Contrast-enhanced Voiding Urosonography for the Diagnosis of Vesicoureteral Reflux and Intrarenal Reflux: a Comparison of Diagnostic Performance with Fluoroscopic Voiding Cystourethrography

Overview

Journal Ultrasonography

Date 2021 Apr 23

PMID 33887876

Citations 8

Authors

DaeHee Kim

Young Hun Choi

Gayoung Choi

Seulbi Lee

Seunghyun Lee

Yeon Jin Cho

Seon Hee Lim

Hee Gyung Kang

Jung-Eun Cheon

Affiliations

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Abstract

Purpose: This study evaluated the diagnostic performance of contrast-enhanced voiding urosonography (ce-VUS) using a second-generation ultrasound contrast agent for the diagnosis of vesicoureteral reflux (VUR) and intrarenal reflux (IRR), and compared it with that of standard fluoroscopic voiding cystourethrography (VCUG).

Methods: Thirty-two consecutive children from April to October 2019 were included in this study. ce-VUS and VCUG were performed simultaneously by two operators with intravesical infusion of a mixture of ultrasound contrast medium, iodinated contrast medium and water. Two pediatric radiologists independently reviewed the ce-VUS and VCUG images and reported the presence and degree of VUR (grades I-V), and the presence and type of IRR.

Results: Twenty-seven of 63 urinary systems showed VUR. Interobserver agreement for VUR grading was very good for both examinations (κ=0.87; 95% confidence interval [CI], 0.82 to 0.92 for ce-VUS and κ=0.92; 95% CI, 0.87 to 0.96 for VCUG). The detection rate of VUR showed no significant difference between the two examinations (P=0.370). Four cases of VUR were missed on ce-VUS, while one case of VUR was missed on VCUG. All four false-negative cases on ce-VUS were grade 1 VUR. The two examinations showed very good agreement regarding VUR grading (κ =0.89; 95% CI, 0.81 to 0.96). IRR was more frequently detected with ce-VUS than with VCUG (10 cases with ce-VUS vs. 3 cases with VCUG, P=0.016).

Conclusion: ce-VUS showed very good agreement with VCUG for detecting grade 2 VUR and above, while grade 1 VUR was sometimes missed with ce-VUS. IRR was more frequently detected with ce-VUS than with VCUG.

Citing Articles

Reduced kidney size and renal function of high-grade vesicoureteral reflux and intrarenal reflux in contrast-enhanced voiding urosonography.

Yan H, Wu C, Zhou J, Huang C, Ma X, Huang Y Front Pediatr. 2025; 12:1478436.

PMID: 39744214 PMC: 11688366. DOI: 10.3389/fped.2024.1478436.

The Intrarenal Reflux Diagnosed by Contrast-Enhanced Voiding Urosonography (ceVUS): A Reason for the Reclassification of Vesicoureteral Reflux and New Therapeutic Approach?.

Saraga M, Saraga-Babic M, Arapovic A, Vukojevic K, Pogorelic Z, Simicic Majce A Biomedicines. 2024; 12(5).

PMID: 38790977 PMC: 11117776. DOI: 10.3390/biomedicines12051015.

Comparison of voiding vesicoureteral urosonography with fluoroscopic voiding cystourethrography in children with vesicoureteral reflux.

Yang B, Wang J, Di Z, Zhao S, Ma Y, Qu Y Pak J Med Sci. 2023; 39(4):967-971.

PMID: 37492338 PMC: 10364298. DOI: 10.12669/pjms.39.4.6665.

A narrative review on the applications of intracavitary contrast-enhanced ultrasonography in pediatric lower genitourinary anomalies.

Ren J, Ma T, Huang S, Chen G, Dietrich C, Peng Y Front Pediatr. 2023; 11:984643.

PMID: 37274817 PMC: 10236366. DOI: 10.3389/fped.2023.984643.

Prevalence of intrarenal reflux in pediatric patients on contrast-enhanced voiding urosonography.

Klein E, Wyers M, Prendergast F, Arzu J, Benya E Pediatr Radiol. 2022; 53(3):387-393.

PMID: 36447052 DOI: 10.1007/s00247-022-05548-8.

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