Mehmet SARIKAYA, Hasan ÖNNER, Fatma ÖZCAN SIKI, Farise YILMAZ, Gonca KARA GEDİK, İlhan ÇİFTCİ

Voiding Sistoüretrogram ile Tanı Konulan Vezikoüreteral Reflü'nün Saptanmasında Dinamik Böbrek Sintigrafisinin Rolü

Amaç: Bu çalışmada voiding sistouretrografi (VCUG) ile vezikoüreteral reflü (VUR) saptanan hastalarda standart dinamik böbrek sintigrafisinin (DRS) VUR'u tanımadaki rolünü değerlendirmeyi amaçladık. Yöntemler: 2013-2013 yılları arasında hastanemizde hem VCUG hem de DRS [teknetyum-99m dietilentriamin pentaasetik asit (Tc-99m DTPA) veya teknesyum-99m merkaptoasetiltriglisin dinamik böbrek sintigrafisi (Tc-99m MAG-3)] yapılan tüm çocuk hastaların verileri. 2022 yılı geriye dönük olarak incelendi. Bebeklerde Tc-99m MAG-3, bir yaşın üzerindeki çocuklarda ise Tc-99m DTPA radyofarmasötiği kullanıldı. VCUG bulgularına göre VUR dereceleri, derece I-II-III düşük dereceli VUR ve IV-V yüksek dereceli VUR olarak gruplandırıldı. DRS'nin hem düşük hem de yüksek VUR dereceli gruplarda VUR'u tespit etmedeki rolü değerlendirildi. Bulgular: Bu çalışmaya 23'ü kız (%41.1) ve 33'ü erkek (%68.9) olmak üzere toplam 56 hasta (ve 69 böbrek ünitesi) dahil edildi. DRS ve VCUG incelemeleri arasında geçen sürenin ortanca değeri dokuz gündü. VCUG'a göre VUR beş böbrek ünitesinde grade I, 19 böbrek ünitesinde grade II, altı böbrek ünitesinde grade III, altı böbrek ünitesinde grade IV ve 33 böbrek ünitesinde grade V idi. DRS'de düşük VUR dereceli grupta 30 böbrek ünitesinin ikisinde (%6,7) VUR tespit edildi. Yüksek VUR dereceli grupta ise 39 böbrek ünitesinin 27'sinde (%69,2) DRS ile birlikte VUR gözlendi. Sonuçlar: Standardize edilmiş DRS, düşük dereceli VUR'u tanımada düşük hassasiyet gösterirken yüksek dereceli VUR'u tespit etmedeki performansı oldukça iyidir. Klinisyenlerin VUR'un standardize DRS ile görülebileceği konusunda farkındalığının arttırılması, eşlik eden VUR patolojilerinin erken tespiti açısından hasta yararına olacaktır.

Anahtar Kelimeler:

Vezikoüreteral Reflü, Sintigrafi, Voiding sistoüreterografi

The Role of Dynamic Renal Scintigraphy in Detecting Vesicoureteral Reflux Diagnosed by Voiding Cystourethrogram

Aims: This study aims to evaluate the role of standardized dynamic renal scintigraphy (DRS) in recognizing vesicoureteral reflux (VUR) in patients detected with VUR by voiding cystourethrography (VCUG). Methods: The data of all pediatric patients who underwent both VCUG and DRS [technetium-99m diethylenetriamine pentaacetic acid (Tc-99m DTPA) or technetium-99m mercaptoacetyltriglycine dynamic renal scintigraphy (Tc-99m MAG-3)] in our hospital between 2013 and 2022 were retrospectively reviewed. Tc-99m MAG-3 was used in infants and Tc-99m DTPA radiopharmaceutical in children over one year old. According to VCUG findings, VUR grades were grouped as grade I-II-III low-grade VUR and IV-V high-grade VUR. The role of DRS in detecting VUR in both low and high-VUR-grade groups was evaluated. Results: A total of 56 patients (and 69 renal units), 23 girls (%41.1), and 33 boys (%68.9) were included in this study. The median value of the time elapsed between the DRS and VCUG examinations was nine days. According to VCUG, VUR was grade I in five renal units, grade II in 19 renal units, grade III in six renal units, grade IV in six renal units, and grade V in 33 renal units. DRS detected VUR in two of 30 renal units (%6.7) in the low VUR grade group. On the other hand, VUR was observed with DRS in 27 of 39 renal units (%69.2) in the high VUR grade group. Conclusions: Standardized DRS shows very low sensitivity in recognizing low-grade VUR, and its performance in detecting high-grade VUR is comparatively better. Raising awareness among clinicians that VUR can be observed with standardized DRS will benefit the patient in terms of early detection of accompanying VUR pathologies.

Keywords:

Vesicoureteral reflux, scintigraphy, Voiding cystourethrogram,

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