PDF(Pubmed)
Abstract：
This study aimed to assess the feasibility of contrast-enhanced ultrasound (CEUS) for the diagnosis of acute pyelonephritis (APN) in pediatric patients with febrile urinary tract infection (UTI).
Between March 2019 and January 2021, study participants with suspected UTI were assessed for APN using ultrasound. Parenchymal echogenicity changes, renal pelvis dilatation, and the presence of a focal suspected lesion were assessed using conventional grayscale ultrasound. The presence and location of a decreased perfusion area were evaluated using color Doppler ultrasound (CDUS) and CEUS. Agreement between each ultrasound examination and a 99mTc‒dimercaptosuccinic acid (DMSA) scan was assessed using the κ value, and the most visible period of the lesion was evaluated using CEUS.
This study enrolled 21 participants (median age, 8.0 months; range, 2.0-61.0 months) with isolated urinary tract pathogens. Five increased parenchymal echotextures (11.9%) and 14 renal pelvic dilatations (33.3%) were confirmed, but no focal lesions were detected on the grayscale images. CDUS and CEUS showed decreased local perfusion suggestive of APN in two and five kidneys, respectively. DMSA scan showed substantial agreement with CEUS findings (κ = 0.80, P = 0.010), but other grayscale and CDUS findings did not agree with DMSA scan results (P > 0.05). All lesions were best observed in the late parenchymal phase on CEUS.
CEUS can reveal renal perfusion defects in pediatric patients with suspected APN without radiation exposure or sedation; therefore, CEUS may be a feasible and valuable diagnostic technique.
Between March 2019 and January 2021, study participants with suspected UTI were assessed for APN using ultrasound. Parenchymal echogenicity changes, renal pelvis dilatation, and the presence of a focal suspected lesion were assessed using conventional grayscale ultrasound. The presence and location of a decreased perfusion area were evaluated using color Doppler ultrasound (CDUS) and CEUS. Agreement between each ultrasound examination and a 99mTc‒dimercaptosuccinic acid (DMSA) scan was assessed using the κ value, and the most visible period of the lesion was evaluated using CEUS.
This study enrolled 21 participants (median age, 8.0 months; range, 2.0-61.0 months) with isolated urinary tract pathogens. Five increased parenchymal echotextures (11.9%) and 14 renal pelvic dilatations (33.3%) were confirmed, but no focal lesions were detected on the grayscale images. CDUS and CEUS showed decreased local perfusion suggestive of APN in two and five kidneys, respectively. DMSA scan showed substantial agreement with CEUS findings (κ = 0.80, P = 0.010), but other grayscale and CDUS findings did not agree with DMSA scan results (P > 0.05). All lesions were best observed in the late parenchymal phase on CEUS.
CEUS can reveal renal perfusion defects in pediatric patients with suspected APN without radiation exposure or sedation; therefore, CEUS may be a feasible and valuable diagnostic technique.
摘要：
目的：本研究旨在评估超声造影（CEUS）诊断小儿发热性尿路感染（UTI）患者急性肾盂肾炎（APN）的可行性。
方法：在2019年3月至2021年1月之间，使用超声评估疑似UTI的研究参与者的APN。实质回声改变，肾盂扩张,使用常规灰阶超声评估是否存在疑似病灶.使用彩色多普勒超声（CDUS）和CEUS评估灌注区域减少的存在和位置。使用κ值评估每次超声检查与99mTc-二巯基琥珀酸（DMSA）扫描之间的一致性，并且使用CEUS评估病变的最可见时段。
结果：本研究招募了21名参与者（中位年龄，8.0个月；范围，2.0-61.0个月）与分离的泌尿道病原体。证实有5例实质回声增加（11.9％）和14例肾盂扩张（33.3％），但是在灰度图像上没有检测到局灶性病变。CDUS和CEUS显示两个和五个肾脏的局部灌注减少，提示APN，分别。DMSA扫描显示与CEUS结果基本一致（κ=0.80，P=0.010），但其他灰度和CDUS结果与DMSA扫描结果不一致(P>0.05)。在CEUS上，所有病变最好在实质晚期观察到。
结论：CEUS可显示疑似APN的儿科患者的肾灌注缺陷，但没有辐射暴露或镇静作用；因此，CEUS可能是一种可行且有价值的诊断技术。
方法：在2019年3月至2021年1月之间，使用超声评估疑似UTI的研究参与者的APN。实质回声改变，肾盂扩张,使用常规灰阶超声评估是否存在疑似病灶.使用彩色多普勒超声（CDUS）和CEUS评估灌注区域减少的存在和位置。使用κ值评估每次超声检查与99mTc-二巯基琥珀酸（DMSA）扫描之间的一致性，并且使用CEUS评估病变的最可见时段。
结果：本研究招募了21名参与者（中位年龄，8.0个月；范围，2.0-61.0个月）与分离的泌尿道病原体。证实有5例实质回声增加（11.9％）和14例肾盂扩张（33.3％），但是在灰度图像上没有检测到局灶性病变。CDUS和CEUS显示两个和五个肾脏的局部灌注减少，提示APN，分别。DMSA扫描显示与CEUS结果基本一致（κ=0.80，P=0.010），但其他灰度和CDUS结果与DMSA扫描结果不一致(P>0.05)。在CEUS上，所有病变最好在实质晚期观察到。
结论：CEUS可显示疑似APN的儿科患者的肾灌注缺陷，但没有辐射暴露或镇静作用；因此，CEUS可能是一种可行且有价值的诊断技术。
