title: Voiding urosonography with second-generation contrast agent versus voiding cystourethrography.
abstract: Contrast-enhanced voiding urosonography (VUS) is becoming more widely used for the diagnosis of vesicoureteric reflux (VUR). The purpose of this study was to evaluate the sensitivity of VUS using a second-generation ultrasound (US) contrast agent and compare it with standard fluoroscopic voiding cystourethrography (VCUG). A total of 183 children with 366 kidney-ureter units (KUUs) underwent VUS and VCUG in the same session with the same catheterization. VUS was performed after intravesical administration of 1 ml of a second-generation ultrasound contrast agent (UCA; SonoVue, Bracco, Italy). VUR was detected in 140 out of 366 cases (38%); in 89 (24.3%) by both methods, in 37 (10.1%) by VUS only, and in 14 (3.8%) by VCUG only. Although there was considerable agreement in the diagnosis of VUR by VUS and VCUG (κ=0.68, standard error [κ]=0.04), the difference in the detection rate of reflux between VUS and VCUG was significant (p<0.00001). The grade of VUR detected with VUS showed moderate agreement with grading by VCUG. Our findings suggest that contrast-enhanced harmonic VUS using a second-generation contrast agent is superior to VCUG in the detection and grading of VUR, and it should be the method of choice for this clinical indication.
authors.affiliation: 1st Department of Pediatrics, Pediatric Radiology Unit, Semmelweis Medical University, 53-54 Str. János Bókay, Budapest, Hungary. kiseva2009@gmail.com
authors.forename: Eva
authors.initials: E
authors.lastname: Kis
authors.forename: Anna
authors.initials: A
authors.lastname: Nyitrai
authors.forename: Ildikó
authors.initials: I
authors.lastname: Várkonyi
authors.forename: István
authors.initials: I
authors.lastname: Máttyus
authors.forename: Orsolya
authors.initials: O
authors.lastname: Cseprekál
authors.forename: György
authors.initials: G
authors.lastname: Reusz
authors.forename: Attila
authors.initials: A
authors.lastname: Szabó
mesh_terms: D002648:Child; D003287:Contrast Media; D003430:Cross-Sectional Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D010743:Phospholipids; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography / Q000379:methods*; D014513:Ureter / Q000000981:diagnostic imaging; D014521:Urethra / Q000000981:diagnostic imaging*; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014554:Urination / Q000502:physiology*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride