Zhu Hui, Chen Minguang, Luo Hongxia, Pan Yin, Zheng Wenjie, Yang Yan
Department of Ultrasound, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Pediatrics, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Transl Pediatr. 2020 Aug;9(4):487-495. doi: 10.21037/tp-20-59.
This study aimed to compare the diagnostic and predictive value of power Doppler ultrasonography (PDU) with Tc-99m dimercaptosuccinic acid (DMSA) renal scintigraphy in pediatric acute pyelonephritis (APN) using a semiquantitative analysis system.
A total of 92 children and infants (184 kidneys) were hospitalized with possible APN. All children were examined by PDU and DMSA scintigraphy within 72 hours of admission. An empiric 9-point semiquantitative analysis system was used to sort kidneys into four grades (grade 0-III). Patients with several episodes of APN and congenital structural anomalies were excluded.
Of 184 kidneys, we found 68 abnormal (grade I-III) and 116 normal (Grade 0) with DMSA scintigraphy, and 84 abnormal and 100 normal with PDU. In all, 23 kidneys were shown to be diseased by PDU but normal on DMSA scintigraphy while 7 kidneys showed the opposite trend. The sensitivity and specificity of PDU for diagnosing APN was 89.7% and 80.2%, respectively (P<0.05). In children older than 6 months, the sensitivity was higher (92%, P<0.05) than that in children younger than 6 months (87%, P<0.05). A moderate agreement (41%, P<0.05) on grade was found between the two methods.
With the help of a semiquantitative analysis system, PDU can obviate the use of DMSA scintigraphy in children older than 6 months for APN diagnosis.
本研究旨在使用半定量分析系统比较能量多普勒超声（PDU）与锝-99m二巯基丁二酸（DMSA）肾闪烁扫描术在小儿急性肾盂肾炎（APN）中的诊断和预测价值。
共有92名儿童和婴儿（184个肾脏）因可能患有APN而住院。所有儿童在入院72小时内接受了PDU和DMSA闪烁扫描术检查。使用经验性的9分半定量分析系统将肾脏分为四个等级（0-III级）。排除患有多次APN发作和先天性结构异常的患者。
在184个肾脏中，DMSA闪烁扫描术发现68个异常（I-III级）和116个正常（0级），PDU发现84个异常和100个正常。共有23个肾脏经PDU显示患病但DMSA闪烁扫描术显示正常，而7个肾脏显示相反趋势。PDU诊断APN的敏感性和特异性分别为89.7%和80.2%（P<0.05）。在6个月以上的儿童中，敏感性（92%，P<0.05）高于6个月以下的儿童（87%，P<0.05）。两种方法在分级上存在中度一致性（41%，P<0.05）。
借助半定量分析系统，PDU可避免对6个月以上儿童使用DMSA闪烁扫描术进行APN诊断。
