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Pediatric Radiology

, Volume 35, Issue 1, pp 73–78 | Cite as

Diagnosis of vesicoureteric reflux with low-dose contrast-enhanced harmonic ultrasound imaging

  • Kassa DargeEmail author
  • Richard-Tobias Moeller
  • Andreas Trusen
  • Felix Butter
  • Nader Gordjani
  • Hubertus Riedmiller
Original Article

Abstract

Background: Harmonic US imaging has been shown to be better than conventional US for the detection and visualisation of microbubbles in contrast-enhanced voiding urosonography (VUS). Objective: To determine the diagnostic efficacy of VUS using a reduced dose of the US contrast medium in comparison to voiding cystourethrography (VCUG). Materials and methods: Fifty-five children (17 boys, 38 girls; mean age 4 years) were recruited. All patients underwent VUS by harmonic imaging followed by VCUG. The dose of the US contrast medium (Levovist) administered intravesically was half of the recommended dose i.e. 5% of the bladder filling volume. Results: A total of 114 kidney-ureter (K-U) units were available for evaluation. Vesicoureteric reflux (VUR) was detected in 29 K-U units by one or both examination modalities. There was a 91.2% concordance rate between VUS and VCUG. VUR in seven and three K-U units were detected only by VUS and VCUG, respectively. Taking VCUG as the reference method, VUS had the following diagnostic results: 86.4% sensitivity, 92.4% specificity, positive and negative predictive values of 73.1 and 96.6%, respectively. Conclusions: Even when the dose of US contrast medium is halved, the diagnostic efficacy of harmonic VUS is comparable to VCUG. Consequently, we recommend an US contrast medium dose of 5% of the bladder filling volume for the diagnosis of VUR using contrast-enhanced harmonic VUS.

Keywords

Kidney Ureter Vesico-ureteric reflux Ultrasound Harmonic imaging Contrast medium Children 

Notes

Acknowledgements

We are very thankful to Mr. Arne Schaefer for the comprehensive statistical analysis and expert advice.

References

  1. 1.
    Darge K (2002) Diagnosis of vesicoureteral reflux with ultrasound. Pediatr Nephrol 17:52–60CrossRefPubMedGoogle Scholar
  2. 2.
    Valentini AL, De Gaetano AM, Destito C, et al (2002) The accuracy of voiding urosonography in detecting vesico-ureteral reflux: a summary of existing data. Eur J Pediatr 161:380–384CrossRefPubMedGoogle Scholar
  3. 3.
    Darge K, Zieger B, Rohrschneider W, et al (2001) Contrast-enhanced harmonic imaging for the diagnosis of vesicoureteral reflux. AJR Am J Roentgenol 177: 1411–1415PubMedGoogle Scholar
  4. 4.
    Darge K, Trusen A, Gordjani N, et al (2003) Intrarenal reflux: diagnosis with contrast-enhanced harmonic US. Pediatr Radiol 33:729–731CrossRefPubMedGoogle Scholar
  5. 5.
    Darge K, Troeger J, Duetting T, et al (1999) Reflux in young patients: comparison of voiding US of the bladder and retrovesical space with echo enhancement versus voiding cystourethrography for diagnosis. Radiology 210:201–207PubMedGoogle Scholar
  6. 6.
    Darge K, Troeger J (2002) Vesicoureteral reflux grading in contrast-enhanced voiding urosonography. Eur J Radiol 43:122–128CrossRefPubMedGoogle Scholar
  7. 7.
    Lebowitz RL, Olbing H, Parkkulainen KV, et al (1985) International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 15:105–109PubMedGoogle Scholar
  8. 8.
    Tranquart F, Grenier N, Eder V, et al (1999) Clinical use of ultrasound tissue harmonic imaging. Ultrasound Med Biol 25:889–894CrossRefPubMedGoogle Scholar
  9. 9.
    Berrocal T, Gaya F, Arjonilla A, et al (2001) Vesicoureteral reflux: diagnosis and grading with echo-enhanced cystosonography versus voiding cystourethrography. Radiology 221:359–365PubMedGoogle Scholar
  10. 10.
    Escape I, Martinez J, Bastart F, et al (2001) Usefulness of echocystography in the study of vesicoureteral reflux. J Ultrasound Med 20:145–149PubMedGoogle Scholar
  11. 11.
    Mentzel HJ, Vogt S, Joan U, et al (2002) Voiding urosonography with ultrasonography contrast medium in children. Pediatr Nephrol 17:272–276CrossRefPubMedGoogle Scholar
  12. 12.
    Radmayr C, Klauser A, Pallwein L, et al (2002) Contrast enhanced reflux sonography in children: a comparison to standard radiological imaging. J Urol 167:1428–1430CrossRefPubMedGoogle Scholar
  13. 13.
    Piaggio G, Degl Innocenti ML, Toma P, et al (2003) Cystosonography and voiding cystourethrography in the diagnosis of vesicoureteral reflux. Pediatr Nephrol 18:18–22CrossRefPubMedGoogle Scholar
  14. 14.
    Nakamura M, Shinozaki T, Taniguchi N, et al (2003) Simultaneous voiding cystourethrography and voiding urosonography reveals utility of sonographic diagnosis of vesicoureteral reflux in children. Acta Paediatr 92:1422–1426CrossRefPubMedGoogle Scholar
  15. 15.
    Valentini AL, Salvaggio E, Manzoni C, et al (2001) Contrast-enhanced gray-scale and color doppler voiding urosonography versus voiding cystourethrography in the diagnosis and grading of vesicoureteral reflux. J Clin Ultrasound 29:65–71CrossRefPubMedGoogle Scholar
  16. 16.
    Riccabona M, Mache CJ, Lindbichler F (2003) Echo-enhanced color doppler cystosonography of vesicoureteral reflux in children: improvement by stimulated acoustic emission. Acta Radiol 44:18–23PubMedGoogle Scholar
  17. 17.
    Bosio M, Manzoni GA (2002) Detection of posterior urethral valves with voiding cystourethrosonography with echo contrast. J Urol 168:1711–1715CrossRefPubMedGoogle Scholar
  18. 18.
    Ascenti G, Zimbaro G, Mazziotti S, et al (2004) Harmonic US imaging of vesicoureteric reflux in children: usefulness of a second generation US contrast agent. Pediatr Radiol 34:481–487CrossRefPubMedGoogle Scholar
  19. 19.
    Galloy M, Mandry D, Pecastaings M, et al (2003) Sonocystography: a new method for the diagnosis and follow-up of vesico-ureteric reflux in children. J Radiol 84:2055–2061PubMedGoogle Scholar
  20. 20.
    Darge K, Zieger B, Rohrschneider W, et al (2001) Reduction in voiding cystourethrographies after the introduction of contrast enhanced sonographic reflux diagnosis. Pediatr Radiol 31:790–795CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Kassa Darge
    • 1
    Email author
  • Richard-Tobias Moeller
    • 1
  • Andreas Trusen
    • 1
  • Felix Butter
    • 1
  • Nader Gordjani
    • 2
  • Hubertus Riedmiller
    • 3
  1. 1.Department of Paediatric RadiologyUniversity Hospital WuerzburgWuerzburgGermany
  2. 2.Department of Paediatric NephrologyUniversity Children’s Hospital WuerzburgWuerzburgGermany
  3. 3.Department of UrologyUniversity Hospital WuerzburgWuerzburgGermany

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