Contrast-Enhanced Harmonic Imaging for the Diagnosis of Vesicoureteral  Reflux in Pediatric Patients

Darge, Kassa; Zieger, B; Rohrschneider, W; Ghods, Susan; Wünsch, R.; Troeger, Jochen

doi:10.2214/ajr.177.6.1771411

Cited by 68 publications

(33 citation statements)

References 10 publications

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“…Performing VUS with fundamental US at higher contrast doses might have improved its detection rate. On the other hand, a recent study by Darge et al using the higher standard contrast dose of 10% of the bladder volume confirms our results: the authors found reflux that was only visible on PIUS and not on fundamental US in 8 KUU (29%) of 27 KKU where reflux and image quality was improved by PIUS in all cases [25].…”

Section: Discussionsupporting

confidence: 91%

Low contrast dose voiding urosonography in children with phase inversion imaging

et al. 2004

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Voiding urosonography (VUS) using a microbubble contrast agent has been introduced as an alternative technique in the diagnosis of vesicoureteral reflux (VUR). This study was undertaken to assess if phase inversion ultrasound (PIUS), a recent microbubble specific imaging technique, has advantages over fundamental in VUS and if it allows a reduction of contrast agent dose. Forty-three children with suspected VUR (aged 3 days-12 years, average of 3.9 years) with 92 kidney-ureter units (KUU) were included. Everyone obtained a baseline US scan that was followed by VUS using Levovist as the contrast agent. Constant switching between fundamental and PIUS performed the enhanced part for comparison. Every child underwent VCUG immediately afterwards. Contrast enhancement was stronger and longer lasting on PIUS than on fundamental US in all 43 cases. Reflux was detected in a total of 21 KUU, out of 92 KUU (23%). PIUS revealed VUR in 18; fundamental in 14 KUU and VCUG depicted 16 cases of reflux (p> or =0.29). The mean volume of Levovist dose administered to the bladder was 7.4+/-3.4% of the bladder volume. VUS using PI mode provided considerably stronger and longer enhancement and slightly improved the detection of VUR. It allowed a reduction of contrast dose and cost by approximately 35% over current dose recommendations for fundamental US.

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Section: Discussionsupporting

confidence: 91%

Low contrast dose voiding urosonography in children with phase inversion imaging

et al. 2004

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“…With newest technical refinements, such as contrast harmonic imaging or stimulated acoustic emission, with inclusion of the bladder into the scanning protocol, even low-degree VUR has become reliably detectable [99]. Now EECS offers a non-ionising method for VUR evaluation, at the cost of little functional information, less accurate grading, equipment and operator dependency, and insufficient anatomical evaluation of the ureters, the urethra or some diverticula (e.g.…”

Section: Other Methods For Vur Evaluationmentioning

confidence: 99%

“…Cyclic filling can be performed; however, this makes the procedure expensive, as new contrast has to be prepared. Contrast harmonic imaging improves contrast delineation and depiction and thus reduces the necessary amount of agent need [99].…”

Section: How To Perform Cystographymentioning

confidence: 99%

Cystography in infants and children: a critical appraisal of the many forms with special regard to voiding cystourethrography

Riccabona

2002

Eur Radiol

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The aim of this study was to describe and discuss the various forms of cystography and their clinical value. Conventional fluoroscopic voiding cystourethrography (VCU), radionuclide cystography and the various sonographic cystographic approaches, including echo-enhanced cystosonography (EECS), are described. Their indications, potential, benefit and setbacks/restrictions are discussed with regard to the literature and the constantly changing clinical demand. With the introduction of EECS a new and reliable tool has been established to be useful for follow-up and screening for vesico-ureteral reflux (VUR); however, with the growing importance of functional disturbances a reliable method to evaluate both function and anatomy/VUR as offered by modified VCU is mandatory, and thus VCU remains to play a major part in evaluating children with urinary tract infection, suspected VUR, hydronephrosis or functional bladder disturbances. While EECS offers a new method for certain indications, such as follow-up examinations in VUR or screening, VCU remains an irreplaceable tool for evaluating anatomy (particularly the male urethra) and bladder function (if performed using the modified technique).

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“…4 ), and various bladder fi lling techniques for direct vesicoureteral refl ux visualization after bladder catheterization. Air, saline (shaken), and -most commonly -sonographic contrast agents have been successfully used for refl ux cystosonography; particularly, contrast -enhanced voiding urosonography (ce-VUS) has been established as a reliable and nonirradiating imaging modality for vesicoureteral refl ux detection, with an even higher sensitivity for vesicoureteral refl ux detection than conventional fl uoroscopic VCUG, particularly using modern agent detection techniques (Bosio 1998 ;Darge et al 1999Darge et al , 2001Kenda et al 2000 ;Berrocal et al 2001 ;Riccabona et al 2003a , b ;Darge et al 2005 ). Any contrast material detected in the ureter or the renal cavities indicates vesicoureteral refl ux (Fig.…”

Section: Ultrasoundmentioning

confidence: 99%

The Pediatric Kidney

Riccabona

2014

Radiological Imaging of the Kidney

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Children are not small adults. In the urinary tract, particularly, there are many conditions that are more or less specifi c to children which need early and reliable diagnosis in order to provide proper treatment to prevent renal damage and severe long-term sequelae such as hypertension or renal insuffi ciency. This is particularly important for all congenital urinary tract malformations and also for many other congenital renal conditions -these are often detected prenatally and, after birth, need prompt and reliable diagnostic workup at minimal invasiveness. Additionally, even in conditions that are the same or similar to adults, the specifi c needs and conditions in childhood require different imaging approaches and algorithms, partially because of each of the following reasons: the child's higher sensitivity to radiation, different physiology, different size and imaging appearance, as well as different potential of the various imaging techniques. These differences are outlined, focusing on some important diseases and queries such as congenital hydronephrosis and obstructive uropathy, impact of vesicoureteral refl ux on the kidney, imaging in infants with urinary tract infection, childhood urolithiasis and nephrocalcinosis, pediatric renal masses, as well as other miscellaneous renal conditions that may manifest in the child and indicate imaging. Additionally, specifi c needs for adapting and applying the various imaging techniques in childhood are discussed.

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Contrast-Enhanced Harmonic Imaging for the Diagnosis of Vesicoureteral Reflux in Pediatric Patients

Cited by 68 publications

References 10 publications

Low contrast dose voiding urosonography in children with phase inversion imaging

Low contrast dose voiding urosonography in children with phase inversion imaging

Cystography in infants and children: a critical appraisal of the many forms with special regard to voiding cystourethrography

The Pediatric Kidney

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