Contrast‐enhanced gray‐scale and color doppler voiding urosonography versus voiding cystourethrography in the diagnosis and grading of vesicoureteral reflux

Abstract

ABSTRACT:Purpose. The purpose of this study was to compare contrast-enhanced gray-scale voiding urosonography (CE-VUS) and contrast-enhanced color Doppler voiding urosonography (CE-CDVUS) with voiding cystourethrography (VCUG) to verify whether the use of color Doppler imaging improves the diagnosis and grading of vesicoureteral reflux (VUR).Methods. In 74 patients, CE-VUS and CE-CDVUS were compared with VCUG, which was used as the gold standard. SHU 508 A (Levovist) was used as the echo-enhancing contrast agent. VUR was diagnosed if hyperechoic dots or color signals were visualized in the ureter on sonograms. VUR grading was based on morphologic and dynamic findings on CE-VUS and morphologic and color findings on CE-CDVUS. VCUG was performed conventionally, and grading by VCUG was in accordance with the international system of radiographic VUR grading. Patients who voided during 1 examination only (either CE-VUS and CE-CDVUS or VCUG) were excluded from the study. Agreement between the results of CE-VUS and VCUG and between those of CE-CDVUS and VCUG in diagnosing VUR was calculated by statistics. CE-VUS and CE-CDVUS were compared for diagnostic accuracy by the McNemar test.Results. The agreement between CE-VUS and VCUG in predicting VUR was 90% ( score, 0.77; p < 0.001). The agreement between CE-CDVUS and VCUG was 96% ( score, 0.91; p < 0.001). CE-CDVUS showed a significantly higher diagnostic accuracy than did CE-VUS (96% versus 90% of cases correctly classified; McNemar 2 = 4; p < 0.05). This was mainly related to the lower number of false-negative results for grade I and grade II VUR when CE-CDVUS was used.Conclusions. The use of color Doppler imaging significantly improves the accuracy of contrast voiding urosonography in the detection and grading of VUR.

Comparison of echo-enhanced ultrasound with fluoroscopic MCU for the detection of vesicoureteral reflux in neonates

“…The mean time for the voiding sonogram in the study of Farina et al [15] (excluding catheterization) was 15 min, with 33 min for the entire examination, compared to 6.35 min (mean) postcatheterization in our study. As we and other authors have noted, the concordance between the two techniques was improved when higher grades of reflux were present, and lower grades of reflux were more frequently missed with echo-enhanced sonography [1,7,11] although colour Doppler can improve detection of low-grade VUR [16].…”

The accuracy of voiding urosonography in detecting vesico-ureteral reflux: a summary of existing data

“…reflux) from an obstructive disease [5]. Nevertheless, US can be helped in detecting reflux by an intra-vesical administration of an echo-contrast agent producing microbubbles which can easily be depicted in the pyelocalyceal system in cases of reflux (VUR) as hyperechoic dots [3,4,6,7,10,13] or colour signals [1,8,15]. The detection of dynamic findings (hyperechoic dots floating from the bladder into the ureter) or colour findings (coloured dots in the urinary tract) as signs of VUR depends on the sonographic modality employed in voiding urosonography (VUS), namely grey-scale (GS) or colour-Doppler (CD).…”

Cyclic contrast-enhanced harmonic voiding urosonography for the evaluation of reflux. Can we keep the cost of the examination low?

“…However, both methods involve ionizing radiation, although with DRNC it is much less than with VCUG [13,14]. To overcome this problem, US methods have been developed for the evaluation of VUR utilizing air [34], air bubbles in shaken saline [35], sonicated albumin [36,37] and, more recently, special US contrast media made from galactose suspension [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. These are used to enhance the ability of US to detect VUR.…”

“…Direct radionuclide cystography (DRNC) is a reliable alternative with a significantly smaller radiation dose; however, it is less available, and it has poor anatomical resolution [13,14]. Contrast-enhanced voiding urosonography (VUS) with microbubbles containing contrast medium (CM) made of galactose-palmitic acid (SH U 508 A, Levovist; Schering, Berlin, Germany) has been used for the last 10 years and has been found to be equally sensitive compared to VCUG and DRNC [15][16][17][18][19][20][21][22][23][24][25]. Harmonic imaging has been shown to be significantly better at depicting microbubbles in the ureters and pelvicalyceal system [26][27][28].…”