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European Journal of Pediatrics

, Volume 173, Issue 8, pp 1095–1101 | Cite as

Voiding urosonography with second-generation ultrasound contrast versus micturating cystourethrography in the diagnosis of vesicoureteric reflux

  • L. S. Wong
  • K. S. TseEmail author
  • T. W. Fan
  • K. Y. Kwok
  • T. K. Tsang
  • H. S. Fung
  • W. Chan
  • K. W. Lee
  • M. W. Y. Leung
  • N. S. Y. Chao
  • K. W. Tang
  • S. C. H Chan
Original Article

Abstract

Vesicoureteric reflux has been associated with paediatric urinary tract infection. Fluoroscopic micturating cystourethrography (MCU) has been the gold standard of diagnostic test for decades; however, it has been criticized owing to its lower detection rate and radiation dose to children. Therefore, new radiation-free reflux imaging modalities have been developed, in which ultrasound-based contrast-enhanced voiding urosonography (ceVUS) is a good example. However, ultrasonography has been considered as an operator-dependent examination. Therefore, our study aimed to examine the inter-observer agreement of this sonographic technique, which has not been evaluated before. Moreover, the second-generation ultrasound contrast SonoVue has been recently marketed, and the data on its efficacy on intravesical use in ceVUS is relatively scarce. Thus, we also aimed to investigate the diagnostic performance and safety profile of SonoVue-enhanced VUS in the diagnosis of vesicoureteric reflux. Our prospective comparative study compared the diagnostic performance of ceVUS with MCU in young children presenting with first episode of urinary tract infection. We performed sequential ceVUS and MCU examinations in 31 patients (62 pelvi-ureter units). Perfect inter-observer agreement (Cohen’s kappa statistics = 1.0, p < 0.001) was achieved in ceVUS, suggesting its good reliability in reflux detection and grading. Using MCU as reference, ceVUS had 100 % sensitivity and 84 % specificity and carried higher reflux detection rate than MCU (p < 0.001). There was no complication encountered. Conclusion: Voiding urosonography is a reliable, sensitive, safe and radiation-free modality in the investigation of vesicoureteric reflux in children. It should be incorporated in the diagnostic algorithm in paediatric urinary tract infection.

Keywords

Voiding urosonography Micturating cystourethrography Vesicoureteric reflux Urinary tract infection Paediatric 

Abbreviations

ceVUS

Voiding urosonography

MCU

Micturating cystourethrography

VUR

Vesicoureteric reflux

RNC

Radionuclide cystography

UTI

Urinary tract infection

Notes

Acknowledgments

The authors would like to thank Dr. Kassa Darge for his technical advices in this study.

Supplementary material

Online resource 1

Cine loop of the left kidney shows the influx of moving echogenic particles into the mildly dilated left renal pelvis and calyces during real-time ceVUS examination (grade III reflux). Real-time examination provides definitive evidence to the diagnosis of vesicoureteric reflux (MPG 840 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • L. S. Wong
    • 1
  • K. S. Tse
    • 1
    Email author
  • T. W. Fan
    • 2
  • K. Y. Kwok
    • 1
  • T. K. Tsang
    • 3
  • H. S. Fung
    • 1
  • W. Chan
    • 4
  • K. W. Lee
    • 5
  • M. W. Y. Leung
    • 6
  • N. S. Y. Chao
    • 6
  • K. W. Tang
    • 1
  • S. C. H Chan
    • 1
  1. 1.Department of Radiology and ImagingQueen Elizabeth HospitalKowloonHong Kong
  2. 2.Scanning DepartmentSt Teresa’s Medical CentreKowloonHong Kong
  3. 3.Department of RadiologyEvangelist HospitalKowloonHong Kong
  4. 4.Department of PaediatricsQueen Elizabeth HospitalKowloonHong Kong
  5. 5.Department of PaediatricsSt Teresa’s Medical CentreKowloonHong Kong
  6. 6.Division of Paediatric Surgery, Department of SurgeryQueen Elizabeth HospitalKowloonHong Kong

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