Barry B P, Hall N, Cornford E, Broderick N J, Somers J M, Rose D H
Department of Radiology, Nottingham City Hospital, UK.
Clin Radiol. 1998 Oct;53(10):747-51. doi: 10.1016/s0009-9260(98)80317-6.
A system for defining renal scarring on ultrasound is proposed and compared with DMSA scintigraphy. Renal scarring was assessed with ultrasound in children following urinary tract infection (UTI) using the following criteria: (1) proximity of sinus echoes to cortical surface; (2) loss of pyramids; (3) irregularity of outline; (4) loss of definition of capsular echo; and (5) calyceal dilatation. Three hundred and thirty-nine consecutive ultrasound scans (US) and DMSA scintigrams, comprising 648 kidneys, were performed and reported blindly and the results were compared. Using DMSA scintigraphy as the gold standard, ultrasound had a positive predictive value of 93% and a negative predictive value of 95%. Ultrasound disagreed with DMSA scintigraphy in 5.2% of kidneys. On review of the cases of disagreement where arbitration was possible by comparison with other imaging, ultrasound was incorrect in 10 kidneys and DMSA was incorrect in 13. We conclude that the sensitivity in the ultrasound detection of renal scarring can be greatly improved using this method. If no scars were detected at ultrasound an alternative explanation for an abnormal DMSA scintigram should be sought.
本文提出了一种用于在超声检查中定义肾瘢痕的系统，并将其与二巯基丁二酸（DMSA）肾闪烁显像进行比较。采用以下标准，对尿路感染（UTI）患儿进行超声检查以评估肾瘢痕：（1）肾窦回声与皮质表面的接近程度；（2）肾锥体缺失；（3）轮廓不规则；（4）包膜回声清晰度丧失；（5）肾盏扩张。对连续339例超声扫描（US）和DMSA肾闪烁显像检查进行了盲法操作并报告，共涉及648个肾脏，然后对结果进行比较。以DMSA肾闪烁显像作为金标准，超声检查的阳性预测值为93%，阴性预测值为95%。超声检查与DMSA肾闪烁显像结果不一致的肾脏占5.2%。在复查那些可以通过与其他影像学检查对比进行仲裁的不一致病例时，超声检查有10个肾脏结果错误，DMSA肾闪烁显像有13个肾脏结果错误。我们得出结论，使用这种方法可大大提高超声检测肾瘢痕的敏感性。如果超声检查未发现瘢痕，则应寻找其他原因来解释异常的DMSA肾闪烁显像结果。
