Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Nursing Intensive Care Unit, Faculty of Nursery and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
J Pediatr Urol. 2022 Feb;18(1):61-74. doi: 10.1016/j.jpurol.2021.10.023. Epub 2021 Nov 3.
The diagnostic value of contrast-enhanced voiding urosonography (ceVUS) in the diagnosis of vesicoureteral reflux (VUR) is still a subject of dispute.
Assessing the diagnostic value of ceVUS in VUR, performing a systematic review and meta-analysis.
An extensive search on Medline, Embase, Scopus and Web of Science databases was conducted by the end of 2020. The inclusion criteria were studies on the diagnostic value of ceVUS for VUR. Two independent researchers summarized the included articles and the findings were reported as area under the curve (AUC), sensitivity and specificity with a 95% confidence interval (95% CI).
Finally, the data of 36 articles were included in the present meta-analysis (2768 children). The VUS assessment showed that 1297 of the cases were true positives, 3661 were true negatives, 398 were false positives and 169 were false negatives. The AUC, sensitivity and specificity of ceVUS with the first-generation contrast agent in the diagnosis of VUR in children and adolescents were obtained as 0.97 (95% CI: 0.95, 0.98), 0.92 (95% CI: 0.86, 0.96) and 0.94 (95% CI: 0.95, 0.98), respectively. Moreover, AUC, sensitivity and specificity of ceVUS with the second-generation contrast agent were 0.97 (95% CI: 0.95, 0.98), 0.93 (95% CI: 0.86, 0.97) and 0.91 (95% CI: 0.86, 0.95).
The findings of the present study showed that diagnostic value of ceVUS with both first-generation and second-generation contrast agents for VUR, is in an excellent range. Although it seems that ceVUS may be applied as a radiation-free alternative to imaging techniques such as VCUG, the presence of 3% of false negatives in this test is a limitation. Since the lack of punctual management of VUR is associated with serious renal complications in children, future studies are recommended to be focused on the evaluation of the Benefit-risk evaluation of ceVUS.
对比增强超声（ceVUS）在诊断膀胱输尿管反流（VUR）中的诊断价值仍存在争议。
评估 ceVUS 在 VUR 中的诊断价值，进行系统评价和荟萃分析。
通过在 Medline、Embase、Scopus 和 Web of Science 数据库中进行广泛搜索，截止到 2020 年底，纳入了关于 ceVUS 对 VUR 诊断价值的研究。两名独立的研究人员总结了纳入的文章，并以曲线下面积（AUC）、敏感性和特异性及 95%置信区间（95%CI）报告了结果。
最终，本荟萃分析纳入了 36 篇文章的数据（2768 例儿童）。VUS 评估显示，1297 例为真阳性，3661 例为真阴性，398 例为假阳性，169 例为假阴性。第一代造影剂诊断儿童青少年 VUR 时，ceVUS 的 AUC、敏感性和特异性分别为 0.97（95%CI：0.95，0.98）、0.92（95%CI：0.86，0.96）和 0.94（95%CI：0.95，0.98）。此外，第二代造影剂的 AUC、敏感性和特异性分别为 0.97（95%CI：0.95，0.98）、0.93（95%CI：0.86，0.97）和 0.91（95%CI：0.86，0.95）。
本研究结果表明，第一代和第二代造影剂的 ceVUS 诊断 VUR 的价值均处于极佳范围。尽管 ceVUS 似乎可以作为 VCUG 等影像学技术的无辐射替代方法，但该检查存在 3%的假阴性是一个局限性。由于儿童 VUR 的及时处理缺失与严重的肾脏并发症相关，建议未来的研究侧重于评估 ceVUS 的获益-风险评估。
