Department of Pediatrics, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
J Urol. 2011 Jan;185(1):258-63. doi: 10.1016/j.juro.2010.09.029. Epub 2010 Nov 13.
The aim of this study was to evaluate the diagnostic accuracy of dimercapto-succinic acid renal scintigraphy and renal ultrasound in identifying high grade vesicoureteral reflux in children after a first episode of urinary tract infection.
A total of 533 children following a first urinary tract infection were included in the analysis. Patients were assessed by 3 diagnostic imaging studies, renal ultrasound, dimercapto-succinic acid scan and voiding cystourethrography. The main event of interest was the presence of high grade (III to V) vesicoureteral reflux. The combined and separate diagnostic accuracy of screening methods was assessed by calculation of diagnostic OR, sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio.
A total of 246 patients had reflux, of whom 144 (27%) had high grade (III to V) disease. Sensitivity, negative predictive value and diagnostic OR of ultrasound for high grade reflux were 83.3%, 90.8% and 7.9, respectively. Dimercapto-succinic acid scan had the same sensitivity as ultrasound but a higher negative predictive value (91.7%) and diagnostic OR (10.9). If both tests were analyzed in parallel by using the OR rule, ie a negative diagnosis was established only when both test results were normal, sensitivity increased to 97%, negative predictive value to 97% and diagnostic OR to 25.3. Only 9 children (6.3%) with dilating reflux had an absence of alterations in both tests.
Our findings support the idea that ultrasound and dimercapto-succinic acid scan used in combination are reliable predictors of dilating vesicoureteral reflux.
本研究旨在评估巯基琥珀酸肾闪烁显像和肾脏超声在识别儿童首次尿路感染后高等级膀胱输尿管反流的诊断准确性。
共纳入 533 例首次尿路感染患儿进行分析。患者接受 3 种诊断影像学检查，包括肾脏超声、巯基琥珀酸扫描和排尿性膀胱尿道造影。主要观察事件为高等级（III 至 V 级）膀胱输尿管反流的存在。通过计算诊断比值比（OR）、敏感性、特异性、阳性预测值、阴性预测值和似然比来评估筛查方法的联合和单独诊断准确性。
共有 246 例患儿存在反流，其中 144 例（27%）存在高等级（III 至 V 级）疾病。超声对高等级反流的敏感性、阴性预测值和诊断 OR 分别为 83.3%、90.8%和 7.9。巯基琥珀酸扫描与超声的敏感性相同，但阴性预测值更高（91.7%）和诊断 OR 更高（10.9）。如果通过使用 OR 规则并行分析两种检查结果，即仅当两种检查结果均正常时才能确立阴性诊断，则敏感性提高至 97%，阴性预测值提高至 97%，诊断 OR 提高至 25.3。仅有 9 例（6.3%）扩张性反流患儿两种检查均未见异常。
我们的研究结果支持联合使用超声和巯基琥珀酸扫描作为扩张性膀胱输尿管反流可靠预测指标的观点。
