Routh Jonathan C, Grant Frederick D, Kokorowski Paul J, Nelson Caleb P, Fahey Frederic H, Treves S Ted, Lee Richard S
Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Clin Pediatr (Phila). 2012 Jan;51(1):23-30. doi: 10.1177/0009922811417294. Epub 2011 Aug 25.
BACKGROUND. The traditional initial imaging approach following pediatric urinary tract infection is the "bottom-up" approach (cystogram and renal ultrasound). Recently, the "top-down" approach (nuclear renal scan followed by cystogram for abnormal scans only) has gained increasing attention. The relative cost and radiation doses of these are unknown METHODS. The authors used a decision model to evaluate these imaging approaches. Cost and effective radiation dose estimates, including sensitivity analyses, were based on one-time imaging only. RESULTS. Comparing hypothetical cohorts of 100 000 children, the top-down imaging approach cost $82.9 million versus $59.2 million for the bottom-up approach. Per-capita effective radiation dose was 0.72 mSv for top-down compared with 0.06 mSv for bottom-up. CONCLUSIONS. Routine use of nuclear renal scans in children following initial urinary tract infection diagnosis would result in increased imaging costs and radiation doses as compared to initial cystogram and ultrasound. Further data are required to clarify the long-term clinical implications of this increase.
背景。小儿尿路感染后的传统初始成像方法是“自下而上”的方法（膀胱造影和肾脏超声）。最近，“自上而下”的方法（仅对异常扫描进行核肾扫描，然后进行膀胱造影）越来越受到关注。这些方法的相对成本和辐射剂量尚不清楚。方法。作者使用决策模型来评估这些成像方法。成本和有效辐射剂量估计，包括敏感性分析，仅基于一次性成像。结果。比较10万名儿童的假设队列，自上而下的成像方法成本为8290万美元，而自下而上的方法为5920万美元。自上而下的人均有效辐射剂量为0.72毫希沃特，而自下而上的为0.06毫希沃特。结论。与初始膀胱造影和超声相比，在小儿初次尿路感染诊断后常规使用核肾扫描会导致成像成本和辐射剂量增加。需要进一步的数据来阐明这种增加的长期临床意义。
