Advertisement

Pediatric Radiology

, Volume 42, Issue 6, pp 660–667 | Cite as

Voiding urosonography including urethrosonography: high-quality examinations with an optimised procedure using a second-generation US contrast agent

  • Carmina DuranEmail author
  • Javier del Riego
  • Luis Riera
  • Cesar Martin
  • Carlos Serrano
  • Pau Palaña
Original Article

Abstract

Background

Voiding urosonography (VUS) is established as a technique for detecting vesicoureteral reflux in children.

Objective

To evaluate the quality of images of the entire urinary tract when using a second-generation US contrast agent and a modified VUS technique.

Materials and methods

We evaluated 307 VUS examinations performed using SonoVue® in 591 pelvi-ureter units in 295 children of mean age, 27.1 (S.D., 42.5) months, with 154 (50.2%) of the examinations performed in boys; 58 children also underwent VUS using Levovist®. Three criteria were used for quality assessment of the bladder image: (1) progressive incorporation of contrast material in the bladder, (2) homogeneous bladder-filling to maximum capacity, and (3) visualisation of the posterior bladder wall.

Results

Criterion 1 was fulfilled in 305 (99.3%), criterion 2 in 304 (99%) and criterion 3 in 304 (99%) studies. In children who underwent VUS with both contrast agents, the concordance between the two techniques was moderate for findings in the bladder (Cohen K = 0.487; P < 0001) and perfect for findings in the male urethra.

Conclusion

By a modified technique we obtained high-quality images of the bladder with the second-generation contrast agent.

Keywords

Vesicoureteral reflux Voiding urosonography Second-generation contrast agent Child 

Notes

Acknowledgements

Special thanks to Inés Artacho, Antoni Malet Munte MD, Eva Castañer MD, John Giba, and Joan Carles Oliva.

References

  1. 1.
    Papadopoulou F, Anthopoulou A, Siomou E et al (2009) Harmonic voiding urosonography with a second-generation contrast agent for the diagnosis of vesicoureteral reflux. Pediatr Radiol 39:239–244PubMedCrossRefGoogle Scholar
  2. 2.
    Hernandez RJ, Goodsitt MM (1996) Reduction of radiation dose in pediatric patients using pulsed fluoroscopy. AJR 167:1247–1253PubMedGoogle Scholar
  3. 3.
    Darge K (2010) Voiding urosonography with US contrast agent for the diagnosis of vesicoureteric reflux in children: an update. Pediatr Radiol 40:956–962PubMedCrossRefGoogle Scholar
  4. 4.
    Darge K, Grattan-Smith JD, Riccabona M (2010) Pediatric uroradiology: state of the art. Pediatr Radiol 41:82–91PubMedCrossRefGoogle Scholar
  5. 5.
    Darge K (2008) Voiding urosonography with US contrast agents for the diagnosis of vesicoureteric reflux in children. II. Comparison with radiological examinations. Pediatr Radiol 38:54–63PubMedCrossRefGoogle Scholar
  6. 6.
    Kis E, Nyitrai A, Várkonyi I et al (2010) Voiding urosonography with 2nd generation contrast agent versus voiding cystourethrography. Pediatr Nephrol 25:2289–2293PubMedCrossRefGoogle Scholar
  7. 7.
    Ascenti G, Zimbaro G, Mazziotti S et al (2004) Harmonic US imaging of vesicoureteric reflux in children: usefulness of a second generation US contrast agent. Pediatr Radiol 34:481–487PubMedCrossRefGoogle Scholar
  8. 8.
    Berrocal T, Gayá F, Arjonilla A et al (2001) Vesicoureteral reflux: diagnosis and grading with echo-enhanced cystosonography versus voiding cystourethrography. Radiology 221:359–365PubMedCrossRefGoogle Scholar
  9. 9.
    Berrocal T, Gayá F, Arjonilla A (2005) Vesicoureteral reflux: can the urethra be adequately assessed by using contrast-enhanced voiding US of the bladder? Radiology 234:235–241PubMedCrossRefGoogle Scholar
  10. 10.
    Duran C, Valera A, Alguersuari A et al (2009) Voiding urosonography: the study of the urethra is no longer a limitation of the technique. Pediatr Radiol 39:124–131PubMedCrossRefGoogle Scholar
  11. 11.
    Darge K, Beer M, Gordjani N et al (2004) Contrast-enhanced voiding urosonography with the use of a 2nd generation US contrast medium: preliminary results. Pediatr Radiol 34:S97CrossRefGoogle Scholar
  12. 12.
    Schneider M (1999) SonoVue, a new ultrasound contrast agent. Eur Radiol 9:S347–348PubMedCrossRefGoogle Scholar
  13. 13.
    Greis C (2004) Technology overview: SonoVue (Bracco, Milan). Eur Radiol 14:P11–15PubMedCrossRefGoogle Scholar
  14. 14.
    Darge K (2008) Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children. I. Procedure. Pediatr Radiol 38:40–53PubMedCrossRefGoogle Scholar
  15. 15.
    Darge K, Bruchelt W, Roessling G et al (2003) Interaction of normal saline solution with ultrasound contrast medium: significant implication for sonographic diagnosis of vesicoureteral reflux. Eur Radiol 13:213–218PubMedGoogle Scholar
  16. 16.
    Darke K, Troeger J (2002) Vesicoureteral reflux grading in contrast-enhanced voiding urosonography. Eur J Radiol 43:122–128CrossRefGoogle Scholar
  17. 17.
    Giordano M, Marzolla M, Puteo F (2007) Voiding urosonography as first step in the diagnosis of vesicoureteral reflux in children: a clinical experience. Pediatr Radiol 37:674–677PubMedCrossRefGoogle Scholar
  18. 18.
    Quaia E (2007) Microbubble ultrasound contrast agents: an update. Eur Radiol 17:1995–2008PubMedCrossRefGoogle Scholar
  19. 19.
    Maté A, Bargiela A, Mosteiro S et al (2003) Contrast ultrasound of the urethra in children. Eur Radiol 13:1534–1537PubMedCrossRefGoogle Scholar
  20. 20.
    Bosio M, Manzoni GA (2002) Detection of posterior urethral valves with voiding cystourethrosonography with echo contrast. J Urol 168:1711–1715PubMedCrossRefGoogle Scholar
  21. 21.
    Riccabona M, Avni FE, Blickman JG et al (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Carmina Duran
    • 1
    Email author
  • Javier del Riego
    • 1
  • Luis Riera
    • 1
  • Cesar Martin
    • 1
  • Carlos Serrano
    • 1
  • Pau Palaña
    • 1
  1. 1.Department of Radiology, UDIAT-Centre DiagnòsticInstitut Universitari Parc Taulí-UABSabadellSpain

Personalised recommendations