Zarei Elham, Hekmat Sepideh, Armandeh Jilla, Khodadost Mahmoud, Ramezani Farkhani Ahmad
Department of Radiology, Ali Asghar Children Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Nuclear Medicine, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2025 Mar 26;39:47. doi: 10.47176/mjiri.39.47. eCollection 2025.
Early detection of vesicoureteral reflux (VUR) is crucial to prevent potential complications such as recurrent urinary tract infections and kidney damage. Noninvasive diagnostic alternatives to voiding cystourethrography (VCUG), such as ultrasound (US) and 99mTc-DMSA scan, offer effective and safe methods for identifying VUR without exposing children to ionizing radiation. This investigation aimed to evaluate the efficacy of US and 99mTc-DMSA scan in detecting VUR compared with VCUG among children with urinary tract infection (UTI).
In this observational study, we included 540 hospitalized children with UTI in Aliasghar Children`s Hospital between April 2017 and May 2019. US and VCUG were performed on all patients, with 99mTc-DMSA administered to some to detect VUR. Sensitivity, specificity, positive and negative predictive values, overall accuracy, and kappa agreement were calculated to evaluate ultrasound efficacy in predicting VUR based on VCUG-confirmed existence or nonexistence of VUR.
Out of 540 patients, VCUG identified VUR in 143 cases, with 90 (63%) classified as grades III to V. US results were abnormal in 97 of the 143 patients (67.8%) confirmed to have VUR via VCUG, while the 99mTc-DMSA scan showed abnormalities in 41 out of 69 (59%) cases detected by VCUG. The sensitivity and negative predictive value (NPV) of the 99mTc-DMSA scan for diagnosing VUR were recorded at 59.42% and 46.59%, respectively. For ultrasound, the overall accuracy was 61.30%, with sensitivity at 67.83%, specificity at 58.94%, NPV at 37.31%, and positive predictive value (PPV) at 83.57%. In children with high-grade VUR (grades III-V) as determined by VCUG, the sensitivity, specificity, and NPV for ultrasound were found to be 80%, 58.2%, and 93.60%, respectively. However, when both US and 99mTc-DMSA scan results were utilized for detecting high-grade VUR, the sensitivity, specificity, and NPV were calculated to be 92%, 42.30%, and 93.20%, respectively.
While both US and the 99mTcDMSA scan are not fully reliable in detecting all grades of VUR individually, integration of US and ^99mTc-DMSA scan demonstrates reliable sensitivity and NPV for effectively excluding high-grade VUR. These findings suggest that in children with normal results from both US and ^99mTc-DMSA scans, there may be no need for VCUG. This approach could significantly reduce unnecessary VCUG procedures, minimizing patient exposure to radiation and enhancing overall diagnostic efficiency in pediatric care.
早期发现膀胱输尿管反流（VUR）对于预防诸如反复尿路感染和肾脏损害等潜在并发症至关重要。排尿性膀胱尿道造影（VCUG）的非侵入性诊断替代方法，如超声（US）和99m锝-二巯基丁二酸（99mTc-DMSA）扫描，为识别VUR提供了有效且安全的方法，同时避免儿童暴露于电离辐射。本研究旨在评估在尿路感染（UTI）患儿中，与VCUG相比，US和99mTc-DMSA扫描检测VUR的疗效。
在这项观察性研究中，我们纳入了2017年4月至2019年5月期间在阿利亚斯加尔儿童医院住院的540例UTI患儿。对所有患者进行了US和VCUG检查，部分患者接受了99mTc-DMSA检查以检测VUR。基于VCUG确诊的VUR存在与否，计算敏感性、特异性、阳性和阴性预测值、总体准确率以及kappa一致性，以评估超声预测VUR的疗效。
在540例患者中，VCUG确诊143例VUR，其中90例（63%）为III至V级。在经VCUG确诊有VUR的143例患者中，97例（67.8%）的US结果异常，而在经VCUG检测出的69例病例中，99mTc-DMSA扫描显示41例（59%）有异常。99mTc-DMSA扫描诊断VUR的敏感性和阴性预测值（NPV）分别为59.42%和46.59%。对于超声，总体准确率为61.30%，敏感性为67.83%，特异性为58.94%，NPV为37.31%，阳性预测值（PPV）为83.57%。在经VCUG确定为高级别VUR（III - V级）的患儿中，超声的敏感性、特异性和NPV分别为80%、58.2%和93.60%。然而，当同时使用US和99mTc-DMSA扫描结果检测高级别VUR时，敏感性、特异性和NPV分别计算为92%、42.30%和93.20%。
虽然US和99mTc-DMSA扫描单独检测所有级别的VUR时并不完全可靠，但将US和99mTc-DMSA扫描相结合显示出可靠的敏感性和NPV，可有效排除高级别VUR。这些发现表明，对于US和99mTc-DMSA扫描结果均正常的儿童，可能无需进行VCUG。这种方法可显著减少不必要的VCUG检查，使患者接触辐射最小化，并提高儿科护理中的整体诊断效率。
