title: Cystosonography and voiding cystourethrography in the diagnosis of vesicoureteral reflux.
abstract: The availability of US (ultrasonography) contrast media in the last few years has prompted investigation into their use in the diagnosis of vesicoureteral reflux (VUR) in children, a common cause of urinary tract infections (UTI) or pyelonephritis. We performed voiding cystourethrography (VCUG) and cystosonography (CSG) in the same session in 158 children (M/F 97/61, mean age 3.9 years, age range 0.1-12.7 years) with clinical suspicion of VUR, studied over a year with an ATL plus 3000 real-time scanner (ATL Ultrasound, Bothell, USA), equipped with 2- to 4- and 4- to 7-MHz convex transducers. US contrast medium Levovist (Schering, Berlin, Germany) was used. VCUG and CSG diagnosed 74 (24.2%) and 77 (25.2%) cases of VUR, respectively. There was no agreement in 67 cases (22%). The percentage of false negatives was similar and high with both techniques. CSG seems to be more sensitive in detecting intermediate (second- and third-degree) VUR. In spite of the moderate relative diagnostic adequacy of both methods, we believe that CSG is an alternative to VCUG, avoiding the risk of ionizing radiation, in the following conditions: (1) first diagnosis in females (not in males, due to the poor vesical and urethral anatomical detail it provides), (2) VUR follow-up, (3) VUR diagnosis in megaureters and/or in ureteroceles, and (4) VUR diagnosis in transplanted kidneys. Further improvements of CSG, both in US contrast media and in US technique, could possibly increase its sensitivity.
authors.affiliation: Department of Nephrology, Dialysis, and Transplantation, Scientific Directorate, G. Gaslini Institute, Largo Gerolamo Gaslini 5, 16148 Genoa, Italy. giorgiopiaggio@ospedale-gaslini.ge.it
authors.forename: Giorgio
authors.initials: G
authors.lastname: Piaggio
authors.forename: Maria Ludovica
authors.initials: ML
authors.lastname: Degl' Innocenti
authors.forename: Paolo
authors.initials: P
authors.lastname: Tomà
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Calevo
authors.forename: Francesco
authors.initials: F
authors.lastname: Perfumo
mesh_terms: D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D011134:Polysaccharides; D012680:Sensitivity and Specificity; D012727:Sex Characteristics; D014463:Ultrasonography / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508