1st Department of Pediatrics, Pediatric Radiology Unit, Semmelweis Medical University, 53-54 Str. János Bókay, Budapest, Hungary.
Pediatr Nephrol. 2010 Nov;25(11):2289-93. doi: 10.1007/s00467-010-1618-7. Epub 2010 Aug 5.
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.
对比增强超声排尿造影术（VUS）在诊断膀胱输尿管反流（VUR）方面的应用越来越广泛。本研究旨在评估第二代超声（US）对比剂 VUS 的灵敏度，并将其与标准荧光透视排尿尿路造影术（VCUG）进行比较。共有 183 名儿童的 366 个肾输尿管单位（KUUs）在同一时段内通过同一导管接受了 VUS 和 VCUG 检查。VUS 在经膀胱内给予 1 毫升第二代超声对比剂（UCA；声诺维，Bracco，意大利）后进行。在 366 例中有 140 例（38%）检测到 VUR；两种方法均检测到 89 例（24.3%），仅 VUS 检测到 37 例（10.1%），仅 VCUG 检测到 14 例（3.8%）。尽管 VUS 和 VCUG 诊断 VUR 的一致性相当（κ=0.68，标准误差 [κ]=0.04），但 VUS 和 VCUG 检测反流的检出率存在显著差异（p<0.00001）。VUS 检测到的 VUR 分级与 VCUG 分级具有中度一致性。我们的研究结果表明，第二代对比剂增强谐波 VUS 在检测和分级 VUR 方面优于 VCUG，应成为该临床适应证的首选方法。
