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

Abstract

Studies comparing voiding urosonography (VUS) with voiding cystourethrography (VCUG) and direct radionuclide cystography (DRNC) were analyzed and detailed tables demonstrating the diagnostic values and grading of vesicoureteric reflux (VUR) are presented. Comparative studies of DRNC were too few and did not allow definite conclusions. Using VCUG as the reference, the results of VUS were as follows: sensitivity 57-100%, specificity 85-100%, positive/negative predictive values 58-100%/87-100%, respectively, and diagnostic accuracy 78-96%. With the exception of two studies the diagnostic accuracy reported was 90% and above. In 19% of pelviureteric units (PUUs) the diagnosis was made only by VUS and in 10% only by VCUG. Thus in 9% of PUUs more refluxes were detected using VUS. In 73.6% the reflux grades were concordant in VUS and VCUG. Reflux grade was found to be higher with VUS than with VCUG in 19.6% of PUUs. In 71.2% of PUUs with grade I reflux on VCUG, the reflux was found to be grade II and higher on VUS. The common selection criteria for VUS as the primary examination for VUR currently include (a) follow-up studies, (b) first examination for VUR in girls, and (c) screening high-risk patients.

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“…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].…”

Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System

“…24 Besides intravascular injection, other routes of ultrasound contrast administration have been reported for urologic application. These include intravesical CEUS, which has become an option for the diagnosis of vesicoureteral reflux in pediatric patients, 25 and voiding urosonography, which shows potential for evaluating the urethra. 26 Defining novel applications for ultrasound contrast could improve diagnostic and therapeutic options for patients without incurring the exposure of ionizing radiation.…”

Whole-Genome Linkage and Association Scan in Primary, Nonsyndromic Vesicoureteric Reflux

“…Suitable families were identified by screening the database for children who had VUR and for whom the reason for investigation was a sibling with VUR. VUR was diagnosed by voiding urosonography, 50 radionuclide cystography, or, in a few cases, x-ray cystography. Blood samples were collected from affected siblings and their parents, and DNA was extracted by standard procedures.…”