title: The role of ultrasonography in predicting vesicoureteral reflux.
abstract: OBJECTIVE
  To evaluate the accuracy of renal and bladder ultrasonography (RBU) in predicting vesicoureteral reflux (VUR) in infants and children.
  
  
  METHODS
  A total of 134 children who had VUR demonstrated on voiding cystourethrography (VCU) and also had RBU within 1 month of the VCU were included in the study, which took place between January 2005 and December 2012. VUR and hydronephrosis were graded with standard methods on VCU and RBU, respectively. Using VCU findings of reflux as the gold standard, diagnostic accuracy measures were performed for hydronephrosis and ureteral visualization on RBU, including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.
  
  
  RESULTS
  Reflux grade was significantly associated with the degree of hydronephrosis (P = .0032). The sensitivity, negative predictive value, and accuracy of ultrasonography in predicting reflux was significantly higher for grade IV+ or grade V reflux compared with lower reflux grades. Also, the specificity of ultrasonography in predicting reflux was constant and at high level across all reflux grades, suggesting that ultrasonography is a good diagnostic screening tool.
  
  
  CONCLUSIONS
  Normal RBU is rare with grade IV-V reflux, and moderate to severe hydronephrosis is rare with reflux grades <IV. RBU is a valid screening test for the selection of patients with a first urinary tract infection who should undergo VCU. Diagnosis of grade IV and V reflux will be delayed in very few cases, using a definition of abnormal RBU to include all degrees of hydronephrosis (Society for Fetal Urology classification).
authors.affiliation: Division of Pediatric Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
authors.forename: Arzu
authors.initials: A
authors.lastname: Kovanlikaya
authors.affiliation: Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
authors.forename: Jacob
authors.initials: J
authors.lastname: Kazam
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY.
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.affiliation: Division of Pediatric Urology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
authors.forename: Dix
authors.initials: D
authors.lastname: Poppas
authors.affiliation: Division of Pediatric Nephrology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
authors.forename: Valerie
authors.initials: V
authors.lastname: Johnson
authors.affiliation: Division of Pediatric Urology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
authors.forename: Carlos
authors.initials: C
authors.lastname: Medina
authors.affiliation: Division of Pediatric Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY. Electronic address: brill@med.cornell.edu.
authors.forename: Paula W
authors.initials: PW
authors.lastname: Brill
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000000981:diagnostic imaging*