目的

对儿童排泄性尿路超声造影检查的造影剂用量及方法进行改良，初步探讨其提高造影图像质量的有效性及临床应用价值。

方法

回顾性纳入2019 年1 月至2023 年8 月于复旦大学附属儿科医院超声科完成排泄性尿路超声造影（CeVUS）的患儿137 例。2019 年1 月至2021 年12月采用传统造影方法（单一剂量），2022 年1 月至2023 年8 月采用改良造影方法（依据年龄、膀胱容量等对剂量进行调整）对反流程度进行评估。将注入造影剂后的膀胱显影图像划分为I ～Ⅲ级（I级图像质量最佳，膀胱轮廓完整清晰，膀胱后方受声影遮挡不明显）。比较传统造影方法与改良造影方法膀胱显影图像分级情况。并分析CeVUS 与排泄性逆行尿路造影（VCUG）检查结果的一致性。

结果

137 例中，采用传统CeVUS 检查方法的患儿100 例，采用CeVUS 改良方法检查的患儿37 例。传统方法膀胱显影图像分级：Ⅰ级1 例（1.0%，1/100），Ⅱ级39 例（39.0%，39/100），Ⅲ级60 例（60.0%，60/100）；改良方法膀胱显影图像分级：Ⅰ级17 例（45.9%，17/37），Ⅱ级16 例（43.2%，16/37），Ⅲ级4 例（10.8%，4/37）。改良方法得到的图像等级优于传统方法（P＜0.01）。共有22 例患儿在CeVUS 相近时间内进行放射科VCUG 检查，两种检查的一致性Kappa 值为0.449（P=0.002）。

结论

CeVUS 改良方法可以使检查过程更为优化，图像更清晰，造影剂使用剂量更小，安全性更好，值得临床推广应用。

Objective

To improve contrast-enhanced voiding urosonography (CeVUS) in pediatrics with regard to contrast medium dosage and examination method, and to preliminarily explore its effectiveness and clinical application value in improving the quality of contrast images.

Methods

A retrospective study was performed on 137 children who underwent CeVUS in the Department of Ultrasound of Children's Hospital of Fudan University from January 2019 to August 2023.Traditional contrast method(single dose) was used from January 2019 to December 2021, and improved contrast method (dose adjustment based on age, bladder capacity, etc.) was used from January 2022 to August 2023 to evaluate vesicoureteral reflux.The images of the bladder after injection of contrast agents were divided into levels I ~ III (the image quality of level I is the best, the outline of the bladder is complete and clear, and the back of the bladder is not obviously obscured by shadow).The classification of the developed images was compared between the traditional contrast method and the improved contrast method.The consistency between CeVUS and voiding cystouretrography (VCUG) was analyzed.

Results

Among the 137 cases, 100 were examined by the traditional CeVUS method and 37 by the modified CeVUS method.The classification of bladder images obtained by the traditional method was: 1 case at level I (1.0%, 1/100), 39 cases at level II (39.0%, 39/100),and 60 cases at level III (60.0%, 60/100); for bladder images obtained by the improved method, there were 17 cases at level I (45.9%, 17/37), 16 cases of level II (43.2%, 16/37), and 4 cases of level III (10.8%, 4/37).The image level obtained by the improved method was better than that of the traditional method (P＜0.01).A total of 22 children underwent radiology VCUG examination at a similar time to CeVUS, and the Kappa value of the two examinations was 0.449 (P=0.002).

Conclusion

The improved CeVUS method can optimize the examination process, make the image clearer, use less contrast agent dose, and have better safety, which is worthy of clinical application.