Contrast-enhanced Voiding Urosonography for Vesicoureteral Reflux Diagnosis in Children

Abstract

Contrast-enhanced voiding urosonography (ceVUS) is a dynamic imaging technique that makes it possible to study the structure of the urinary tract after the administration of intravesical contrast material. Initially, ceVUS was indicated mainly to study vesicoureteral reflux (VUR); however, since the ability of ceVUS to depict the structure of the urethra was demonstrated in both sexes, ceVUS is now indicated for examination of the entire urinary tract. The main benefit of ceVUS is that it does not use ionizing radiation. In recent years, fundamental changes have occurred in the understanding of VUR. The lessening effect of VUR and the low rate of occurrence of urethral pathologic conditions have given rise to changes in the indications for tests for these conditions. In addition to being able to help confirm a diagnosis of VUR, the ceVUS technique can be used to depict obstructive and nonobstructive urethral pathologic conditions, as well as normal variants, on high-quality images. Furthermore, ceVUS enables real-time assessment of voiding function. For these reasons, ceVUS should be not only an alternative to voiding cystourethrography, but also the technique of choice for the study of the entire urinary tract in pediatric patients. Online supplemental material is available for this article. RSNA, 2017.

The evaluation of vesicoureteral reflux among children using contrast-enhanced ultrasound: a literature review

“…In 2001, the second-generation contrast SonoVue (sulfur hexafluoride with a phospholipid shell) Bracco SpA, Milan, Italy, was introduced in Europe and later in the United States [12,21]. SonoVue has since become the most studied US contrast for intravesical instillation and diagnosis of VUR.…”

AIUM Practice Parameter for the Performance of Contrast‐Enhanced Ultrasound Examinations

“…Imaging should be performed continuously from contrast injection until the imaging target is adequately characterized. The presence and degree of arterial‐phase enhancement should be documented. Pediatric voiding urosonography Contrast Dose: To date, published studies have used either SHLM contrast or PPM contrast. The FDA‐recommended contrast dose and administration of SHLM contrast are a 1‐mL injection into a bladder that is partially filled with normal saline.…”

“…Pediatric voiding urosonography Contrast Dose: To date, published studies have used either SHLM contrast or PPM contrast. The FDA‐recommended contrast dose and administration of SHLM contrast are a 1‐mL injection into a bladder that is partially filled with normal saline.…”

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

“…118,150,151 No radiation exposure with catheterization VUS VUS allows real-time observation of the whole urinary tract including the urethra after the administration of intravesical contrast material. 152 It has been used for two decades, and has become popular for the diagnosis of VUR in children, especially in European countries. 153 Recently, VUS has also become more popular in the USA.…”