膀胱输尿管反流(VUR)是常见的先天性尿路异常,可表现为收集系统扩张或发热感染。VUR可导致需要手术的永久性肾后遗症,但也可自发消退而无并发症。因此,重要的是要认识到那些需要成像筛查的患者群体,确认,或者对VUR的持续监控,避免过度诊断。在适当的患者人群中,VUR的准确诊断可以早期治疗和预防肾盂肾炎和瘢痕形成。各种成像方式可用于诊断和分级VUR,包括排尿膀胱尿道图(VCUG),放射性核苷酸膀胱造影(RNC),和对比增强尿路超声造影(ceVUS)。本文的目的是总结当前对VUR诊断和管理的理解,并讨论这些成像方式的优势和陷阱。考虑因素包括VUR成像的适应症,病人准备,进行检查,与放射学报告有关的问题,和成本效益。重点放在ceVUS上,这是三种成像模式中最新推出的,并且在儿科放射科医生中得到了越来越多的支持。
Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that can present with collecting system dilation or as a febrile infection. VUR can lead to permanent renal sequelae requiring surgery but can also spontaneously resolve without complication. Therefore, recognizing patient populations who warrant imaging for screening, confirmation, or ongoing surveillance for VUR is important, as is avoiding overdiagnosis. In the appropriate patient populations, an accurate diagnosis of VUR allows early treatment and prevention of pyelonephritis and scarring. Various imaging modalities are available to diagnose and grade VUR, including voiding cystourethrography, radionucleotide cystography, and contrast-enhanced voiding urosonography (ceVUS). The objective of this article is to summarize the current understanding of VUR diagnosis and management and to discuss these imaging modalities\' strengths and pitfalls. Considerations include indications for VUR imaging, patient preparation, conduct of the examination, issues related to radiologic reporting, and cost-effectiveness. An emphasis is placed on ceVUS, which is the most recently introduced of the three imaging modalities and is receiving growing support among pediatric radiologists.