Vezikoüreteral reflü saptanan pediatrik olgularda shear wave elastografi ve superb mikrovasküler görüntüleme yöntemleri ile böbrek parankim hasarının değerlendirilmesi ve sintigrafi sonuçları ile karşılaştırılması
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Vezikoüreteral reflü idrarın mesaneden üreter ve pelvikalisiyel sisteme anormal geri kaçışı olup, tekrarlayan idrar yolu enfeksiyonu gelişimine ve piyelonefrite yol açabilir. Piyelonefrit sırasında oluşan yangı unilateral veya bilateral böbreklerde renal parankimal skar olarak adlandırılan kalıcı zedelenmeye neden olabilir. Bu nedenle vezikoüreteral reflünün erken tanı ve tedavisi tekrarlayan idrar yolu enfeksiyonunun ve renal skar gelişiminin önlenerek böbrek fonksiyonunun korunması açısından önemlidir. Dimerkaptosüksinik asit sintigrafisi skar dokusunu göstermede altın standart yöntemdir ancak yüksek radyasyon maruziyeti içermektedir. Çalışmamızda superb microvascular imaging ve shear wave elastografi gibi güncel ultrasonografi yöntemlerini kullanarak skar dokusu izlenen böbrek parankiminde artmış elastisiteyi ve azalmış kan akımını değerlendirerek skar dokusu varlığını öngörmede bu iki yöntemin etkinliğini araştırdık. Prospektif çalışmamızda 40 hasta dahil edilmiş olup, vezikoüreteral reflü olan 49 böbrek ve vezikoüreteral reflü olmayan 31 böbrek bulunmaktadır. Tüm böbreklerin süperb mikrovasküler imaging ile vaskülarite özellikleri ve shear wave elastografi ile parankim sertlik dereceleri bağımsız 2 radyolog tarafından incelendi. Shear wave elastografi ve süperb mikrovasküler imaging değerleri skar dokusu olan ve olmayan böbreklerde istatistiksel anlamlı farklılık saptanmıştır (p<0,01). Shear wave elastografi ve süperb mikrovasküler imaging değerlerinde vezikoüreteral reflü olan ancak skar dokusu olmayan böbrekler ile vezikoüreteral reflü olmayan böbreklerde anlamlı farklılık saptanmadı (p>0.05). Çalışmamız, literatüre bakıldığında skar dokusunun mikrovaskülarizasyonunu ve doku elastisitesinin birlikte etkili bir şekilde değerlendirildiği ilk çalışma olması açısından önem taşımaktadır. SWE ve SMI ucuz, radyasyon içermeyen yöntemler olması, skar dokusunun saptanması ve değerlendirilmesinde faydalı yöntemler olması nedeniyle vezikoüreteral reflü tanısı alan, dimerkaptosüksinik asit sintigrafisi ile böbreklerinde skar bulunan hastaların tedavi takibinde kullanılabilecek tamamlayıcı alternatif yöntemler olarak değerlendirilebilir.
Vesicoureteral reflux is the abnormal reflux of urine from the bladder into the ureter and pelvicalyceal system, which can lead to the development of recurrent urinary tract infections and pyelonephritis. The inflammation that occurs during pyelonephritis can cause permanent damage to unilateral or bilateral kidneys, called renal parenchymal scarring. Therefore, early diagnosis and treatment of vesicoureteral reflux is important to protect renal function by preventing recurrent urinary tract infection and renal scar development. Dimercaptosuccinic acid scintigraphy is the gold standard method for demonstrating scar tissue, but it involves high radiation exposure. In our study, we investigated the effectiveness of these two methods in predicting the presence of scar tissue by evaluating increased elasticity and decreased blood flow in the kidney parenchyma where scar tissue was observed, using current ultrasonography methods such as superb microvascular imaging and shear wave elastography. In our prospective study, 40 patients were included, 49 kidneys with vesicoureteral reflux and 31 kidneys without vesicoureteral reflux. The vascularity characteristics of all kidneys with superb microvascular imaging and the parenchymal stiffness levels with shear wave elastography were examined by 2 independent radiologists. A statistically significant difference was found in shear wave elastography and superb microvascular imaging values in kidneys with and without scar tissue (p<0.01). There was no significant difference in shear wave elastography and superb microvascular imaging values between kidneys with vesicoureteral reflux but without scar tissue and kidneys without vesicoureteral reflux (p>0.05). When we examine the literatüre, our study appears to be the first study in which both microvascularization of scar tissue and tissue elasticity are effectively evaluated together. Shear wave elastography and superb microvascular imaging can be considered as complementary alternative methods that can be used in the follow-up of the treatment of kidneys with scarring detected by dimercaptosuccinic acid scintigraphy in vesicoureteral reflux patients, as they are inexpensive, radiation-free methods and useful methods in detecting scar tissue.
Vesicoureteral reflux is the abnormal reflux of urine from the bladder into the ureter and pelvicalyceal system, which can lead to the development of recurrent urinary tract infections and pyelonephritis. The inflammation that occurs during pyelonephritis can cause permanent damage to unilateral or bilateral kidneys, called renal parenchymal scarring. Therefore, early diagnosis and treatment of vesicoureteral reflux is important to protect renal function by preventing recurrent urinary tract infection and renal scar development. Dimercaptosuccinic acid scintigraphy is the gold standard method for demonstrating scar tissue, but it involves high radiation exposure. In our study, we investigated the effectiveness of these two methods in predicting the presence of scar tissue by evaluating increased elasticity and decreased blood flow in the kidney parenchyma where scar tissue was observed, using current ultrasonography methods such as superb microvascular imaging and shear wave elastography. In our prospective study, 40 patients were included, 49 kidneys with vesicoureteral reflux and 31 kidneys without vesicoureteral reflux. The vascularity characteristics of all kidneys with superb microvascular imaging and the parenchymal stiffness levels with shear wave elastography were examined by 2 independent radiologists. A statistically significant difference was found in shear wave elastography and superb microvascular imaging values in kidneys with and without scar tissue (p<0.01). There was no significant difference in shear wave elastography and superb microvascular imaging values between kidneys with vesicoureteral reflux but without scar tissue and kidneys without vesicoureteral reflux (p>0.05). When we examine the literatüre, our study appears to be the first study in which both microvascularization of scar tissue and tissue elasticity are effectively evaluated together. Shear wave elastography and superb microvascular imaging can be considered as complementary alternative methods that can be used in the follow-up of the treatment of kidneys with scarring detected by dimercaptosuccinic acid scintigraphy in vesicoureteral reflux patients, as they are inexpensive, radiation-free methods and useful methods in detecting scar tissue.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
