1.6±0.8标准差）在统计学上有差异（p<0.05）。当预测梗阻的阈值设定为肾积水3级及以上时，敏感性为88%，特异性为95%。对于肾盂输尿管积水，27名儿童中有15名（56%）被诊断为梗阻，34个肾脏中的17个（50%）受累。将扩张程度加权为评分以评估肾积水和输尿管扩张的分级，即肾盂输尿管积水评分等于肾积水分级加上输尿管扩张分级。在梗阻性巨输尿管中，平均肾盂输尿管积水评分（5.8±1.0）与非梗阻性巨输尿管（平均肾盂输尿管积水评分2.7±1.9）在统计学上有差异（p<0.001）。当预测梗阻的阈值设定为肾盂输尿管积水评分为5及以上时，敏感性为94%，特异性为80%。虽然仅超声检查不能用于诊断尿路梗阻，但梗阻的放射学诊断与肾积水分级或肾盂输尿管积水评分相关。
