超声排泄性尿路造影在膀胱输尿管反流分级中的诊断价值

Diagnostic value of contrast-enhanced voiding urosonography in grading of vesicoureteral reflux

目的评估超声排泄性尿路造影(CeVUS)在膀胱输尿管反流(VUR)诊断及分级评判中的准确性及超声观察者间分级的一致性。方法纳入39例(共79个肾盂-输尿管单位)进行CeVUS及X线逆行尿路造影(VCUG)检查的患儿进行回顾性分析。以VCUG检查结果为金标准,计算CeVUS对VUR诊断的特异度、灵敏度及分级的准确率。以Kappa检验分析2名超声医师间对诊断VUR不同的超声征象及VUS分级评判的一致性。结果79个肾盂-输尿管单位的CeVUS检查结果与VCUG比较显示,CeVUS诊断VUR的特异度为90.6%,灵敏度89.4%。42个显示反流的肾盂-输尿管单位的分级准确率为90.5%,其中Ⅱ、Ⅲ、Ⅳ及Ⅴ级的准确率分别为100%、80.0%、93.8%和90.9%。2名观察者对输尿管显影、输尿管扭曲、肾盂显影、肾盂扩张程度、肾盏显影、肾盏扩张程度、肾盏形态失常的判断的κ值分别为1.00、1.00、1.00、0.66(95%CI:0.52~0.80)、0.91(95%CI:0.82~1.00)、0.79(95%CI:0.70~0.89)、0.69(95%CI:0.56~0.81)。对VUS整体分级判断的一致性为0.87(95%CI:0.80~0.93)。结论CeVUS在对儿童VUR的诊断和分级上的准确率较高,且可避免辐射损害,应作为VUR诊断的首选检查和随访工具。应用CeVUS的VUR分级系统进行分级时,观察者间总体分级一致性极好,具有较好的临床应用价值。

Objective To assess the accuracy of contrast-enhanced voiding urosonography (CeVUS) in diagnosing and grading of vesicoureteral reflux (VUR) and the consistency of the grading between the ultrasound observers.Methods Thirty-nine patients (79 Pyeloureteric units) examined by CeVUS and voiding cystourethrography (VCUG) were retrospectively analyzed.Based on the results of VCUG as the gold standard,the specificity,sensitivity and accuracy of grading diagnosis of CeVUS were calculated,and the consistency of different ultrasonic signs and grading evaluation of VUR between two ultrasound doctors was analyzed by Kappa test.Results Compared with VCUG,the specificity and sensitivity of CeVUS in 79 PUUs was 90.6% and89.4%,respectively.The accuracy of grading of 42 pyeloureteral units with reflux was 90.5%,the accuracy of grade Ⅱ,Ⅲ,Ⅳ,Ⅴ was 100%,80.0%,93.8% and 90.9%,respectively.The judgment of ureter development,ureter distortion,renal pelvis development,degree of renal pelvic dilatation,calyceal development,degree of calyceal dilatation,loss of renal pelvis contour between observers,the values of κ were 1,1,1,0.66 (0.52-0.80),0.91 (0.82-1.00),0.79 (0.70-0.89),and 0.69 (0.56-0.81) (95% confidence interval in brackets),respectively.The consistency of overall grading judgment was 0.87 (0.80-0.93).Conclusion This study suggested that CeVUS with no ionizing radiation has a high accuracy in diagnosing and grading of VUR in children.It should be the first choice for the diagnosis and follow-up tool of VUR.When using CeVUS grading system for grading VUR,the overall consistency of the grading between the observers was excellent,which shows the feasibility of the CeVUS grading system even with different doctors.