Veziko üreteral reflü hastalığında ultrasonun rolünü nasıl belirleyebiliriz?

Amaç: Ultrasonografinin (US), veziko-üreteral reflü tanısındaki rolünü, endikasyonlarını açıklamak ve özellikli hasta grubunda, tanıda gold standart olan voiding sistoüretrografi’yle (VCUG) kıyaslamayı amaçladık. Gereç ve Yöntemler: Nisan 2010 - Mart 2019 tarihleri arasında tek bir radyolog tarafından uygulanmış 532 VCUG ve eş zamanlı US tetkiki retrospektif olarak değerlendirildi. Demografik özellikler, US’de; pelvik staz, pelvikaliksiyel dilatasyon, hidroüreteronefroz ile VCUG’de reflü varlığı kaydedildi. İki testi kıyaslamak için ROC analizi yapıldı. Bulgular: Yaşları 5 ay- 18 yaş arasında değişen hastaların 342’ si (% 64,3) kadın, 190 ‘ı (% 35,7) erkek idi. Hastalar 6 yaş altı (n=286) ve 6 yaş üstü (n=246) olmak üzere iki gruba ayrıldı. 6 yaş altında US ve VCUG bulgularında korelasyon saptanırken (p<0.005, OR=6,977), 6 yaş üstünde saptanmadı (p=0,539). ROC analizinde US’nin VUR saptamadaki, sensitivite, spesifite, pozitif prediktif değer (PPV), ve negatif prediktif değeri (NPV) 6 yaş altında; % 89,76 , % 47,86 %, % 65,1 ve % 81,2 (AUC= 0,688, p= 0,0001), 6 yaş üstünde % 50,49, % 53,55, % 38,0 ve % 65,8 (AUC=0,520, p= 0,5720) olarak hesaplandı. Tartışma: US, hastalığın tanısında kolay, tekrarlanabilen, güvenli ve etkin bir yöntemdir. Yüksek sensitivite (% 89,7) ve NPV ( % 81,2) oranları ile 6 yaş altında tarama testi olarak kullanılabilir. VCUG tüm yaş gruplarında kesin tanı için gold standart incelemedir.

Anahtar Kelimeler:

Vezikoüreteral reflü, Voiding sistoüreterografi, , Ultrasonografi, , Pediatri, , Tanı, , Görüntüleme

How can we specify the role of ultrasonography in the vesico – ureteral reflux disease?

Objectives: We aimed to explore the role and indication for the use of ultrasonography (US) in the vesico-ureteral reflux (VUR) disease and demonstrate the non – inferiority against the gold standard voiding cystourethrography (VCUG) for the screening in a certain group of patients. Material and Methods: This is a retrospective analysis of 532 simultaneous VCUG and US examinations between April 2010 and March 2019, by a single radiologist in our hospital. Demographic characteristics, pelvic stasis, pelvi – calyxeal dilatation and hydro – uretero – nephrosis in the US, and reflux in the VCUG were recorded. ROC analysis was done for comparing the two tests. Results: Among the cases between 5 months to 18 years of age, 342 (64.3 %) were female, and 190 (35.7 %) were male. The cases were divided into two groups below and after 6 years of age (N = 246 (46.2 %), and 286 (43.8%) respectively. There was a correlation between US and VCUG findings below the age of 6 (p<0.005, OR=6,977), but not in the cases over (p=0,539). In the ROC analysis of US in detection of VUR, compared to VCUG, sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) below 6 years age is 89,76 %, 47,86 %, 65,1 %, and 81,2 % (AUC= 0,688, p= 0,0001) respectively, and those above 6 years of age are 50,49 %, 53,55 %, 38,0 %, and 65,8 % (AUC=0,520, p= 0,5720). Conclusion: US is easy, reproducible, safe and effective for diagnosis, and staging of the disease. Its high sensitivity (89.7 %), and negative predictive value (81.2 %), can make it an initial screening test in the patients below 6 years of age. VCUG as a gold standard modality can be reserved for definitive diagnosis in the suspected cases below the age of 6 and all of the cases after the age of 6.

Keywords:

Vesicoureteral reflux, , Voiding cysto-urethrography, Ultrasonography, Pediatrics, Diagnosis, Screening,

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