Department of Pediatrics, Mackay Memorial Hospital, No 92, Section 2, Chungshan North Road, Taipei, Taiwan.
Pediatr Nephrol. 2012 Jun;27(6):955-63. doi: 10.1007/s00467-012-2104-1. Epub 2012 Mar 1.
The lack of good evidence for improved outcomes in children and young infants with febrile urinary tract infection (UTI) after aggressive treatment for vesicoureteral reflux (VUR) has raised doubts regarding the need for routine voiding cystourethrography (VCUG), and the appropriate imaging evaluation in these children remains controversial.
This prospective study aimed to determine whether abnormalities found on acute dimercaptosuccinic acid (DMSA) scan and ultrasound (US) can help indicate the necessity of voiding cystourethrography (VCUG) in young infants.
For 3.5 years, all infants younger than 3 months presenting with first febrile UTI were prospectively studied. All infants were hospitalized and investigated using US (<3 days after admission), DMSA scan (<5 days after admission), and VCUG (7-10 days after antibiotic treatment) after diagnosis. The association among findings of US, DMSA scan, and VCUG were evaluated.
From 220 infants, there were abnormal results in 136 (61.8%) US and in 111 (50.5%) DMSA scans. By US, ten infants (4.5%) with abscess or structural abnormalities other than VUR were diagnosed. High-grade (III-V) VUR was present in 39 patients (17.7%). The sensitivities for high-grade VUR of renal US alone (76.9%) or DMSA scan alone (82.1%) were not as good as that of the "OR rule" strategy, which had 92.3% sensitivity and 94.3% negative predictive value.
To screen high-grade VUR in young infants with febrile UTI, US and acute DMSA scan could be performed first. VCUG is only indicated when abnormalities are apparent on either US or DMSA scan or both.
由于积极治疗儿童和幼婴发热性尿路感染（UTI）后，其膀胱输尿管反流（VUR）的改善结局缺乏良好证据，因此对于常规排尿性膀胱尿道造影（VCUG）的必要性以及这些儿童的适当影像学评估存在争议。
本前瞻性研究旨在确定急性二巯丁二酸扫描（DMSA）和超声（US）检查中发现的异常是否有助于指示年幼婴儿行 VCUG 的必要性。
在 3.5 年内，所有 3 个月以下因首次发热性 UTI 就诊的婴儿均进行前瞻性研究。所有婴儿在诊断后均住院并接受 US（入院后 3 天内）、DMSA 扫描（入院后 5 天内）和 VCUG（抗生素治疗后 7-10 天）检查。评估 US、DMSA 扫描和 VCUG 检查结果之间的相关性。
在 220 例婴儿中，有 136 例（61.8%）US 异常，111 例（50.5%）DMSA 扫描异常。通过 US 检查，诊断出 10 例（4.5%）有脓肿或除 VUR 以外的结构异常的婴儿。39 例（17.7%）存在高级别（III-V）VUR。单纯肾脏 US（76.9%）或单纯 DMSA 扫描（82.1%）对高级别 VUR 的敏感性均不如“OR 规则”策略，其敏感性为 92.3%，阴性预测值为 94.3%。
对于发热性 UTI 的幼婴筛查高级别 VUR，可首先进行 US 和急性 DMSA 扫描。只有在 US 或 DMSA 扫描或两者均有异常时，才需要进行 VCUG。
