Can ultrasound parameters predict the diagnostic yield of diuretic renal scintigraphy in pediatric hydronephrosis?

TL;DR

This study explores whether ultrasound measurements can predict the usefulness of a kidney imaging test in children with hydronephrosis.

Contribution

The study identifies that ultrasound parameters can predict obstruction patterns in diuretic renal scintigraphy but not non-diagnostic results.

Findings

Ultrasound parameters did not reliably predict non-diagnostic diuretic renal scintigraphy outcomes.

Ultrasound parameters effectively identified obstruction patterns in diuretic renal scintigraphy.

Anterior-posterior renal pelvic diameter showed the highest predictive performance for obstruction patterns.

Abstract

Diuretic renal scintigraphy (DRS) is a valuable imaging tool for distinguishing obstructive from non-obstructive hydronephrosis, especially in pediatric patients, but non-diagnostic results are not uncommon. In this retrospective analytical study, we examined if kidney ultrasound (US) parameters can predict non-diagnostic DRS, and DRS with an obstruction pattern, potentially guiding patient selection to reduce unnecessary radiation exposure. The study included 67 patients (134 kidneys), 1-month to 4-years of age who underwent both DRS and US. Receiver operating characteristic (ROC) curve analysis of US parameters including parenchymal thickness, cortical thickness, medullary pyramidal thickness, anterior-posterior renal pelvic diameter, was done to assess the predictiveness of these parameters for prediction of DRS results. None of the US parameters reliably predicted non-diagnostic DRS results (AUC range: 0.41–0.61). However, these parameters demonstrated good predictiveness for identifying DRS with an obstruction pattern (AUC range: 0.69–0.87), with anterior-posterior renal pelvic diameter showing the highest performance. These findings suggest that while US parameters cannot predict non-diagnostic DRS outcomes, they are effective in identifying obstruction patterns on DRS.

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