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Can Duplex Doppler ultrasound predict the complete
obstruction in children with unilateral ureteropelvic junction
obstruction?
Poster No.:
C-0212
Congress:
ECR 2016
Type:
Scientific Exhibit
Authors:
A. H. Sarrami , M. Riahinezhad , M. Farghadani ; Isfahan, Is/IR,
1
2
2
3 1
3
Isfahan/IR, NORTH FARABI/IR
Keywords:
Obstruction / Occlusion, Diagnostic procedure, Ultrasound-Colour
Doppler, Ultrasound, Nuclear medicine conventional, Pediatric,
Kidney, Arteries / Aorta
DOI:
10.1594/ecr2016/C-0212
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Page 1 of 6
Aims and objectives
Duplex Doppler ultrasound is a safe and useful modality for evaluation of children
with hydronephrosis. It may be used to improve the ability of conventional ultrasound
in distinguishing between obstructive and non-obstructive hydronephrosis. Resistive
index (RI) is the most valuable duplex index reflecting the renal obstructive conditions.
Diagnostic value of RI has been shown in the evaluation of hydronephrosis in children
as well as in adults. In children with unilateral ureteropelvic junction obstruction (UPJO)
increase of RI in intraparenchymal arteries may be a noticeable finding. However, RI is
an age dependent parameter and utility of the adult's threshold value in young children
can be misleading. It has been shown that the utility of RI ratio and a comparison of
RI values between the right and left kidneys are more reliable than using a RI cutoff
value in the evaluation of children with unilateral obstruction. In this study we assess the
value of these indices as a non-ionizing convenient method for predicting the degree of
obstruction in children with unilateral UPJO.
Images for this section:
Fig. 1: Duplex Doppler indices used for the evaluation of patients with UPJO
© isfahan University of medical sciences, Alzahra Hospital - Isfahan/IR
Page 2 of 6
Methods and materials
In a prospective study between January 2014 and March 2015, children referred to
radiology department of Emam Hosein Children hospital (a tertiary center in Isfahan, Iran)
for evaluation of unilateral hydronephrosis were enrolled, consecutively. The patients
with the evidence of UPJO in grey-scale ultrasound were offered for supplementary
Doppler study. In duplex Doppler study mean of RI of arcuate arteries in upper, middle
and lower parts of both kidneys of each patient were obtained. Then RI ratio and
difference of RI between kidneys of each patient (dRI) were calculated and recorded.
Voiding cystourethrogram was done for exclusion of the cases with concomitant
vesicoureteral reflux. In the next step, standard diuretic renal scintigraphy with Tc 99m
diethylenetriamine pentaacetic acid (DTPA) was performed for the patients.
Images for this section:
Fig. 2: 99m TC-DPTA scan from a 1 year-old female with right sided hydronephrosis. The
scan shows persistent retention of isotope in right kidney, left kidney has cleared off well.
© isfahan University of medical sciences, Alzahra Hospital - Isfahan/IR
Page 3 of 6
Fig. 3: 99m TC-DPTA time-activity curves from the same patient which show reduce in
renal function and complete obstruction in right kidney.
© isfahan University of medical sciences, Alzahra Hospital - Isfahan/IR
Page 4 of 6
Results
Of the 51 patients with primary diagnosis of UPJO in grey scale ultrasound, 27 were
confirmed as UPJO by diuretic renal scintigraphy, and the others had various degrees
of decrease in renal function and perfusion or had normal scan. UPJO patients were 16
(59.3%) male and 11 (40.7) female aged 2 months to 9 years. Rate of non-complete
and complete UPJO were 85.2% and 14.8%, respectively. Mean RI in kidneys with
complete UPJO was 0.77 ± 0.09 and in kidneys with non-complete UPJO was 0.68 ± 0.05
(p=0.009). Evaluating the ability of the indices in distinguishing the complete from noncomplete UPJO, the area under the ROC curve for RI was 79.8% (95% CI 46.1, 100), for
RI ratio was 90.8% (95% CI 77.9, 100.0) and for dRI was 92.4% (95% CI 79.4, 100.0).
Conclusion
Using RI, RI ratio and dRI can provide a non-ionizing convenient method for predicting
complete UPJO and may be used for supporting the results of DPTA scan especially in
challenging diuretic renograms. Larger studies are needed to validate our findings.
Personal information
Maryam Riahinezhad MD, Radiologist, Emam Hosein Children hospital, Isfahan
University of Medical Sciences, Isfahan, Iran; [email protected]
Amir Hossein Sarrami MD, Resident of Radiology, Emam Hosein Children hospital,
Isfahan University of Medical Sciences, Isfahan, Iran; [email protected]
Maryam Farghadani MD, Radiologist, Alzahra hospital, Isfahan University of Medical
Sciences, Isfahan, Iran; [email protected]
References
1- Lee HJ, Kim SH, Jeong YK, Yeun KM. Doppler sonographic resistive index in
obstructed kidneys. J Ultrasound Med. 1996;15(9):613-8; quiz 619-20.
Page 5 of 6
2- Lim GY, Jang HS, Lee EJ, Lim YS, Jung SE, Lee JM, et al. Utility of the resistance
index ratio in differentiating obstructive from nonobstructive hydronephrosis in children.
J Clin Ultrasound. 1999;27(4):187-93.
3- Okada T, Yoshida H, Iwai J, Matsunaga T, Yoshino K, Ohtsuka Y, et al.
Pulsed Doppler sonography of the hilar renal artery: differentiation of obstructive from
nonobstructivehydronephrosis in children. J Pediatr Surg. 2001;36(3):416-20.
4- Brkljaci# B, Kuzmi# AC, Dmitrovi# R, Rados M, Vidjak V. Doppler sonographic renal
resistance index and resistance index ratio in children and adolescents with unilateral
hydronephrosis. Eur Radiol. 2002;12(11):2747-51.
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