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2013 ; 13
(55
): 394-407
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English Wikipedia
2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and monitoring
of treatment of vesicoureteral reflux in children - can it replace voiding
cystourethrography?
#MMPMID26674600
Wo?niak MM
; Pawelec A
; Wieczorek AP
; Zaj?czkowska MM
; Borz?cka H
; Nachulewicz P
J Ultrason
2013[Dec]; 13
(55
): 394-407
PMID26674600
show ga
INTRODUCTION: Vesicoureteral reflux appears in 20-50% of pediatric patients with
recurrent urinary tract infections. The most common method of diagnosing this
disease is voiding cystourethrography. However, contemporary pediatric radiology
does not favor this method due to exposure to X-radiation. AIM: The aim of this
study was to assess the usefulness of 2D/3D/4D contrast-enhanced voiding
urosonography in the diagnosis and treatment monitoring of vesicoureteral reflux
in children and the possibility of using contrast-enhanced voiding urosonography
to replace voiding cystourethrography. MATERIAL AND METHODS: Voiding
cystourethrography and contrast-enhanced voiding urosonography were conducted in
80 pediatric patients in order to assess sensitivity, specificity, positive and
negative predictive values as well as the number of vesicoureteral refluxes
detected by each of the two methods. The second stage of the study involved
performing voiding urosonography in an extended protocol in 58 children in order
to determine the usefulness of three-dimensional (3D/4D) examinations in the
assessment of vesicoureteral reflux and the ability to assess the urethra.
RESULTS: The concordance between the two methods was 86.95%. The sensitivity of
voiding urosonography was 84.51%, specificity - 90.99%, positive predictive value
- 85.71% and negative predictive value - 90.17%. A 3D/4D assessment of the
urinary bladder and transperineal 2D morphological assessment of the urethra were
possible in all patients (100%). Assessment of the urethra during micturition
with the use of 2D/3D/4D techniques was possible in all patients in whom voiding
was elicited (95.83%), and 3D/4D assessment of vesicoureteral reflux was possible
in all patients with reflux (100%). Although the application of 3D/4D techniques
allowed accurate specification of the grade of reflux in all cases (100%), it
appeared particularly useful in differentiating between grades II and III
(70.97%). CONCLUSIONS: Contrast-enhanced voiding urosonography allows the
diagnosis and monitoring of treatment of vesicoureteral reflux in pediatric
patients as well as assessment of the urethra in both girls and boys. The method
is characterized by high sensitivity and specificity. Moreover, it is safe,
relatively inexpensive and can replace voiding cystourethrography.