Hayatghaibi Shireen E, Alves Vinicius V, Coley Brian D, Previtera Melissa J, Zhang Bin, Ayyala Rama S, Iyer Ramesh, Trout Andrew T
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Radiology, Northwestern University, Chicago, IL, USA.
AJR Am J Roentgenol. 2025 Jul 9. doi: 10.2214/AJR.25.32739.
Fluoroscopic voiding cystourethrography (VCUG) is the most commonly used imaging test for the detection of vesicoureteral reflux (VUR) in children, although contrast-enhanced urosonography (ceVUS) and nuclear cystography (RNC) are also used for this purpose. The purpose of this study was to perform a systematic review and meta-analysis to determine the sensitivity and specificity of ceVUS and RNC for the detection of pediatric VUR using VCUG as the reference standard The Embase, Medline, BIOSIS, Scopus, Cochrane, and Web of Science databases were searched from their date of inception through June 2024 for studies performed in children that reported the sensitivity and specificity of ceVUS or RNC for the detection of VUR using VCUG as the reference standard. Studies' risk of bias was assessed using the QUADAS-2 tool. Diagnostic performance data were extracted from each study on a kidney-ureter level if available and on a patient level otherwise. Pooled sensitivity and specificity were estimated using bivariate random-effects models. Metaregression analysis was performed. Of 2757 unique studies screened, 42 studies with 3124 total children were included in the final analysis. Twenty-six and 16 studies were at overall high and low risk of bias, respectively. Using VCUG as the reference standard, ceVUS (37 studies) had pooled sensitivity of 86% (95% CI: 82-90%) and pooled specificity of 92% (95% CI: 90-94%). Using VCUG as the reference standard, RNC (5 studies) had pooled sensitivity of 81% (95% CI: 62-92%) and pooled specificity of 89% (95% CI: 75-95%). In metaregression analysis, publication year, sample size, patient age, and overall risk of bias had no significant association with sensitivity or specificity for either ceVUS or RNC (all p>.05). Pooled diagnostic performance estimates were derived for the available imaging tests for detecting VUR. However, most studies had an overall high risk of bias, highlighting a need for higher-quality comparative studies. The results may help shape evolving guidelines and inform selection among the available imaging tests in clinical practice.
荧光透视排尿膀胱尿道造影（VCUG）是检测儿童膀胱输尿管反流（VUR）最常用的影像学检查，不过对比增强超声检查（ceVUS）和核素膀胱造影（RNC）也用于此目的。本研究的目的是进行系统评价和荟萃分析，以确定以VCUG作为参考标准时ceVUS和RNC检测小儿VUR的敏感性和特异性。从创刊至2024年6月，检索了Embase、Medline、BIOSIS、Scopus、Cochrane和Web of Science数据库，查找在儿童中进行的、报告了以VCUG作为参考标准时ceVUS或RNC检测VUR的敏感性和特异性的研究。使用QUADAS-2工具评估研究的偏倚风险。若可行，从每项研究中提取肾脏-输尿管层面的诊断性能数据，否则提取患者层面的诊断性能数据。使用双变量随机效应模型估计合并敏感性和特异性。进行了Meta回归分析。在筛选的2757项独特研究中，最终分析纳入了42项研究，共3124名儿童。26项和16项研究分别处于总体高偏倚风险和低偏倚风险。以VCUG作为参考标准时，ceVUS（37项研究）的合并敏感性为86%（95%CI：82-90%），合并特异性为92%（95%CI：90-94%）。以VCUG作为参考标准时，RNC（5项研究）的合并敏感性为81%（95%CI：62-92%），合并特异性为89%（95%CI：75-95%）。在Meta回归分析中，发表年份、样本量、患者年龄和总体偏倚风险与ceVUS或RNC的敏感性或特异性均无显著关联（所有p>0.05）。得出了用于检测VUR的现有影像学检查的合并诊断性能估计值。然而，大多数研究总体偏倚风险较高，这突出表明需要开展更高质量的比较研究。研究结果可能有助于完善不断演变的指南，并为临床实践中现有影像学检查的选择提供参考。
