Cystosonography and voiding cystourethrography in the diagnosis of vesicoureteral reflux

• Published in: Pediatric nephrology (Berlin, West) Vol. 18; no. 1; pp. 18 - 22
• Main Authors: PIAGGIO, Giorgio, DEGL'INNOCENTI, Maria Ludovica, TOMA, Paolo, CALEVO, Maria Grazia, PERFUMO, Francesco
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 2003; Springer Nature B.V
• Subjects: Biological and medical sciences; Child; Child, Preschool; Contrast Media; False Negative Reactions; Female; Humans; Infant; Infant, Newborn; Investigative techniques, diagnostic techniques (general aspects); Kidney - diagnostic imaging; Male; Medical sciences; Polysaccharides; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sensitivity and Specificity; Sex Characteristics; Ultrasonic investigative techniques; Ultrasonography - methods; Urinary system; Vesico-Ureteral Reflux - diagnostic imaging; Sonography; Human; Urinary system disease; Radiodiagnosis; Urinary tract disease; Micturition; Vesicoureteral reflux; Echography; Urinary tract infections; Bladder disease; Diagnosis; Technique; Cystosonography; Voiding cystourethrography; Child; Cystourethrography; Comparative study
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-002-0974-3

The availability of US (ultrasonography) contrast media in the last few years has prompted investigation into their use in the diagnosis of vesicoureteral reflux (VUR) in children, a common cause of urinary tract infections (UTI) or pyelonephritis. We performed voiding cystourethrography (VCUG) and cystosonography (CSG) in the same session in 158 children (M/F 97/61, mean age 3.9 years, age range 0.1-12.7 years) with clinical suspicion of VUR, studied over a year with an ATL plus 3000 real-time scanner (ATL Ultrasound, Bothell, USA), equipped with 2- to 4- and 4- to 7-MHz convex transducers. US contrast medium Levovist (Schering, Berlin, Germany) was used. VCUG and CSG diagnosed 74 (24.2%) and 77 (25.2%) cases of VUR, respectively. There was no agreement in 67 cases (22%). The percentage of false negatives was similar and high with both techniques. CSG seems to be more sensitive in detecting intermediate (second- and third-degree) VUR. In spite of the moderate relative diagnostic adequacy of both methods, we believe that CSG is an alternative to VCUG, avoiding the risk of ionizing radiation, in the following conditions: (1) first diagnosis in females (not in males, due to the poor vesical and urethral anatomical detail it provides), (2) VUR follow-up, (3) VUR diagnosis in megaureters and/or in ureteroceles, and (4) VUR diagnosis in transplanted kidneys. Further improvements of CSG, both in US contrast media and in US technique, could possibly increase its sensitivity.