Sonocystografia mikcyjna 2D/3D/4D w diagnostyce i monitorowaniu leczenia odpływów pęcherzowo- -moczowodowych u dzieci – czy może zastąpić rentgenowską cystouretrografię mikcyjną?

Abstract

IntroductionVesicoureteral reflux appears in 20–50% of pediatric patients with recurrent urinary tract infections. The most common method of diagnosing this disease is voiding cystourethrography. However, contemporary pediatric radiology does not favor this method due to exposure to X-radiation.AimThe aim of this study was to assess the usefulness of 2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and treatment monitoring of vesicoureteral reflux in children and the possibility of using contrast-enhanced voiding urosonography to replace voiding cystourethrography.Material and methodsVoiding cystourethrography and contrast-enhanced voiding urosonography were conducted in 80 pediatric patients in order to assess sensitivity, specificity, positive and negative predictive values as well as the number of vesicoureteral refluxes detected by each of the two methods. The second stage of the study involved performing voiding urosonography in an extended protocol in 58 children in order to determine the usefulness of three-dimensional (3D/4D) examinations in the assessment of vesicoureteral reflux and the ability to assess the urethra.ResultsThe concordance between the two methods was 86.95%. The sensitivity of voiding urosonography was 84.51%, specificity – 90.99%, positive predictive value – 85.71% and negative predictive value – 90.17%. A 3D/4D assessment of the urinary bladder and transperineal 2D morphological assessment of the urethra were possible in all patients (100%). Assessment of the urethra during micturition with the use of 2D/3D/4D techniques was possible in all patients in whom voiding was elicited (95.83%), and 3D/4D assessment of vesicoureteral reflux was possible in all patients with reflux (100%). Although the application of 3D/4D techniques allowed accurate specification of the grade of reflux in all cases (100%), it appeared particularly useful in differentiating between grades II and III (70.97%).ConclusionsContrast-enhanced voiding urosonography allows the diagnosis and monitoring of treatment of vesicoureteral reflux in pediatric patients as well as assessment of the urethra in both girls and boys. The method is characterized by high sensitivity and specificity. Moreover, it is safe, relatively inexpensive and can replace voiding cystourethrography.

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

“…With contrast-enhanced ultrasound (CEUS) it is possible to differentiate diffuse inflammatory diseases from abscesses. Thus, contrast-enhanced voiding urosonography allows the diagnosis and monitoring of the treatment of vesicoureteral reflux in pediatric patients as well as assessment of the urethra 106 .…”

The evaluation of vesicoureteral reflux among children using contrast-enhanced ultrasound: a literature review

“…1e5 illustrate cases from the senior author's personal experience on the utilization of contrast-enhanced US in assessing VUR. Some investigators have applied special software to incorporate real-time reconstruction of the urinary tract using a three-dimensional plane [22,23]. In 2017, Duran et al [12] summarized the diagnostic utility of SonoVue for diagnosis of VUR in children with a detailed description of procedural technique and quality assurance criteria to ensure high accuracy.…”

Color Doppler dynamic tissue perfusion measurement: a novel tool in the assessment of renal parenchymal perfusion in children with vesicoureteral reflux

“…For patients in study group 2 (with UTIs without VUR), the analysis included data from both kidneys (60 kidneys). VUR had previously been diagnosed or excluded with contrast-enhanced voiding urosonography (ce-VUS) performed by the standard protocol used in our center [ 12 ]. Recurrent UTIs were diagnosed based on clinical symptoms, and positive urine analysis and culture.…”