Echo-enhanced ultrasound voiding cystography in children: a new approach

Abstract

The development of echo-enhancing agents has significantly improved the detection of the movement of fluid within the urinary tract by ultrasonography (US). The purpose of our study was to compare ultrasound voiding cystography (USVC) for the detection of vesicoureteric reflux (VUR) in children with direct radionuclide voiding cystography (DRVC). Ninety-nine children, aged 1.1-12.3 years, with 198 potentially refluxing units, were investigated simultaneously by DRVC and USVC. The indications for cystography were urinary tract infection, follow-up of a previously detected VUR, and screening of siblings of children with VUR. During the investigation an echo-enhancing agent (Levovist) was administered intravesically through a catheter already in place for the DRVC. The movement of both agents, radiotracer and Levovist, was registered simultaneously by a computerized gamma camera and US, respectively. The results were analyzed with DRVC representing the reference diagnostic test. The overall sensitivity and specificity of USVC for the detection of VUR were 79% and 92%, respectively. USVC may represent a reliable diagnostic tool for the detection and follow-up of VUR in children.

Diagnostic challenges in Urinary Tract Infections in Children

“…Ultrasound study (U/S) after filling the bladder with levovist, a U/S sensitive contrast, could help diagnose VUR (19), yet it requires catheterization and has low sensitivity and specificity. In detection of renal involvement and confirming pyelonephritis, none of the acute phase reactants such as leukocytes in blood, erythrocyte sedimentation rate (ESR), c-reactive protein (CRP) or leukocyte in urine or detection of antibody coated bacteria are considered reliable in diagnosis of renal involvement.…”

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

“…Indeed, PD-VUS seems to be superior to VCUG [3], and also to DRVC [6,18], in this respect. The prolonged duration of PD-VUS could allow detection of short-lasting refluxes possibly overlooked by VCUG.…”

“…Effectiveness of this tool has already been evaluated in several studies comparing on the same child findings at VUS and at a reference imaging modality either VCUG or direct radionuclide voiding cystography (DRVC) [3][4][5][6]. Nevertheless, both VCUG and DRVC are partially unreliable reference standards presenting some limitation in the assessment of laterality and/or grading of VUR.…”

Does the ureteric jet Doppler waveform have a role in detecting vesicoureteric reflux?

“…Several other imaging modalities have been developed to investigate the occurrence of VUR, such as direct and indirect nuclear studies and ultrasound imaging with ultrasound contrast medium injected into the bladder [18]. Both direct nuclear imaging and ultrasound with contrast medium involves catherisation of the bladder.…”