Abstract
Contrast-enhanced ultrasound (CEUS) is a new potential modality for the quantitative evaluation of the microvascular perfusion of a parenchymal organ. To prospectively and quantitatively analyse the role of CEUS in evaluating renal perfusion for assessing renal function in children with ureteropelvic junction obstruction (UPJO). The study protocol was approved by the local ethics committee, and written informed consent was obtained from the patients' parents or guardians. Ultrasonography, CEUS, and radioisotope renography were performed for 51 children (42 boys, 9 girls; mean age, 6.75±4.14 years) with unilateral UPJO. The slope of the ascending curve (A), time to peak (TTP), peak intensity (PI), and area under the curve (AUC) were recorded during CEUS; quantitative data were calculated by QLab system (semiautomated border tracking, Philips Healthcare) software. Sensitivity and specificity values were determined for CEUS with respect to radioisotope renography. CEUS was used to evaluate 102 kidneys in 51 patients, for which the perfusion time-intensity curve (TIC) was determined. The TIC of renal cortical perfusion in all groups showed an asymmetrical single-peak curve, which could be clearly distinguished between the experimental group and the control group. Compared with the control group, the experimental group showed a markedly prolonged TTP but a significantly decreased A (P<0.05). There was no significant correlation between the AUC, PI and differential renal function (DRF), but the correlation coefficient between TTP, A and DRF remained significant (p<0.001).The receiver operating characteristic (ROC) curves drawn to differentiate DRF using the TTP value yielded an area under the ROC curve (AUROC) of 0.86. For a quantitative assessment of DRF less than 40% by CEUS, the sensitivity and specificity values were 92.86% and 76.14%, respectively. Unlike in previous studies, no significant difference in the AUC or PI was found between the control group and the experimental group in this study (P>0.05). Renal blood perfusion could not be evaluated overall by CEUS. Parenchymal thinning may be considered a limitation to CEUS. This preliminary experience represents the first report of evaluating the diagnostic value of CEUS in assessing renal function in children with UPJO. CEUS is a highly sensitive, rapid, and cost-effective diagnostic imaging modality for detecting and monitoring renal function noninvasively.
Highlights
Contrast-enhanced ultrasonography (CEUS) is a new potential modality for the quantitative evaluation of the microvascular perfusion of a parenchymal organ
This preliminary experience represents the first report of evaluating the diagnostic value of CEUS in assessing renal function in children with Ureteropelvic junction obstruction (UPJO)
The glomerular filtration rate (GFR) and differential renal function (DRF) were determined by 99mTc DTPA renography
Summary
Contrast-enhanced ultrasonography (CEUS) is a new potential modality for the quantitative evaluation of the microvascular perfusion of a parenchymal organ. Ureteropelvic junction obstruction (UPJO) is a common cause of upper urinary obstruction in children and is usually detected by antenatal or neonatal ultrasound screening. Diuretic renography (DRG) is the only diagnostic tool for evaluating differential renal function and upper urinary drainage in UPJO patients. Contrast-enhanced ultrasound (CEUS) has become widely used to investigate renal vessels and parenchymal abnormalities[3,4,5]. Studies have shown that contrast-enhanced US is almost as sensitive as radioisotope renography in the quantitative diagnosis of chronic renal insufficiency, and correspondingly, contrast-enhanced US could be a useful tool for the assessment of renal function in children with UPJO[7,8,9]. Ionizing radiation exposure is a known risk factor for patients with leukaemia and brain tumours, especially for children with a higher radiation sensitivity and longer life expectancy[10, 11].The EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) release guidelines state that intravenous CEUS is safe and effective in paediatric populations and can be used effectively to avoid ionizing radiation exposure[11]
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