Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children

Abstract

Voiding urosonography (VUS) encompasses examination of the urinary tract with intravesical administration of US contrast agent (UCA) for diagnosis of vesicoureteric reflux (VUR). The real breakthrough for US examination of VUR came with the availability of stabilized UCAs in the mid-1990s. This article presents a comprehensive review of various procedural aspects of VUS. Different US modalities are available for detecting the echogenic microbubbles: fundamental mode, colour Doppler US, harmonic imaging and dedicated contrast imaging with multiple display options. The reflux is graded (1 to 5) in a similar manner to the system used in voiding cystourethrography (VCUG). The most commonly used UCA for VUS, Levovist, is galactose-based and contains air-filled microbubbles. The recommended concentration is 300 mg/ml at a dose of 5-10%, or less than 5%, of the bladder filling volume when using fundamental or harmonic imaging modes, respectively. There are preliminary reports of VUS using a second-generation UCA, SonoVue. Here the UCA volume is less than 1% of the bladder filling volume. There is no specific contraindication to intravesical administration of UCA. The safety profile of intravesical Levovist is very high with no reports of side effects over a decade of use in VUS.

Nonionizing photoacoustic cystography in vivo

“…Our clinical interests include monitoring vesicoureteral reflux (VUR), the retrograde flow of urine from the bladder into the upper urinary tract, in children using PAC. VUR is commonly diagnosed after patients (typically children) have a urinary tract infection [13][14][15]. By transporting bacteria from the bladder, VUR causes renal infections such as pyelonephritis.…”

“…Therefore, early detection and treatment of VUR are essential. Two main methods have been used to evaluate VUR: fluoroscopic voiding cystourethrography (VCUG) and direct radionuclide voiding cystography (DRNC) [14]. Although radiation dose reduction has been achieved in fluoroscopic VCUG, this method is still ionizing.…”

“…The pediatric VUR guidelines panel of the American Urological Association strongly urges the development of techniques with less radiation exposure [13,15]. Echo-enhanced urosonography has been applied to monitor VUR, and it offers the advantages of nonionizing, real-time, and portable imaging capability [14]. However, echoenhanced urosonography is sensitive to high-grade reflux only [16].…”

Untitled

“…The following clinical applications of EV-CEUS have been described in case studies: percutaneous nephrostomy [80], biliary tract imaging via percutaneous transhepatic cholangiography and drainage (PTCD) [81], abscess drainage [82], swallow CEUS for imaging Zenker's diverticulum, voiding vesicoureteral reflux sonography [83,84], salivary gland duct imaging [85], contrast-enhanced hysterosalpingo-sonography (CE-HyCoSy [86], biliary tract imaging via endoscopic retrograde cholangiography (ERCP) [87] and fistula imaging [88].…”

Ultrasound examination in childhood: opportunities and new ways

“…Az MCU és MSC megegyezik a refl ux kizárásában és észlelésében, de az MSC érzékenyebb, és ez utóbbival több és sok esetben magasabb fokozatú refl ux látható, mint MCU-val [24,25,26,27,28,29,30].…”