DIAGNOSTIC VALUE OF INTRAVENOUS CONTRAST ENHANCED POWER DOPPLER ULTRASOUND IN CHILDREN WITH ACUTE PYELONEPHRITIS

Purpose: Acute pyelonephritis (APN) is a major cause of morbidity in children with urinary tract infection and can result in irreversible renal scar- ring. Renal scarring can be prevented by early diagnosis and aggressive tre- atment. DMSA renal cortical scintigraphy is regarded as the gold standard method for the diagnosis of APN. The purpose of our prospective study was to determine the effectiveness of contrast-enhanced PDUS in the diagnosis of APN. Materials and Methods: Twenty-three patients (20 female, 3 male; 5 mon- ths to 9 years) were evaluated with B-mode ultrasound, PDUS, contrast- enhanced PDUS and Tc-99m-DMSA scintigraphy. Scintigraphy was consi- dered the gold standard method. The sonographic findings were correlated with scintigraphic data. Results: The sensitivity rates of B-mode ultrasound, PDUS and contrast- enhanced PDUS were (respectively) 30%, 78% and 86%; specificity rates were 84.09%, 59.09% and 79.54%; accuracy rates were 64.49%, 65.94%and 81.88%; positive predictive values were 51.72%, 52.00% and 70.49%; and the negative predictive values were 67.88%, 82.53% and 90.90%. Conclusion: The sensitivity of B-mode US in the diagnosis of APN is very low and the diagnostic value of this modality is doubtful. The sensitivity of PDUS is high enough but the specificity of this technique is lower than ex- pected. Contrast-enhanced PDUS achieved high sensitivity and specificity rates. We think that this imaging modality can be part of the diagnostic and follow-up protocol for APN and even may replace scintigraphic techniqu- es. Key Words: Akut pyelonefrit, kontrastli power Doppler US. AKUT PYELONEFRITLI COCUKLARDA INTRAVENOZ KONTRASTLI POWER DOPPLER SONOGRAFININ T ANIYA KATKISI Amac: Akut pyelonefrit (APN), cocukluk caginin uriner enfeksiyonlari icinde kalici renal skarlara yolacabilen onemli bir morbidite nedenidir. Re- nal skar gelisimi erken tani ve uygun tedavi ile onlenebilir. DMSA renal kortikal sintigrafi gunumuzde APN teshisinde altin standart yontem olarak kabul edilmektedir. Bu prospektif calismanin amaci kontrastli power Dopp- ler US’nin APN teshisindeki etkinligini ortaya koymaktir. Materyal ve Metot: APN on tanili 23 hasta (20 kiz, 3 erkek; 5 ay-9 yas) B-mode ultrason, PDUS, kontrastli PDUS ve Tc-99m-DMSA sintigrafi ile incelenmistir. Sintigrafi altin standart yontem olarak Kabul edilmistir. So- nografik bulgular sintigrafik bulgularla kiyaslanmistir. Bulgular: B-mod ultrason, PDUS ve kontrastli PDUS’nin duyarlilik deger- leri (sirasiyla) % 30, % 78, % 86; ozgulluk degerleri % 84.09, % 59.09, %79.54; dogruluk degerleri % 64.49, % 65.94, % 81.88; pozitif kestirim degerleri % 51.72, % 52.00, % 70.49 ve negative kestirim degerleri % 67.88,% 82.53 and % 90.90 olarak bulunmustur. Sonuc: APN tanisinda B-mod sonografinin duyarliligi cok dusuk olup, tanisal degeri tartismalidir. PDUS’nin duyarliligi yuksek ancak ozgullugu sinirlidir. Kontrastli PDUS tetkiki ile yuksek duyarlilik ve ozgulluk deger- lerine ulasilmis olup, bu yontemin APN’nin tani ve takip protokolunde yer alabilecegi, hatta bu konudaki bilgi birikimi ve tecrube arttikca sintigrafinin yerini alabilecegi dusunulmektedir. Anahtar Kelimeler: Akut pyelonefrit, kontrastli power Doppler US.