Dynamic and static ultrasound features predictive of vesicoureteral reflux and renal damage in children and adolescents with neurogenic bladder

ABSTRACT Purpose: This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB). Materials and Methods: A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively. Results: A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring. Conclusion: DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.

Intima-media thickness of the carotid arteries is affected by pubertal maturation in healthy adolescents / Espessura médio-intimal das artérias carótidas é relacionada à maturação puberal em adolescentes saudáveis

ABSTRACT Objective: To contribute to the assessment of normal parameters of carotid intima-media thickness (CIMT) in healthy adolescents. Methods: A cross-sectional study was conducted through clinical, laboratory and ultrasound evaluation in 61 healthy adolescents. The inclusion criteria consisted of being in good health. The exclusion criteria were: presence or history of any chronic disease; being obese or overweight according to the World Health Organization (WHO) established criterion; continuous use of medication; or presenting a febrile condition or requiring medication within 48-hours prior to assessment. The pubertal stages were evaluated using the Tanner criteria. The high-resolution B-mode ultrasound examinations were performed according to the recommendations of the Consensus Statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Results: Adolescents were 14±2.6 years old, 62.3% female, 19 (31%) at early puberty (Tanner II and III), and 38 (62%) at late puberty (Tanner IV and V). They presented normal clinical and laboratorial parameters. CIMT values were 0.46±0.04 to 0.55±0.04 mm on the right and 0.48±0.02 to 0.53±0.04 mm on the left, according to pubertal maturation. CIMT values increased significantly on the right and left sides, according to pubertal stage (p<0.001 and p=0.016), and maximum internal diameters of the common carotid artery (p<0.025 and p<0.003). It was higher in males compared to females. Conclusions: An increase in CIMT in the healthy adolescents group, according to both age, and the degree of pubertal maturation should be considered when evaluating adolescents in diagnostic procedures.

RESUMO Objetivo: Contribuir para a avaliação dos parâmetros normais da espessura médio-intimal carotídea (EMIC) em adolescentes saudáveis. Métodos: Estudo transversal realizado por meio de avaliações clínicas, laboratoriais e ultrassonográficas em 61 adolescentes saudáveis. O critério de inclusão foi ter boa saúde. Os critérios de exclusão foram: presença ou histórico de doença crônica; obesidade ou sobrepeso segundo os parâmetros estabelecidos pela Organização Mundial da Saúde (OMS); uso contínuo de medicação; e quadro febril ou que necessitasse de uso de medicação nas 48 horas anteriores à avaliação. Os estágios puberais foram avaliados pela escala de Tanner. As ultrassonografias em modo B de alta resolução foram realizadas seguindo as recomendações do Consensus Statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force (Declaração de Consenso da Força Tarefa da Sociedade Americana de Ecocardiografia sobre Espessura Médio-Intimal Carotídea). Resultados: Os adolescentes tinham 14±2,6 anos, 62,3% eram do sexo feminino, 19 (31%) estavam em estágios iniciais da puberdade (2 e 3) e 38 (62%) em estágios avançados (4 e 5) de acordo com a escala de Tanner. Todos apresentavam parâmetros clínicos e laboratoriais normais. Os valores da EMIC variaram de 0,46±0,04 a 0,55±0,04 mm do lado direito e 0,48±0,02 a 0,53±0,04 mm do lado esquerdo, conforme a maturação puberal. Houve aumento significativo nos valores da EMIC em ambos os lados de acordo com o estágio puberal (p<0,001 e p=0,016) e os diâmetros internos máximos da artéria carótida comum (p<0,025 e p<0,003). A EMIC foi maior em participantes do sexo masculino em relação ao feminino. Conclusões: O aumento da EMIC em adolescentes saudáveis, conforme a idade e o grau de maturação puberal, deve ser levado em consideração nas avaliações diagnósticas.