VUS HI and a second-generation contrast agent improved the identification of reflux in children. Our data reveal a higher sensitivity of the method compared to VCUG. Thus it can be used as an alternative radiation-free imaging method.

The practice of contrast-enhanced ultrasound in children is in the setting of off-label use or research. The widespread practice of pediatric contrast-enhanced US is primarily in Europe. There is ongoing effort by the Society for Pediatric Radiology (SPR) and International Contrast Ultrasound Society (ICUS) to push for pediatric contrast-enhanced US in the United States. With this in mind, the main objective of this review is to describe the status of US contrast agent safety in non-cardiac applications in children. The five published studies using pediatric intravenous contrast-enhanced US comprise 110 children. There is no mention of adverse events in these studies. From a European survey 948 children can be added. In that survey six minor adverse events were reported in five children. The intravesical administration of US contrast agents for diagnosis of vesicoureteric reflux entails the use of a bladder catheter. Fifteen studies encompassing 2,951 children have evaluated the safety of intravesical US contrast agents in children. A European survey adds 4,131 children to this group. No adverse events could be attributed to the contrast agent. They were most likely related to the bladder catheterization. The existing data on US contrast agent safety in children are encouraging in promoting the widespread use of contrast-enhanced US.

Revascularization of the graft occurs gradually along its length, with the intra-articular site being the first and the faster part to complete this phase, while both the intraosseous sites are still in progress throughout the first postoperative year. Revascularization is an important link at the intrinsic healing chain of the ACL graft. The surrounding microenvironment does seem to play a significant role in this process, and the differences in its composition along the graft course are reflected at the revascularization progress of the corresponding sites.

During the healing process the amount of revascularization tissue influences the MR imaging characteristics of the graft according to the examined site and the time interval after surgery. By 2 years postoperatively, revascularization completion coincides with the homogeneously low signal intensity of the graft, closely resembling native ACL.

There were no serious adverse events. Only a few minor events were reported, most likely due to the catheterization process. Thus, ce-VUS with intravesical administration of the second-generation US contrast agent (SonoVue®) for vesicoureteral reflux detection or exclusion had a favorable safety profile in our study group.

CDS were a common finding among children with UTI who had duplication anomalies. Although CDS and IDS were accompanied by VUR more often than were single systems, CDS were associated more often with severe VUR, other serious complications and poor renal function.

The ESPR Uroradiology Task Force and the ESUR Paediatric Working Group present two new recommendations on imaging in childhood cystic kidney disease and in childhood renal transplantation, and address the presently restricted availability of contrast-enhanced (ce) US in children. New insights into the genetics require an updated classification of paediatric cystic kidney disease along with a new concept of diagnostic imaging. Characteristic imaging features are key to the new classification. Available recommendations for imaging renal transplantation in children are not satisfactory. The

Vesicoureteral reflux (VUR) may occur intermittently and cyclic voiding cystourethrography (VCUG) can enhance the ability of the method to detect reflux. We undertook this prospective study to assess how often VUR may occur intermittently during VCUG and to evaluate the reliability of the method by performing cyclic VCUG. Two hundred seventy-five children younger than 2 years underwent two cycles of VCUG. Ninety-seven refluxing kidney-ureter units (KUU) from 68 children were identified during the two cycles. In 18 children VUR was demonstrated in the first, and in 50 children only in the second, cycle. Discrepancy between the two cycles regarding the presence and/or grade of VUR was observed in 85 KUU from 63 of 275 children (23%). In 21 of these 63 children VUR was > or = grade III. In the presence of reflux in the first cycle, discordant findings in the second cycle were found in 11 of 23 KUU (48%) or in 13 of 18 children (72.2%). In the absence of VUR in the first cycle, the second cycle disclosed reflux in 50 of 257 children (19.5%). In conclusion, intermittent VUR occurred in up to 23% of children undergoing VCUG. In more than one-third of them VUR was of major degree. Cyclic VCUG can enhance the ability of the method to detect and grade reflux.