Departamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brasil.
Departamento de Urologia, Universidade Estadual de Feira de Santana - UEFS, Feira de Santana, BA, Brasil.
Int Braz J Urol. 2023 Nov-Dec;49(6):700-715. doi: 10.1590/S1677-5538.IBJU.2023.0311.
This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB).
A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively.
A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring.
DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.
本研究旨在分析动态和静态超声（DSUS）在检测神经源性膀胱（NB）患儿中膀胱输尿管反流（VUR）和肾瘢痕的诊断准确性。
本研究采用报告诊断准确性研究指南进行回顾性、纵向、观察性研究。将 DSUS（指标试验）数据与排尿性膀胱尿道造影（VCUG）和 99mTc-二巯丁二酸肾闪烁显像（参考试验）进行比较。使用 DSUS 上肾盂直径（RPD）/远端输尿管直径和肾实质变薄分别评估预测 VUR 和肾瘢痕的整体性能。
共纳入 107 例患者（66 例女性，中位年龄 9.6 岁）。17 例（15.9%）患者存在 VUR，其中 8 例为双侧。对于整体反流程度，RPD 和远端输尿管直径的 AUC 分别为 0.624 和 0.630。DSUS 参数在检测高级别 VUR 方面的诊断性能稍好。RPD 和远端输尿管直径的 AUC 分别为 0.666 和 0.691。RPD 为 5mm 和远端输尿管直径为 6.5mm 的截断值具有最佳的诊断优势比（DOR）来识别高级别 VUR。逼尿肌收缩时 RPD 的增加具有 89.2%的准确性。肾实质变薄对肾瘢痕的准确性为 88%。
DSUS 对 NB 患儿的 VUR 和肾瘢痕具有良好的诊断准确性，所有测量值均具有较高的阴性预测值（NPV）。在本研究中，逼尿肌收缩期间 RPD 的增加被证明是指示 VUR 存在的最准确参数。
