{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:30:15Z","timestamp":1786980615086,"version":"build-2736575974"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100017577","name":"Basic Public Welfare Research Program of Zhejiang Province","doi-asserted-by":"publisher","award":["LGF22H050004"],"award-info":[{"award-number":["LGF22H050004"]}],"id":[{"id":"10.13039\/501100017577","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Key Research and Development Program of China","award":["2023YFC2706400"],"award-info":[{"award-number":["2023YFC2706400"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Digit Imaging. Inform. med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Vesicoureteral reflux (VUR) is a urinary system disorder characterized by the abnormal flow of urine from the bladder back into the ureters and kidneys, often leading to renal complications, particularly in children. Accurate grading of VUR, typically determined through voiding cystourethrography (VCUG), is crucial for effective clinical management and treatment planning. This study proposes a novel multi-head convolutional neural network for the automatic grading of VUR from VCUG images. The model employs a dual-stream architecture with a modified ResNet-50 backbone, enabling independent analysis of the left and right urinary tracts. Our approach categorizes VUR into three distinct classes: no reflux, mild to moderate reflux, and severe reflux. The incorporation of deep supervision within the network enhances feature learning and improves the model\u2019s ability to detect subtle variations in VUR patterns. Experimental results indicate that the proposed method effectively grades VUR, achieving an average area under the receiver operating characteristic curve of 0.82 and a patient-level accuracy of 0.84. This provides a reliable tool to support clinical decision-making in pediatric cases.<\/jats:p>","DOI":"10.1007\/s10278-025-01438-1","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T13:56:21Z","timestamp":1739541381000},"page":"3517-3525","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Automated Grading of Vesicoureteral Reflux (VUR) Using a Dual-Stream CNN Model with Deep Supervision"],"prefix":"10.1007","volume":"38","author":[{"given":"Guangjie","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2195-2074","authenticated-orcid":false,"given":"Lixian","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuxin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9878-088X","authenticated-orcid":false,"given":"Xiaoqing","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1448-7937","authenticated-orcid":false,"given":"Wenqian","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fandong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linfeng","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9935-9969","authenticated-orcid":false,"given":"Gang","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"1438_CR1","doi-asserted-by":"publisher","unstructured":"Greenbaum LA, Mesrobian HG. Vesicoureteral reflux. Pediatr Clin North Am. 2006;53(3):413\u201327, vi. https:\/\/doi.org\/10.1016\/j.pcl.2006.02.010. PMID: 16716788.","DOI":"10.1016\/j.pcl.2006.02.010"},{"issue":"3","key":"1438_CR2","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1016\/j.juro.2010.05.065","volume":"184","author":"CA Peters","year":"2010","unstructured":"Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol. 2010 Sep;184(3):1134-44. https:\/\/doi.org\/10.1016\/j.juro.2010.05.065. Epub 2010 Jul 21. PMID: 20650499.","journal-title":"J Urol."},{"issue":"4","key":"1438_CR3","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s00383-011-2863-y","volume":"27","author":"MA Koyle","year":"2011","unstructured":"Koyle MA, Elder JS, Skoog SJ, Mattoo TK, Pohl HG, Reddy PP, Abidari JM, Snodgrass WT. Febrile urinary tract infection, vesicoureteral reflux, and renal scarring: current controversies in approach to evaluation. Pediatr Surg Int. 2011 Apr;27(4):337-46. https:\/\/doi.org\/10.1007\/s00383-011-2863-y. Epub 2011 Feb 9. PMID: 21305381.","journal-title":"Pediatr Surg Int."},{"key":"1438_CR4","doi-asserted-by":"publisher","unstructured":"Wildbrett P, Schwebs M, Abel JR, Lode H, Barthlen W. Spontaneous vesicoureteral reflux resolution in children: A ten-year single-centre experience. Afr J Paediatr Surg. 2013 Jan-Apr;10(1):9\u201312. https:\/\/doi.org\/10.4103\/0189-6725.109375. PMID: 23519850.","DOI":"10.4103\/0189-6725.109375"},{"key":"1438_CR5","doi-asserted-by":"publisher","unstructured":"Frimberger D, Mercado-Deane MG; SECTION ON UROLOGY; SECTION ON RADIOLOGY. Establishing a Standard Protocol for the Voiding Cystourethrography. Pediatrics. 2016 Nov;138(5):e20162590. https:\/\/doi.org\/10.1542\/peds.2016-2590. 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Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997 May;157(5):1846-51. PMID: 9112544.","journal-title":"J Urol."},{"issue":"1","key":"1438_CR8","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jpurol.2011.12.011","volume":"9","author":"CS Cooper","year":"2013","unstructured":"Cooper CS, Birusingh KK, Austin JC, Knudson MJ, Brophy PD. Distal ureteral diameter measurement objectively predicts vesicoureteral reflux outcome. J Pediatr Urol. 2013 Feb;9(1):99-103. https:\/\/doi.org\/10.1016\/j.jpurol.2011.12.011. Epub 2012 Jan 9. PMID: 22236467.","journal-title":"J Pediatr Urol."},{"issue":"1","key":"1438_CR9","doi-asserted-by":"publisher","first-page":"68.e1","DOI":"10.1016\/j.jpurol.2020.11.018","volume":"17","author":"N Baydilli","year":"2021","unstructured":"Baydilli N, Selvi I, Pinarbasi AS, Akinsal EC, Demirturk HC, Tosun H, Demirci D. Additional VCUG-related parameters for predicting the success of endoscopic injection in children with primary vesicoureteral reflux. J Pediatr Urol. 2021 Feb;17(1):68.e1-68.e8. https:\/\/doi.org\/10.1016\/j.jpurol.2020.11.018. Epub 2020 Nov 20. PMID: 33272864.","journal-title":"J Pediatr Urol."},{"key":"1438_CR10","doi-asserted-by":"publisher","first-page":"106369","DOI":"10.1016\/j.cmpb.2021.106369","volume":"210","author":"Y Eroglu","year":"2021","unstructured":"Eroglu Y, Yildirim K, \u00c7inar A, Yildirim M. Diagnosis and grading of vesicoureteral reflux on voiding cystourethrography images in children using a deep hybrid model. Comput Methods Programs Biomed. 2021 Oct;210:106369. https:\/\/doi.org\/10.1016\/j.cmpb.2021.106369. Epub 2021 Aug 22. 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Batra, \u201cGrad-CAM: Visual Explanations from Deep Networks via Gradient-Based Localization,\u201d Int J Comput Vis, vol. 128, no. 2, pp. 336\u2013359, Feb. 2020, https:\/\/doi.org\/10.1007\/s11263-019-01228-7.","journal-title":"Int J Comput Vis"}],"container-title":["Journal of Imaging Informatics in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10278-025-01438-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10278-025-01438-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10278-025-01438-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T19:24:58Z","timestamp":1765567498000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10278-025-01438-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,14]]},"references-count":16,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1438"],"URL":"https:\/\/doi.org\/10.1007\/s10278-025-01438-1","relation":{},"ISSN":["2948-2933"],"issn-type":[{"value":"2948-2933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,14]]},"assertion":[{"value":"25 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 February 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 February 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This research was approved by the Institutional Review Board (IRB) of the Medical Ethics Committee at Children\u2019s Hospital, Zhejiang University School of Medicine, China (IRB Approval ID: 2024-IRB-0278-P-01), and conducted in compliance with the Declaration of Helsinki. Given the retrospective nature of the data analysis involved in this study, the IRB granted a waiver for the requirement of informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}