[Cystosonography with echoenhancer. A new imaging technique for the diagnosis of vesicoureteral reflux].
OBJECTIVE
To analyze the utility of contrast enhanced ultrasonography of the bladder and kidneys (cystosonography) for the diagnosis of vesicoureteral reflux (VUR) by comparing the results of this new imaging modality with those of micturating cystourethrography (MCU).


METHODS
A total of 169 patients (293 kidney units) aged between 3 days and 18 years were sonographically evaluated for the presence of VUR after filling the bladder with saline and a galactose and palmitic acid suspension (Levograf) as an echoenhancing agent. Ultrasonographic images were obtained during bladder filling and micturation. This procedure was always followed by MCU during the same diagnostic session.


RESULTS
In 50 kidney units both cystosonography and MUR detected VUR during bladder filling. In 22 units, only cystosonography detected passive reflux during bladder filling and in 3 only MCU did so. In 56 units, both methods detected active VUR during micturation. In 17 units, only cystosonography detected active reflux during micturation, the results of MCU being normal, and in 5, only MCU detected active reflux. Overall, of the 293 kidney units, VUR was not detected by either of the imaging modalities in 204(69.6%) and was detected by both methods, irrespective of whether it was active or passive, in 63(21.5%). In 19 units, VUR (active or passive) was observed only by cystosonography and in 7 only by MCU. When MCU was used as the reference method, cystosonography had a sensitivity of 90.5% and a specificity of 91.4%.


CONCLUSIONS
Contrastenhanced cystosonography is a reliable modality, with sufficient sensitivity and specificity in the diagnosis of VUR and does not expose patients to ionizing radiation.
Berrocal Frutos T
Servicio de Radiodiagnóstico. Hospital Infantil La Paz. Madrid.
Gayá Moreno F
Gómez León N
Jaureguízar Monereo E
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007089:Image Enhancement; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008962:Models, Theoretical; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
D003287:Contrast Media