Tacyildiz Suna Yergin, Tacyildiz Celal, Bilgici Meltem Ceyhan
Department of Radiology, Agri Training and Research Hospital, Agri, Turkey; Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.
Department of Radiology, Agri Training and Research Hospital, Agri, Turkey; Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.
J Pediatr Urol. 2025 Jun 27. doi: 10.1016/j.jpurol.2025.06.028.
Vesicoureteral reflux (VUR) is a disease that refers to retrograde escape of urine from the bladder to the urinary collecting system. It is mostly seen in the pediatric age group. Children with VUR have an increased risk of urinary tract infections (UTIs), pyelonephritis, and kidney scarring. The aim of this study was to investigate the effect of VUR on the affected kidney in children via shear wave elastography (SWE) and to evaluate its relationship with dimercaptosuccinic acid (DMSA) data.
Our study was conducted prospectively between January 2020 and May 2023, including 52 children who were diagnosed with VUR, and 54 healthy children constituted the control group. Kidneys were divided into upper pole, mid-kidney, and lower pole, and at least three SWE values in meters per second (m/sec) were obtained from each zone. For each kidney, we obtained the arithmetic mean of the three zones. We obtained DMSA scintigraphy images from the patients within a month. We compared the DMSA data and SWE values of healthy controls and children with VUR.
Compared with the control group, the mean SWE values in the right and left kidneys were significantly lower in VUR patients with no scar on the DMSA (p = 0.039 for right, p = 0.00 for left). There was no significant difference between the mean SWE values in pediatric patients with scarred VUR and those in the control group (p = 0.584 for right, p = 0.184 for left). In the patient and control groups, a positive correlation was observed between age and the SWE values (for the right kidney, p < 0.001 in the patient group and control group; for the left kidney, p = 0.003 in the patient group and p = 0.001 in the control group, p < 0.05).
In our study, the SWE values of kidneys diagnosed with VUR without a scar were significantly lower than those of the control group. There was no significant difference between the SWE values of the VUR-diagnosed kidney with scar and the control group. SWE may be a useful modality to determine whether the kidney is affected by the disease by measuring parenchymal stiffness in children with VUR without scarring.
SWE may help detect renal parenchymal involvement in children with VUR, especially before scar formation, and could serve as a complementary, radiation-free imaging modality to DMSA. SWE values increase with age in children.
膀胱输尿管反流（VUR）是一种尿液从膀胱逆行至泌尿系统的疾病。多见于儿童群体。患有VUR的儿童发生尿路感染（UTI）、肾盂肾炎和肾瘢痕形成的风险增加。本研究的目的是通过剪切波弹性成像（SWE）研究VUR对儿童患侧肾脏的影响，并评估其与二巯基丁二酸（DMSA）数据的关系。
我们的研究于2020年1月至2023年5月前瞻性进行，包括52例被诊断为VUR的儿童，54例健康儿童构成对照组。肾脏分为上极、肾中部和下极，每个区域至少获取三个以米每秒（m/sec）为单位的SWE值。对于每个肾脏，我们获取三个区域的算术平均值。在一个月内从患者处获取DMSA闪烁扫描图像。我们比较了健康对照组和VUR患儿的DMSA数据和SWE值。
与对照组相比，DMSA检查无瘢痕的VUR患者左右肾脏的平均SWE值显著降低（右侧p = 0.039，左侧p = 0.00）。有瘢痕的VUR患儿与对照组的平均SWE值之间无显著差异（右侧p = 0.584，左侧p = 0.184）。在患者组和对照组中，年龄与SWE值之间存在正相关（对于右侧肾脏，患者组和对照组p < 0.001；对于左侧肾脏，患者组p = 0.003，对照组p = 0.001，p < 0.05）。
在我们的研究中，诊断为无瘢痕VUR的肾脏的SWE值显著低于对照组。诊断为有瘢痕的VUR肾脏与对照组的SWE值之间无显著差异。SWE可能是一种通过测量无瘢痕的VUR患儿肾实质硬度来确定肾脏是否受疾病影响的有用方法。
SWE可能有助于检测VUR患儿的肾实质受累情况，尤其是在瘢痕形成之前，并且可作为DMSA的一种无辐射的补充成像方法。儿童的SWE值随年龄增加。
