How may Doppler indices help in the differentiation of obstructive from nonobstructive hydronephrosis?

(2018) How may Doppler indices help in the differentiation of obstructive from nonobstructive hydronephrosis? Journal of Research in Medical Sciences. ISSN 1735-1995

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Abstract

Background: We assess the potency of different Doppler indices in the differentiation of obstructive and nonobstructive hydronephrosis. Materials and Methods: In this study, infants and children who were referred for the evaluation of unilateral hydronephrosis were enrolled. Ultrasonography for the assessment of the degree of hydronephrosis and a voiding cystourethrogram for the exclusion of vesicoureteral reflux was performed. Then, Doppler ultrasonography was done for both kidneys of each patient using four classic Doppler indices as well as the difference (delta) of each index between to kidneys. Diuretic renography with 99 mTc-ethylene dicysteine (99 mTc-EC) was performed for each patient. Results: Thirty-nine patients met the inclusion criteria. After diuretic renography, 29 (74.35) patients had shown a nonobstructive pattern, and ten (25.65) patients had a partial (intermediate) or complete obstruction. Using receiver operating characteristic (ROC) curve, none of the classic indices of Doppler duplex (i.e., resistive index RI, resistance index, end diastolic velocity, and peak systolic velocity) had the ability to make a difference between obstructive and nonobstructive hydronephrosis. However, by calculating the difference (delta) of these indices between two kidneys of each patient, delta RI could differentiate the nonobstructive condition, significantly (P = 0.006). A cutoff value of 0.055 has 60% sensitivity and 82.8% specificity. The area under the ROC curve for delta RI is 0.795 (standard error: 0.086, 95% confidence interval CI: 0.626, 0.964). Furthermore, RI ratio between two kidneys of each patient could differentiate the nonobstructive condition, significantly (P = 0.012). A cutoff point of 1.075 has 70% sensitivity and 82.8% specificity. The area under the ROC curve for RI ratio was 0.769 (standard error: 0.104, 95% CI: 0.565, 0.973). Conclusion: This study shows that RI ratio and delta RI with a high specificity could differentiate nonobstructive hydronephrosis and therefore it is a promising way to use especially in the follow-up of children with hydronephrosis.

Item Type: Article
Keywords: doppler hydronephrosis pediatric radioisotope renography ultrasonography ureteropelvic junction obstruction renal-resistive index ureteropelvic junction obstruction vesicoureteral reflux pelvis dilatation children sonography infants scintigraphy kidneys ultrasonography
Divisions: Faculty of Medicine > Department of Basic Science > Department of Medical Physics
Faculty of Medicine > Departments of Clinical Sciences > Department of Pediatrics
Faculty of Medicine > Departments of Clinical Sciences > Department of Radiology
Other
Journal or Publication Title: Journal of Research in Medical Sciences
Journal Index: ISI
Volume: 23
Identification Number: ARTN 76 10.4103/jrms.JRMS₆₂₇₁₇
ISSN: 1735-1995
Depositing User: Zahra Otroj
URI: http://eprints.mui.ac.ir/id/eprint/9729

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