Abstract:
Objective
s To investigate the clinical utility of contrast-enhanced voiding urosonography （ceVUS） in detecting intrarenal reflux （IRR） and analyze its spatial correlation with renal parenchymal damage identified by dimercaptosuccinic acid （DMSA） scintigraphy.
Methods
A cohort of 205 non-duplex kidney patients， 410 pyeloureteral units （PUUs） were selected at the Children's Hospital Affiliated to Zhejiang University School of Medicine from January 2021 to December 2024， 302 vesicoureteric reflux（VUR）-positive diagnosed by ceVUS was analyzed.IRR was defined as contrast agent infiltration into renal collecting tubules.Kidneys were divided into upper， middle， and lower thirds along the long axis for IRR localization.IRR detection rates across VUR grades and age groups were compared.Kendall’s correlation analysis was performed to evaluate spatial concordance between IRR and DMSA abnormalities in 98 patients（196 PUUs）.
Results
The overall IRR detection rate was 20.86% （63/302 PUUs）， exclusively observed in grade III-V VUR.Grade-specific detection rates were： III （27.08%， 26/96）， IV （43.55%， 27/62）， and V （52.63%，10/19）.IRR incidence was significantly higher in infants＜1 year （27.28% ［35/126］ vs 15.91% ［28/176］， P＜0.05）.IRR distribution was： upper （42.06%， 53/126）＞lower （33.33%， 42/126）＞middle （24.60%， 31/126）.DMSA abnormalities occurred in 51.53% （101/196）， showing a strong association with IRR （80.00% ［44/55］ vs 40.42%［57/141］， P＜0.05）.DMSA abnormalities were distributed as： upper （47.78%， 75/157）＞lower （36.94%， 58/157）＞middle （15.29%， 24/157）.IRR and DMSA abnormalities demonstrated a moderate spatial correlation （Kendall’s τ=0.543， P＜0.05）.
Conclusion
CeVUS effectively identifies IRR in grade III-V VUR， particularly in younger children.The spatial concordance between IRR and DMSA abnormalities supports incorporating IRR into VUR grading systems to optimize clinical decision-making.
Key words:
Contrast-enhanced voiding urosonography,
Vesicoureteral reflux,
Intrarenal reflux,
Dimercaptosuccinic acid imaging,
Child
Xiuzhen Yang, Li Li, Zheming Xu, Jingjing Wang, Jingjing Ye. Contrast-enhanced voiding urosonography-based assessment of intrarenal reflux： spatial correlation of intrarenal reflux with DMSA scintigraphy findings[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(04): 348-353.