剪切波弹性成像能否用于鉴别儿童梗阻性与非梗阻性肾积水？

Can Shear-Wave Elastography be Used to Discriminate Obstructive Hydronephrosis from Nonobstructive Hydronephrosis in Children?

机构信息

From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., M.A.D., R.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D., J.M.R.), Section of Pediatric Urology, Department of Urology (K.H.K.), and Division of Nuclear Medicine, Department of Radiology (R.K.J.B.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.

出版信息

Radiology. 2015 Oct;277(1):259-67. doi: 10.1148/radiol.2015142884. Epub 2015 May 12.

DOI:10.1148/radiol.2015142884

PMID:25965902

Abstract

PURPOSE

To determine if ultrasonographic (US) renal shear-wave speed (SWS) measurements obtained either before or after intravenous diuretic administration can be used to discriminate obstructive hydronephrosis from unobstructive hydronephrosis in children, with diuretic renal scintigraphy as the reference standard.

MATERIALS AND METHODS

Institutional review board approval and parental informed consent were obtained for this HIPAA-compliant prospective cross-sectional blind comparison with a reference standard. Between November 2012 and September 2014, 37 children (mean age, 4.1 years; age range, 1 month to 17 years) underwent shear-wave elastography of the kidneys immediately before and immediately after diuretic renal scintigraphy (reference standard for presence of urinary tract obstruction). Median SWS measurements (in meters per second), as well as change in median SWS (median SWS after diuretic administration minus median SWS before diuretic administration) were correlated with the amount of time required for kidney radiotracer activity to fall by 50% after intravenous administration of the diuretic (T1/2). Median SWS measurements were compared with degree of obstruction and degree of hydronephrosis with analysis of variance. Receiver operating characteristic (ROC) curves were created.

RESULTS

Radiotracer T1/2 values after diuretic administration did not correlate with median SWS measurements obtained before (r = -0.08, P = .53) or after (r = -0.0004, P >.99) diuretic administration, nor did they correlate with intraindividual change in median SWS (r = 0.07, P = .56). There was no significant difference in pre- or postdiuretic median SWS measurements between kidneys with scintigraphic evidence of no, equivocal, or definite urinary tract obstruction (P > .5) or for median SWS measurements between kidneys with increasing degree of hydronephrosis (P > .5). ROC curves showed poor diagnostic performance of median SWS in discerning no, equivocal, or definite urinary tract obstruction (area under the ROC curve ranged from 0.50 to 0.62).

CONCLUSION

US SWS measurements did not enable discrimination of obstructive hydronephrosis from unobstructive hydronephrosis in children.

摘要

目的

通过与利尿剂肾闪烁照相法（作为参考标准）对比，确定在给予患儿静脉注射利尿剂前后，通过超声测量肾脏剪切波速度（SWS）能否鉴别梗阻性与非梗阻性肾积水。

材料与方法

本研究经 HIPAA 认证，为前瞻性、盲法、对照研究，于 2012 年 11 月至 2014 年 9 月期间共纳入 37 名儿童（平均年龄 4.1 岁，1 个月至 17 岁）。所有儿童均在利尿剂肾闪烁照相法检查前即刻和检查后即刻进行肾脏剪切波弹性成像检查（该检查用于判断尿路是否梗阻）。以中位数表示 SWS 测量值（以米/秒为单位），并计算 SWS 中位数的变化值（利尿剂后 SWS 中位数减去利尿剂前 SWS 中位数），与静脉给予利尿剂后肾脏示踪剂活性降低 50%所需的时间（T1/2）进行相关性分析。采用方差分析比较 SWS 中位数与梗阻程度、积水程度的相关性。绘制受试者工作特征（ROC）曲线。

结果

利尿剂后 T1/2 值与利尿剂前（r = -0.08，P =.53）或利尿剂后（r = -0.0004，P >.99）的 SWS 中位数测量值均无相关性，也与个体内 SWS 中位数的变化值（r = 0.07，P =.56）无相关性。在无、不确定或明确尿路梗阻的闪烁照相法证据的肾脏之间，或在积水程度逐渐加重的肾脏之间，利尿剂前或后 SWS 中位数测量值均无显著差异（P >.5）。ROC 曲线显示 SWS 中位数鉴别无、不确定或明确尿路梗阻的诊断效能较差（ROC 曲线下面积范围为 0.50 至 0.62）。