Dacher J N, Pfister C, Monroc M, Eurin D, LeDosseur P
Department of Pediatric Radiology, Hôpital Charles Nicolle, Rouen, France.
AJR Am J Roentgenol. 1996 Jun;166(6):1451-5. doi: 10.2214/ajr.166.6.8633462.
Focal areas of decreased perfusion may be shown by power Doppler sonography in children with acute pyelonephritis. The purposes of this study were to assess the ability of power Doppler sonography to reveal acute pyelonephritis and to compare the sonographic images with enhanced CT images.
We performed B-mode sonography, power Doppler sonography, and enhanced CT (reference method) of the kidneys of 30 children with symptoms suggesting upper urinary tract infection. All imaging studies were obtained within 24 hr of admission of each child to our hospital. Power Doppler sonography was performed with the same equipment and the same settings for all children. Imaging studies were performed before the results of urine cultures were obtained. Triangular areas of decreased perfusion visible on both longitudinal and axial scans were considered indicative of acute pyelonephritis on power Doppler sonographic images. On CT images, areas of decreased attenuation of the renal parenchyma visible immediately after IV injection of iodinated contrast agent or areas of increased attenuation on delayed scans were considered indicative of acute pyelonephritis. Power Doppler sonography and CT were compared for each renal pole (n = 120).
For 17 (89%) of the 19 patients with CT-proven acute pyelonephritis, power Doppler sonography diagnosed this condition on the correct side. Seventeen (77%) of the 22 poles showing acute pyelonephritis on CT scans were also revealed by power Doppler sonography. The two patients in whom acute pyelonephritis was not revealed by power Doppler sonography were an obese 15-year-old girl and a 7-year-old boy with right upper pole pyelonephritis. This boy was one of the first patients to be included in the study. Also, in an obese 11-year-old girl, a false-positive indication of pyelonephritis was given by power Doppler sonography.
Power Doppler sonography seems to be significantly more sensitive than conventional sonography for the detection of acute pyelonephritis in children. This noninvasive technique should be able to replace CT or dimercaptosuccinic acid scintigraphy in many children with urinary tract infections.
能量多普勒超声检查可能显示急性肾盂肾炎患儿存在灌注降低的局灶区域。本研究的目的是评估能量多普勒超声检查揭示急性肾盂肾炎的能力，并将超声图像与增强CT图像进行比较。
我们对30例有提示上尿路感染症状的儿童的肾脏进行了B型超声检查、能量多普勒超声检查和增强CT（参考方法）。所有影像学检查均在每个儿童入院后24小时内完成。对所有儿童使用相同的设备和相同的设置进行能量多普勒超声检查。在获得尿培养结果之前进行影像学检查。在纵向和轴向扫描上均可见的灌注降低的三角形区域在能量多普勒超声图像上被视为急性肾盂肾炎的指征。在CT图像上，静脉注射碘化造影剂后立即可见的肾实质衰减降低区域或延迟扫描时衰减增加的区域被视为急性肾盂肾炎的指征。对每个肾极（n = 120）的能量多普勒超声检查和CT检查结果进行比较。
在19例经CT证实为急性肾盂肾炎的患者中，17例（89%）能量多普勒超声检查在正确的一侧诊断出了这种情况。CT扫描显示有急性肾盂肾炎的22个肾极中，17个（77%）也被能量多普勒超声检查发现。能量多普勒超声检查未发现急性肾盂肾炎的两名患者是一名肥胖的15岁女孩和一名患有右上极肾盂肾炎的7岁男孩。这个男孩是该研究纳入的首批患者之一。此外，在一名肥胖的11岁女孩中，能量多普勒超声检查给出了肾盂肾炎的假阳性指征。
能量多普勒超声检查在检测儿童急性肾盂肾炎方面似乎比传统超声检查明显更敏感。这种非侵入性技术应该能够在许多患有尿路感染的儿童中替代CT或二巯基丁二酸闪烁扫描。
