title: Voiding urosonography with second-generation ultrasound  contrast versus micturating cystourethrography  in the diagnosis of vesicoureteric reflux.
abstract: Vesicoureteric reflux has been associated with paediatric urinary tract infection. Fluoroscopic micturating cystourethrography (MCU) has been the gold standard of diagnostic test for decades; however, it has been criticized owing to its lower detection rate and radiation dose to children. Therefore, new radiation-free reflux imaging modalities have been developed, in which ultrasound-based contrast-enhanced voiding urosonography (ceVUS) is a good example. However, ultrasonography has been considered as an operator-dependent examination. Therefore, our study aimed to examine the inter-observer agreement of this sonographic technique, which has not been evaluated before. Moreover, the second-generation ultrasound contrast SonoVue has been recently marketed, and the data on its efficacy on intravesical use in ceVUS is relatively scarce. Thus, we also aimed to investigate the diagnostic performance and safety profile of SonoVue-enhanced VUS in the diagnosis of vesicoureteric reflux. Our prospective comparative study compared the diagnostic performance of ceVUS with MCU in young children presenting with first episode of urinary tract infection. We performed sequential ceVUS and MCU examinations in 31 patients (62 pelvi-ureter units). Perfect inter-observer agreement (Cohen’s kappa statistics = 1.0, p < 0.001) was achieved in ceVUS, suggesting its good reliability in reflux detection and grading. Using MCU as reference, ceVUS had 100 % sensitivity and 84 % specificity and carried higher reflux detection rate than MCU (p < 0.001). There was no complication encountered. Conclusion: Voiding urosonography is a reliable, sensitive, safe and radiation-free modality in the investigation of vesicoureteric reflux in children. It should be incorporated in the diagnostic algorithm in paediatric urinary tract infection.
authors.affiliation: Department of Radiology and Imaging, Queen Elizabeth Hospital, Kowloon, Hong Kong. sunnytks@gmail.com
authors.forename: L S
authors.initials: LS
authors.lastname: Wong
authors.forename: K S
authors.initials: KS
authors.lastname: Tse
authors.forename: T W
authors.initials: TW
authors.lastname: Fan
authors.forename: K Y
authors.initials: KY
authors.lastname: Kwok
authors.forename: T K
authors.initials: TK
authors.lastname: Tsang
authors.forename: H S
authors.initials: HS
authors.lastname: Fung
authors.forename: W
authors.initials: W
authors.lastname: Chan
authors.forename: K W
authors.initials: KW
authors.lastname: Lee
authors.forename: M W Y
authors.initials: MW
authors.lastname: Leung
authors.forename: N S Y
authors.initials: NS
authors.lastname: Chao
authors.forename: K W
authors.initials: KW
authors.lastname: Tang
authors.forename: S C H
authors.initials: SC
authors.lastname: Chan
mesh_terms: D002675:Child, Preschool; D003287:Contrast Media; D003430:Cross-Sectional Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D014463:Ultrasonography; D014551:Urinary Tract / Q000000981:diagnostic imaging*; D014554:Urination; D014567:Urography / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media