Potential role of colour-Doppler cystosonography with echocontrast in the screening and follow-up of vesicoureteral reflux.
Primary vesicoureteral reflux is a predisposing factor for urinary tract infections in children. The first-choice technique for the diagnosis of vesicoureteral reflux is voiding cystourethrography, followed by cystoscintigraphy; cystoscintigraphy, however, has the advantage of only minor irradiation of the patient, but it does not allow the morphological evaluation of bladder and vesicoureteral reflux grading. Colour-Doppler cystosonography with echocontrast is a recently introduced method for imaging vesicoureteral reflux. The aim of our study is to evaluate the role of colour-Doppler cystosonography with echocontrast in the diagnosis of vesicoureteral reflux. Twenty children (11M, 9F) aged between 0.4 and 4.9 y underwent colour-Doppler cystosonography using a diluted solution of Levovist (Schering, Germany), after filling up the bladder with saline. In all patients, vesicoureteral reflux diagnosis and grading had been performed previously by voiding cystourethrography within 5 d from ultrasonography. Our data showed high accuracy in the detection of medium to severe vesicoureteral reflux (grades III-V), confirmed by radiological features in 9/9 patients. Conversely, in the 11 patients with mild vesicoureteral reflux (grades I-II), this technique showed extremely low sensitivity, allowing diagnosis in only four cases.


CONCLUSIONS
Colour-Doppler cystosonography, because of the absence of ionizing radiations, has great advantages, particularly in patients needing prolonged monitoring. Despite experiences reported in the literature, this technique has a role in the diagnosis of vesicoureteral reflux. Our group chooses colour-Doppler cystosonography for the follow-up of medium-severe grade vesicoureteral reflux already diagnosed by radiology and/or scintigraphy. Cystoscintigraphy is employed only to confirm cases resulting negative at ultrasonography.
Ascenti
G
G
Institute of Radiological Sciences, Faculty of Medicine and Surgery, University of Messina, Italy.
Chimenz
R
R
Zimbaro
G
G
Mazziotti
S
S
Scribano
E
E
Fede
C
C
Ricca
M
M
D000367:Age Factors; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011134:Polysaccharides; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508