The value of colour Doppler ultrasonography for identification of crossing vessels in children with pelvi-ureteric junction obstruction.
BACKGROUND
Pelvi-ureteric junction (PUJ) obstruction is caused by the presence of an aperistaltic dysplastic segment at the PUJ. Besides this intrinsic aetiology, extrinsic abnormalities, mainly crossing vessels, may be an associated factor.


OBJECTIVE
To determine the reliability of colour Doppler US in the detection of crossing vessels in children with surgically proven PUJ obstruction.


METHODS
Forty-eight patients (50 kidneys) with PUJ obstruction, surgically treated from 1998 to 2001, were prospectively studied by colour Doppler US prior to open pyeloplasty. There were 33 boys and 15 girls (age 2 months-12 years; median 3.5 years). There were 24 right kidneys and 26 left kidneys. The indication for surgery was according to the usual criteria. The crossing vessel was considered as present when depicted on colour Doppler US at the PUJ.


RESULTS
Colour Doppler assessment of the crossing vessels was correct in all but two patients. At surgery, a crossing vessel was found in 14 kidneys (i.e. 28%). Colour Doppler US results were correlated with intra-operative findings in 50 renal units. Surgically proven vessels in 14 kidneys were identified by colour Doppler US in 13, and not shown in 1. In PUJ obstruction without a crossing vessel ( n=36), US findings were concordant in 26, discordant in 8 and inconclusive in 2 (with kidney malrotation) cases. Colour Doppler US had a sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy of 92.8%, 76.5%, 62%, 96.3% and 78%, respectively. The reliability of colour Doppler US was greatly improved with the increasing experience of the sonographer, as shown by the results of the last 2 years (26 kidneys):Se=100%, Sp=87.5%, PPV=81.8%, NPV=100%, accuracy=88.5%.


CONCLUSIONS
Colour Doppler US is reliable in the detection of crossing vessels at the PUJ.
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D018615:Ultrasonography, Doppler, Color; D014513:Ureter / Q000098:blood supply / Q000000981:diagnostic imaging; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging*