Yang Xiuzhen,Fu Junfen,Ye Jingjing,et al.Value of contrast-enhanced voiding urosonography in the diagnosis of vesicoureteral reflux and urethrovaginal diseases in children[J].Journal of Clinical Pediatric Surgery,,22():924-929.[doi:10.3760/cma.j.cn101785-202204058-005]
Click Copy

Value of contrast-enhanced voiding urosonography in the diagnosis of vesicoureteral reflux and urethrovaginal diseases in children

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第22卷 Number: 2023 10 Page: 924-929 Column: 专题·膀胱输尿管反流的诊治 Date of publication: 2023-10-28
Author(s):
Yang Xiuzhen1;  Fu Junfen2;  Ye Jingjing1;  Xu Zheming3;  Shen Yiding3
1 Department of Ultrasonography, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310052, China;
2 Department of Endocrinology, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310052, China;
3 Department of Urology, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310052, China
Keywords:
Vesico-Ureteral Reflux;  Diagnosis; Contrast-Enhanced Voiding Urosonography; Intrarenal reflux; Urethra; Vagina; Child
DOI:
10.3760/cma.j.cn101785-202204058-005
Abstract:
Objective To explore the value of contrast-enhanced voiding urosonography (CeVUS) in the diagnosis of vesicoureteral reflux (VUR) and urethrovaginal diseases in children.Methods From September 2020 to December 2021,the relevant clinical data were retrospectively reviewed for 207 children with suspected VUR examined by CeVUS.And CeVUS was performed by SonoVue (Bracco,Italy) and intravesical administration via catheter while urethrovaginal examinations were performed in girls.According to the international VUR grading system,VUR was divided into five grades.Grade of VUR,presence of intrarenal reflux (IRR) and abnormal findings of urethrovaginal tract were recorded,.And the diagnostic value of CeVUS was examined in children with VUR and urethrovaginal abnormalities.Eighteen patients were examined by voiding cystourethrogram (VCUG) during the same period.Weighted Kappa test was utilized for comparing the consistency of CeVUS and VCUG in diagnosis of VUR.Results A total of 416 pyeloureteral units (PUUs) were examined in 207 children,including duplicate kidney (n=3) and unilateral renal absence (n=1).No adverse events related to contrast agent were reported.Among them,97 (97/207,46.86%) were diagnosed with VUR.Among 416 PUUs,145(145/416,34.86%) were diagnosed as VUR.Twenty-four IRR occurred in grade Ⅲ and above.Among 18 children examined by CeVUS and VCUG at the same time (2 duplicate kidneys & 1 unilateral kidney absence,a total of 37 PUUs),Weighted Kappa value of VUR consistency was 0.747 (P<0.01,95%CI:0.554-0.941).Among 37 PUUs,12 PUUs had IRR on CeVUS,one VUR in lower pole of duplex kidney missed a diagnosis by VCUG.Also there were urethrovaginal abnormalities (n=5),Y-shaped ureter (n=1) and miniature kidney at reflux side (n=6).Conclusion CeVUS is safe and has high consistency with VCUG. CeVUS has advantages over VCUG in the diagnosis of IRR and duplicate kidney with VUR. CeVUS can also detect urethrovaginal abnormalities. CeVUS can be used as the preferred imaging method for VUR in children.

References:

[1] Duran C,Beltrán VP,González A,et al.Contrast-enhanced voiding urosonography for vesicoureteral reflux diagnosis in children[J].Radiographics,2017,37(6):1854-1869.DOI:10.1148/rg.2017170024.
[2] Sidhu PS,Cantisani V,Dietrich CF,et al.The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications:update 2017(long version)[J].Ultraschall Med,2018,39(2):e2-e44.DOI:10.1055/a-0586-1107.
[3] Chua ME,Mendoza JS,Ming JM,et al.Diagnostic accuracy of contrast-enhanced voiding urosonogram using second-generation contrast with harmonic imaging (CEVUS-HI) study for assessment of vesicoureteral reflux in children:a meta-analysis[J].World J Urol,2019,37(10):2245-2255.DOI:10.1007/s00345-018-2587-x.
[4] 邹翔宇,孙佩璇,石静,等.排尿性尿路超声造影对儿童原发性膀胱输尿管反流的诊断价值[J].临床小儿外科杂,2022,21(2):151-155.DOI:10.3760/cma.j.cn101785-202006044-010.Zou XY,Sun PX,Shi J,et al.Role of contrast enhanced voiding urosonography in the diagnosis of pediatric vescoureteral reflux[J].J Clin Ped Sur,2022,21(2):151-155.DOI:10.3760/cma.j.cn101785-202006044-010.
[5] Darge K,Troeger J.Vesicoureteral reflux grading in contrast-enhanced voiding urosonography[J].Eur J Radiol,2002,43(2):122-128.DOI:10.1016/s0720-048x(02)00114-6.
[6] Blumenthal I.Vesicoureteric reflux and urinary tract infection in children[J].Postgrad Med J,2006,82(963):31-35.DOI:10.1136/pgmj.2005.036327.
[7] Siomou E,Giapros V,Serbis A,et al.Voiding urosonography and voiding cystourethrography in primary vesicoureteral reflux associated with mild prenatal hydronephrosis:a comparative study[J].Pediatr Radiol,2020,50(9):1271-1276.DOI:10.1007/s00247-020-04724-y.
[8] Cvitkovic-Roic A,Turudic D,Milosevic D,et al.Contrast-enhanced voiding urosonography in the diagnosis of intrarenal reflux[J].J Ultrasound,2022,25(1):89-95.DOI:10.1007/s40477-021-00568-w.
[9] Fukui S,Watanabe M,Yoshino K.Intrarenal reflux in primary vesicoureteral reflux[J].Int J Urol,2013,20(6):631-636.DOI:10.1111/iju.12015.
[10] Chua ME,Kim JK,Mendoza JS,et al.The evaluation of vesicoureteral reflux among children using contrast-enhanced ultrasound:a literature review[J].J Pediatr Urol,2019,15(1):12-17.DOI:10.1016/j.jpurol.2018.11.006.
[11] Kim D,Choi YH,Choi G,et al.Contrast-enhanced voiding urosonography for the diagnosis of vesicoureteral reflux and intrarenal reflux:a comparison of diagnostic performance with fluoroscopic voiding cystourethrography[J].Ultrasonography,2021,40(4):530-537.DOI:10.14366/usg.20157.

Memo

收稿日期:2023-4-19。
通讯作者:傅君芬,Email:fjf68@zju.edu.cn

Last Update: 1900-01-01