Eur J Pediatr DOI 10.1007/s00431-014-2297-3
ORIGINAL ARTICLE
Voiding urosonography with second-generation ultrasound contrast versus micturating cystourethrography in the diagnosis of vesicoureteric reflux L. S. Wong & K. S. Tse & T. W. Fan & K. Y. Kwok & T. K. Tsang & H. S. Fung & W. Chan & K. W. Lee & M. W. Y. Leung & N. S. Y. Chao & K. W. Tang & S. C. H Chan
Received: 27 December 2013 / Revised: 10 March 2014 / Accepted: 11 March 2014 # Springer-Verlag Berlin Heidelberg 2014
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 contrastenhanced voiding urosonography (ceVUS) is a good example. However, ultrasonography has been considered as an Communicated by Jaan Toelen Electronic supplementary material The online version of this article (doi:10.1007/s00431-014-2297-3) contains supplementary material, which is available to authorized users. L. S. Wong : K. S. Tse (*) : K. Y. Kwok : H. S. Fung : K. W. Tang : S. C. H. Chan Department of Radiology and Imaging, Queen Elizabeth Hospital, Kowloon, Hong Kong e-mail: [email protected] T. W. Fan Scanning Department, St Teresa’s Medical Centre, Kowloon, Hong Kong T. K. Tsang Department of Radiology, Evangelist Hospital, Kowloon, Hong Kong W. Chan Department of Paediatrics, Queen Elizabeth Hospital, Kowloon, Hong Kong K. W. Lee Department of Paediatrics, St Teresa’s Medical Centre, Kowloon, Hong Kong M. W. Y. Leung : N. S. Y. Chao Division of Paediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong
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
ORIGINAL ARTICLE
Voiding urosonography with second-generation ultrasound contrast versus micturating cystourethrography in the diagnosis of vesicoureteric reflux L. S. Wong & K. S. Tse & T. W. Fan & K. Y. Kwok & T. K. Tsang & H. S. Fung & W. Chan & K. W. Lee & M. W. Y. Leung & N. S. Y. Chao & K. W. Tang & S. C. H Chan
Received: 27 December 2013 / Revised: 10 March 2014 / Accepted: 11 March 2014 # Springer-Verlag Berlin Heidelberg 2014
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 contrastenhanced voiding urosonography (ceVUS) is a good example. However, ultrasonography has been considered as an Communicated by Jaan Toelen Electronic supplementary material The online version of this article (doi:10.1007/s00431-014-2297-3) contains supplementary material, which is available to authorized users. L. S. Wong : K. S. Tse (*) : K. Y. Kwok : H. S. Fung : K. W. Tang : S. C. H. Chan Department of Radiology and Imaging, Queen Elizabeth Hospital, Kowloon, Hong Kong e-mail: [email protected] T. W. Fan Scanning Department, St Teresa’s Medical Centre, Kowloon, Hong Kong T. K. Tsang Department of Radiology, Evangelist Hospital, Kowloon, Hong Kong W. Chan Department of Paediatrics, Queen Elizabeth Hospital, Kowloon, Hong Kong K. W. Lee Department of Paediatrics, St Teresa’s Medical Centre, Kowloon, Hong Kong M. W. Y. Leung : N. S. Y. Chao Division of Paediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong
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
