Nisa Eda İLARSLAN ÇULLAS, Nuriye Özlem KÜÇÜK, Ömer Suat FİTÖZ, Fatma Fatoş YALÇINKAYA, Derya Gökmen ÖZTUNA

Doku harmonik görüntülemeli ultrasonografi ile birlikte power Doppler ultrasonografinin çocukluk çağı ateşli idrar yolu enfeksiyonu tanısındaki rolü

Amaç: Bu çalışmada; ateşli idrar yolu enfeksiyonu geçiren çocuklarda böbrekte parankimal tutulumun ortaya konulmasında altın standart gö- rüntüleme yöntemi olarak kabul edilen Tc-99m dimerkaptosüksinikasit böbrek sintigrafisi ile karşılaştırıldığında; doku harmonik görüntülemeli ultrasonografi ile birlikte power Doppler ultrasonografinin başarısı araş- tırılmıştır. Gereç ve Yöntemler: Bu ileriye dönük çalışmaya ilk kez ateşli idrar yolu enfeksiyonu tanısıyla hastanede yatarak tedavi edilen 60 hasta alındı. Tüm hastalar başvurudan sonraki ilk üç gün içinde hem Tc-99 m dimerkaptosüksinikasit böbrek sintigrafisi, hem de doku harmonik görüntü- lemeli ultrasonografi- power Doppler ultrasonografi ile değerlendirildi. Bulgular: Doku harmonik görüntülemeli ultrasonografi-power Doppler ultrasonografi ile değerlendirilen hastaların (n=60) 29unda böbrekte akut enfeksiyon bulgusu saptanırken; hastaların (n=60) 33ünde dimerkaptosüksinikasit böbrek sintigrafisinde anormallik saptandı. İlk kez ateşli idrar yolu enfeksiyonu tanısı alan hastalarda doku harmonik gö- rüntülemeli ultrasonografi - power Doppler ultrasonografinin altın standart görüntüleme yöntemi olarak kabul edilen Tc-99m dimerkaptosüksinikasit böbrek sintigrafisi ile karşılaştırıldığında; duyarlılığı %57,58 (%95 güvenirlik aralığı: %40,81-%72,76), özgüllüğü %62,96 (%95 güvenirlik aralığı: %44,23-%78,47), pozitif kestirim değeri: %65,52 (%95 güvenirlik aralığı: %52,04-%77), negatif kestirim değeri: %54,84 (%95 güvenirlik aralığı: %41,54-%67,52) olarak hesaplandı. Çıkarımlar: Her ne kadar eldeki veriler power Doppler ultrasonografinin başarısının henüz yeterli düzeyde olmadığını gösterse de; hastalar erken dönemde ve uygun sedasyon ile değerlendirildiğinde; pratik ve radyasyon içermeyen bir yöntem olan power Doppler ultrasonografi çocukluk çağı ateşli idrar yolu enfeksiyonu tanısında düzenli olarak uygulamalarda yer alabilir.

The role of tissue harmonic imaging ultrasound combined with power Doppler ultrasound in the diagnosis of childhood febrile urinary tract infections

Aim: This study assessed the ability of tissue harmonic imaging ultrasound combined with power Doppler ultrasound in the detection of childhood febrile urinary tract infections in comparison with the gold standard reference method: Tc-99m dimercaptosuccinicacid renal cortical scintigraphy. Material and Methods: This prospective study included 60 patients who were hospitalized with a first episode of febrile urinary tract infections. All children were examined with dimercaptosuccinicacid scan and tissue harmonic imaging ultrasound combined with power Doppler ultrasound within the first 3 days of admission. Results: Signs indicative of acute infection were observed in 29 patients according to the results of tissue harmonic imaging ultrasound combined with power Doppler ultrasound while dimercaptosuccinicacid scan revealed abnormal findings in 33 patients. The sensitivity, specificity, positive predictive value and negative predictive value of tissue harmonic imaging combined with power Doppler ultrasound using dimercaptosuccinicacid scintigraphy as the reference method in patients diagnosed with first episode febrile urinary tract infections were calculated as 57.58% (95% confidence interval: 40.81%-72.76%); 62.96% (95% confidence interval: 44.23%-78.47%); 65.52% (95% confidence interval: 52.04%-77%); 54.84% (95% confidence interval: 41.54%-67.52%); respectively. Conclusions: Although current results exhibit inadequate success of power Doppler ultrasound, this practical and radiation-free method may soon be comprise a part of the routine ultrasonographic evaluation of febrile urinary tract infections of childhood if patients are evaluated early and under appropriate sedation.

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