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Harmonic voiding urosonography with a second-generation contrast agent for the diagnosis of vesicoureteral reflux

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Abstract

Background

Voiding urosonography with harmonic imaging (VUS HI) has been introduced as a sensitive and radiation-free imaging method for the diagnosis and follow-up of vesicoureteral reflux (VUR) in children.

Objective

The purpose of this study was to evaluate the sensitivity of VUS HI using a second-generation US contrast agent compared to standard voiding cystourethrography (VCUG).

Materials and methods

A total of 228 children with 463 kidney-ureter units (KUUs) underwent two cycles of VUS HI and two cycles of VCUG at the same session. VUS HI was performed after intravesical administration of 1 ml of a second-generation US contrast agent (sulphur-hexafluoride gas microbubbles, SonoVue, Bracco, Italy). For statistical analysis we used McNemar’s test, Student’s t-test and k coefficient tests.

Results

VUR was shown in 161/463 (34.7%) KUUs, 57 by both methods, 90 only by VUS, and 14 only by VCUG. Concordance in findings regarding the presence or absence of VUR was found in 359/463 (77.5%) KUUs (k=0.40). The difference in the detection rate of reflux between the two methods was significant (P<0.01). More importantly, reflux missed by VCUG was of higher grade (2 grade I, 65 grade II, 19 grade III, 4 grade IV) than that missed by VUS (8 grade I, 5 grade II, 1 grade III).

Conclusion

VUS HI and a second-generation contrast agent improved the identification of reflux in children. Our data reveal a higher sensitivity of the method compared to VCUG. Thus it can be used as an alternative radiation-free imaging method.

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Authors and Affiliations

  1. Department of Radiology, University Hospital of Ioannina, P.O. Box 1186, University Avenue, Ioannina, 45110, Greece

    Frederica Papadopoulou, Amalia Anthopoulou, Stavros Efremidis & Constantinos Tsamboulas

  2. Paediatric Clinic, University Hospital of Ioannina, Ioannina, Greece

    Ekaterini Siomou

  3. Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Kassa Darge

Authors
  1. Frederica Papadopoulou
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  2. Amalia Anthopoulou
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  3. Ekaterini Siomou
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  4. Stavros Efremidis
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  5. Constantinos Tsamboulas
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  6. Kassa Darge
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Correspondence to Frederica Papadopoulou.

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Papadopoulou, F., Anthopoulou, A., Siomou, E. et al. Harmonic voiding urosonography with a second-generation contrast agent for the diagnosis of vesicoureteral reflux. Pediatr Radiol 39, 239–244 (2009). https://doi.org/10.1007/s00247-008-1080-x

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  • DOI: https://doi.org/10.1007/s00247-008-1080-x

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