Diagnostic accuracy of contrast-enhanced voiding urosonogram using second-generation contrast with harmonic imaging (CEVUS-HI) study for assessment of vesicoureteral reflux in children: a meta-analysis
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To assess the diagnostic accuracy and safety of contrast-enhanced voiding urosonogram using second-generation contrast with harmonic imaging (CEVUS-HI) in detecting vesicoureteral reflux (VUR) among children.
A systematic literature search was performed in March 2018. Relevant comparative studies from Medline, EMBASE, World of Science, Scopus, CENTRAL, WHO trial registry and Clinicaltrials.gov were identified and appraised using QUADAS-2. Diagnostic accuracy parameters were determined using VCUG as the reference standard. Adverse effects related to ultrasound contrast were summarized. The heterogeneity and inter-study variability were determined. After appropriate subgroup diagnostic accuracy parameters were investigated, summarizing receiver operator characteristics was constructed using the bivariate model meta-regression to determine the area under the curve (AUC).
A total of 12 studies with low–high risk of bias, including 1917 ureteral units from 953 patients were assessed for this meta-analysis. The included studies reported no serious adverse events associated with the ultrasound contrast. The pooled diagnostic accuracy parameters of CEVUS-HI in detecting VUR amongst children were: sensitivity 90.43 (95% CI 90.36–90.50), specificity 92.82 (95% CI 92.76–92.87), the calculated (+) likelihood-ratio 12.59 (95% CI 12.49–12.68), (−) likelihood-ratio of 0.103 (95% CI 0.102–0.104) and extrapolated pooled diagnostic odds-ratio was 122.12 (95% CI 120.75–123.49). Heterogeneity with interstudy variability was noted (p < 0.0001, I-squared > 70%). The AUC was determined to be 0.965 for VUR detection.
The pooled diagnostic accuracy parameters from low–moderate quality of evidence have illustrated that the CEVUS-HI study has an excellent safety profile and acceptable diagnostic accuracy. It may be considered as an alternative diagnostic modality for assessment of VUR among children.
KeywordsContrast-enhanced voiding urosonogram Diagnostic accuracy Vesicoureteral reflux Voiding cystourethrogram
MEC: Protocol/project development, data collection or management, data analysis, manuscript writing/editing. JSM: Protocol/project development, data collection or management, data analysis, manuscript writing/editing. JMM: Data collection, manuscript editing/revision. JSD: Data analysis, manuscript writing/editing. OG: Protocol/project development, data collection or management, data analysis.
Compliance with ethical standards
Conflict of interest
All authors have nothing to disclose.
The study was approved and registered in our institutional research board as exempt for review.
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