Hydronephrosis is a standard congenital anomaly that’s more and more recognized throughout prenatal ultrasound. Though ultrasound can be the first-line take a look at to display screen for hydronephrosis in infants, it’s poor at figuring out dilating vesicoureteral reflux (VUR), one reason for hydronephrosis. A voiding cystourethrogram (VCUG) can higher characterize VUR however is extra invasive and costlier.
However what if urologists might draw on sure ultrasound findings to foretell which sufferers usually tend to have VUR — and would profit from additional screening with VCUG?
That’s the objective of a brand new machine studying mannequin developed by urologist Hsin-Hsiao (Scott) Wang, MD, director of Boston Kids’s Computational Healthcare Analytics Program, and his colleagues. The mannequin is believed to be the primary of its variety for precisely predicting danger of dilating VUR primarily based on options of early postnatal ultrasound.
Strong efficiency in predicting VUR
Since 2014, urologists have relied on the standardized urinary tract dilation (UTD) classification system to guage hydronephrosis in infants. The system makes use of six pre- and postnatal ultrasound findings to categorise the chance of UTD severity; on the whole, the extra a kidney seems dilated, the extra seemingly the presence of some underlying anatomical abnormalities. Nonetheless, this strategy can’t present a particular prognosis or predict outcomes.
Wang and his colleagues have already developed machine studying fashions to foretell which kids with recurrent urinary tract infections — a symptom of VUR — would possibly advantage additional testing. For a brand new examine, printed within the Journal of Pediatric Urologythey sought to develop a mannequin that might reliably predict dilating VUR primarily based on postnatal ultrasound and decide which infants would profit from VCUG.
To take action, the group reviewed information from 280 infants who had undergone first ultrasound imaging for hydronephrosis after which VCUG to verify dilating VUR at Boston Kids’s. Primarily based on this info, they developed a machine studying mannequin that makes use of distinct affected person and imaging particulars (equivalent to demographics and UTD classification options) to foretell danger of dilating VUR amongst infants with hydronephrosis. When put to the take a look at, the mannequin’s capability to foretell VUR was robust, with an “space beneath curve” of 0.81 out of 1.0.
Extra strong mannequin within the works
What’s extra, the mannequin is intuitive and interpretable for medical use, says Wang. “The mannequin could be simply reviewed and utilized in routine medical settings when counseling sufferers for the subsequent steps of administration for hydronephrosis,” he explains.
The group is at present engaged on an much more strong mannequin, drawing from some 15,000 affected person information to supply an algorithm that hopefully will predict every affected person’s future when it comes to hydronephrosis: Will it resolve by itself or will the kid develop anatomy that must be corrected?
“We hope to construct a crystal ball for urologists so children don’t need to endure pointless testing,” says Wang.
Study extra about Boston Kids’s Division of Urology and Computational Healthcare Analytics Program.
