Diagnostic Accuracy of Renal Ultrasonography for Vesicoureteral Reflux in Infants and Children Aged Under 24 Months with Urinary Tract Infections

Abstract

Purpose To compare the diagnostic accuracies of renal ultrasonography (US) and voiding cystourethrography (VCUG) for vesicoureteral reflux (VUR). Materials and MethodsThis retrospective study included infants and children (< 24 months of age) with urinary tract infections who underwent renal US and VCUG. The incidences of decreased or increased renal size, increased renal parenchymal echogenicity, ureteral dilation, ureteral wall thickening, renal pelvic dilation, pelvic wall thickening, and accentuated pelvic dilation in the prone position were compared. Grade 3 or higher VUR was classified as "highgrade." A total of 138 patients (109 males; mean age, 3 months) were included. Multivariate logistic regression analysis was performed, and diagnostic accuracy was calculated.Results Fifty-three (38.4%) and 43 (31.2%) patients exhibited all-grade and high-grade VUR. Decreased renal size was significantly related to all-grade [odds ratio (OR): 16.6; 95% confidence interval (CI): 3.4-81.3; p = 0.001) and high-grade VUR (OR: 29.7; 95% CI: 5.7-155.3; p < 0.001). Accentuated pelvic dilation in the prone position, increased renal parenchymal echogenicity, and ureteral dilation were related to all-grade and high-grade VUR. ConclusionDecreased renal size showed the highest diagnostic accuracy for US-based diagnosis of all-grade and high-grade VUR. Accentuated pelvic dilation in the prone position, increased renal parenchymal echogenicity, and ureteral dilation may aid in the diagnosis of high-grade VUR.

The role of ultrasound in the diagnosis of vesicoureteral reflux disease

“…In most of the previous studies, none of these parameters were not evaluated in US [13,17,18]. In some studies emphasizing the importance of US parameters other than APRPD (such as decreased renal size, increased renal parenchymal echogenicity and ureteral dilation), decreased renal size and ureter dilatation were found to be the most important parameters [19,20].…”

Comparison of Urinary Tract Dilatation and Society of Fetal Urology systems in the detection of vesicourethral reflux and renal scar

“…In our study, the most important reason for the superiority of UTD sensitivity, PPV, and NPV over SFU was that the ureter dilation and parenchymal echogenicity increased the UTD degree even with a normal pelvicalyceal system. In many studies, these parameters are shown to increase the sensitivity and specificity of US detection for VUR [ 17 , 18 ].…”