Abstract:
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Purpose: It has been proposed that a meticulous ultrasound of the renal tract can exclude reflux and thus avoid the need for micturating cystourethrography (MCUG) in neonates. This study evaluates the accuracy of ultrasound for vesicoureteric reflux(VUR).
Methods and Materials: Ultrasound and MCUG examinations in 227 children aged 12 months and under, presenting with proven urinary tract infection (UTI) were studied retrospectively. The ultrasound criteria used to evaluate each kidney were renal size, presence of scarring, presence of pelvi-calyceal or ureteric dilatation, cortico-medullary differentiation and renal pelvis thickening. The corresponding MCUG was graded according to the International system of radiographic grading of vesicoureteral reflux.
Results: There was reflux into 140 kidneys on direct MCUG and thus prevalence of VUR is 31%. Of the 140 refluxing kidneys, positive ultrasound findings were present in 1 of 14 with Grade1 VUR, 5 of 99 with Grade2 VUR, 3 of 21 with Grade3 VUR, 2 of those with Grade4 VUR and both with Grade5 VUR. The latter were the only renal units to demonstrate scarring. Ultrasound abnormalities were found in 9 of 312 kidneys without VUR. Thus the sensitivity of ultrasound in detecting is 10%. The specificity is 97%. The negative predictive value and positive predictive value for ultrasound are 70% and 60% respectively.
Conclusion: This data therefore emphasizes the importance of the MCUG in the investigation of UTI in the infant under 1 year, as the presence of VUR cannot be determined with ultrasound alone.
Low MD, D,
The Importance of the Micturating Cystourethrogram in the Investigation of Urinary Tract Infection in Children Aged 1 Year and Under. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3101880.html
