Contrast-enhanced voiding urosonography for the diagnosis of vesicoureteral reflux and intrarenal reflux: a comparison of diagnostic performance with fluoroscopic voiding cystourethrography

Kim, Dae–Hee; Choi, Young Hun; Choi, Ga‐Young; Lee, Seulbi; Lee, Seung–Hyun; Cho, Yeon Jin; Lim, Seon Hee; Kang, Hee Gyung; Cheon, Jung Eun

doi:10.14366/usg.20157

Cited by 19 publications

(19 citation statements)

References 23 publications

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“…Out of all the detected VURs, the percentage of detected IRRs in this study was 47.5%. If we exclude the results of Cvitkovic Roic et al who reported 12% IRR, other studies also showed a higher incidence of IRR on ceVUS, which is a much higher incidence than in patients examined by VCUG, which has been reported to be 1–11% ( 17 , 19 , 20 , 22 , 25 , 26 ).…”

Section: Discussionmentioning

confidence: 75%

“…Since IRR was assigned as a potential place of parenchymal damage in the previous studies ( 17 , 22 , 23 , 29 , 30 ), we expect more parenchymal changes at the places of IRR in this study. Moreover, since a higher number of IRRs can be detected by ceVUS than by VCUG ( 19 , 26 ), we expect some other signs of parenchymal damage, not only scars, diagnosed by DMSA scan in renal regions affected by IRR in patients diagnosed by ceVUS.…”

Section: Introductionmentioning

confidence: 96%

“…No one of the two boys from that case series had a posterior urethral valve (PUV). Recently, three articles reported that the incidence of IRR was 12–49.5% of all VURs diagnosed by ceVUS ( 19 , 25 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

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The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan

et al. 2022

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PurposeTo describe the parenchymal defects in kidneys with intrarenal reflux (IRR) diagnosed using contrast-enhanced voiding urosonography (ceVUS) and 99mTc-DMSA scintigraphy (DMSA scan).Materials and MethodsA group of 186 uretero-renal units (URUs) was analyzed using ceVUS and DMSA scans: 47 without vesicoureteral reflux (VUR) (group A) and 139 with VURs, comprising 73 VURs without (group B), and 66 with IRR (group C). VURs included non-dilating (grades I–II), mildly non-dilating (grade III), and non-dilating (grades IV–V) grades. The parenchymal changes were analyzed using a DMSA scan.ResultsThe median age for VUR diagnosis was 16.5 months in girls, and 8.5 months in boys (Z = 3.9; p = 0.001). IRR occurred in 51.4% of boys and in 25.9% of girls (χ2 = 12.4; p < 0.001). The non-dilating VUR occurred in 44% of boys and 24.1% of girls (χ2 = 7.7; p = 0.005). IRRs characterized upper and lower renal segments (81.8 and 63.6%) and middle segments (33.3%). Both incidence and increase in IRR correlated with the grade of VUR (p < 0.001). The incidence of reduced DMSA signal was statistically different among groups A + B and C, but not between groups A and B (χ2 = 32.2; p < 0.001). No statistically significant relationship existed between the reduced DMSA signal and the grade of VUR in group C. The reduced DMSA signal appeared in 9.9% positions in kidneys from group A, 14% from group B, and 32% from group C. Out of all 118 IRRs, 38.1% had reduced and 61.9% had normal DMSA signal. Among 11 parenchymal scars found in all three groups, 2 belonged to group B, 9 to group C, while group A had no scars.ConclusionThe parenchymal changes are the most prominent in the group with IRR, but they do not significantly differ among kidneys with different grades of VUR. VURs of higher grades are associated with a higher incidence of IRR and early clinical presentation. Scars can also appear in lower-grade VURs accompanied by IRR. Boys with VUR have earlier clinical presentation than girls, as they have significantly higher grades of VUR with a higher proportion of IRRs. Therefore, we suggest a subdivision of VURs into those with IRR and abundant parenchymal damage, and those without IRR and less parenchymal damage.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 96%

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The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan

et al. 2022

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“…Likewise, in the analysis of DMSA scans, multiple IRRs in a single pole were evaluated as a single lesion, and the largest IRR was selected among multiple lesions. We classified IRR into three types according to its extent, as follows [ 10 ]: type 1 IRR, mild IRR (confined to a single medullary pyramid, which was seen as a string of tiny bubbles refluxed into the medulla with CeVUS); type 2 IRR, moderate IRR (involving several tiny bubbles refluxed into less than half of the renal parenchyma); type 3 IRR, extensive IRR (involving more than half of the renal parenchyma) ( Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…From this perspective, contrast-enhanced voiding ultrasonography (CeVUS), an ionizing radiation-free alternative to fluoroscopic VCUG, is an emerging A c c e p t e d A r t i c l e modality for the diagnosis of VUR. In addition, there have been some reports suggesting that CeVUS could depict IRR better than conventional VCUG [8][9][10][11]. Therefore, we assume that CeVUS, which shows high sensitivity in diagnosis of IRR, would be highly correlated with the sites of photon defects on acute DMSA renal scans.…”

Section: Introductionmentioning

confidence: 96%

Contrast-enhanced voiding ultrasonography to detect intrarenal reflux in children: comparison with 99mTc-DMSA renal scans

Cho

2022

Ultrasonography

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To evaluate the diagnostic performance of contrast-enhanced voiding ultrasonography (CeVUS) detecting intrarenal reflux (IRR) and propose the correlation between sites of IRR detected by CeVUS and photon defect sites in acute 99mTc-DMSA renal scan in pediatric patients. Methods: Fifty-four kidneys from 27 patients (20 males and 7 females; mean age, 5.6±4.1 months) who underwent CeVUS and acute DMSA renal scan for recurrent urinary tract infection (UTI) or pyelonephritis were included. Pediatric experts compared the results of CeVUS with acute DMSA renal scan, including the grade of vesicoureteral reflux and the presence and location of IRR.Results: Thirteen renal units (13/54, 24.1%) of 10 patients (9 males and 1 female; mean age, 6.3±3.7 months; age range, 0-13 months) showed VUR and eight renal units (8/54, 14.8%) demonstrated IRR on CeVUS. Ten renal units of 8 patients (6 males and 2 females; mean age, 6.9±1.4 months; age range, 2-13 months) showed 19 photon defects on acute DMSA renal scan. Among 54 renal units, 52 (96.3%) showed concordant results, and 2 renal units (3.7%) showed discordant results between CeVUS and acute DMSA renal scan. IRR accounted for 15/19 (78.9%) photon defects in 8 renal units of 7 patients, on using CeVUS. In the per-renal unit-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CeVUS were 80%, 100%, 100%, 95.7%, and 96.3%, respectively. Conclusion:CeVUS showed good performance in detecting IRR, and the IRR sites detected by CeVUS showed a high correlation with photon defect sites in acute DMSA scan. Therefore, CeVUS may play an important role in managing patients with recurrent UTI or pyelonephritis with reduced radiation exposure.

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Effects of Intrarenal Reflux on Renal Growth in Children With Grades III–V Primary Vesicoureteral Reflux

Xiuzhen,

Zheming,

et al. 2024

J of Ultrasound Medicine

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The phenomenon of intrarenal reflux (IRR) has been considered a crucial link between vesicoureteral reflux (VUR) and segmental scarring. We conducted a study on renal length in 104 children diagnosed with Grades III–V VUR, with or without IRR, using contrast‐enhanced voiding urosonography (ceVUS). The patients were divided into two treatment groups: the conservative antibiotic prophylaxis (CAP) group and the operation group, which were further categorized into two subgroups: the IRR group and the non‐IRR group. Our findings revealed an incidence rate of 35.96% (41/114) for IRR occurrence, with 43.42% (33/76) occurring in upper renal segments, 32.89% (25/76) in lower segments, and 23.68% (18/76) in middle segments. In the CAP group where the effects of IRR persisted, the renal growth observed was as follows: IRR group—0.19 ± 0.13 cm; non‐IRR group—0.39 ± 0.23 cm; contralateral negative group—0.66 ± 0.35 cm; control group—0.46 ± 0 .25 cm respectively (P < .05). In the operation group, where the effects of IRR were eliminated, the renal growth for the IRR group, non‐IRR group, contralateral negative group, and control group was 0.46 ± 0.22 cm, 0.54 ± 0.31 cm, 0.67 ± 0 .42 cm, and 0.36 ± 0.17 cm respectively (P < .005). In conclusion, the presence of IRR can impact renal growth in children diagnosed with Grades III–V primary VUR. Following surgical intervention, the IRR kidney does not exhibit catch‐up growth; however, it demonstrates parallel growth alongside the unaffected kidney. Conversely, the non‐IRR kidney experiences catch‐up growth. Therefore, for children presenting with Grades III–V primary VUR combined with IRR, a more aggressive treatment approach such as surgery is recommended.

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Contrast-enhanced voiding urosonography for the diagnosis of vesicoureteral reflux and intrarenal reflux: a comparison of diagnostic performance with fluoroscopic voiding cystourethrography

Abstract: Contrast-enhanced voiding urosonography for the diagnosis of vesicoureteral reflux and intrarenal reflux: Comparison of diagnostic performance with fluoroscopic voiding cystourethrography

Cited by 19 publications

References 23 publications

The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan

The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan

Contrast-enhanced voiding ultrasonography to detect intrarenal reflux in children: comparison with 99mTc-DMSA renal scans

Effects of Intrarenal Reflux on Renal Growth in Children With Grades III–V Primary Vesicoureteral Reflux

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