Contrast-enhanced Voiding Urosonography with Second-generation Ultrasound Contrast Agent versus Micturating Cystourethrogram for Diagnosis of Vesicoureteric Reflux
JAWK Tang, JCH Tse, AYT Lai, BMH Lai, KYK Tang, SY Luk, DPY Lai, KY Che, WWC Wong, WK Kan
Hong Kong J Radiol 2018;21:16-25
https://doi.org/10.12809/hkjr1916908
Objective: To review the performance of contrast-enhanced voiding urosonography (ceVUS) and micturating cystourethrogram (MCU) in diagnosing vesicoureteric reflux (VUR), and to evaluate the safety profile of ceVUS and the relevant imaging findings.
Methods: We retrospectively reviewed all patients who underwent both ceVUS and MCU in the same setting between August 2016 and May 2017. All ceVUS were performed with Philips Affiniti 70 ultrasound system. SonoVue was used as the contrast agent for ceVUS. All the patients then received MCU under fluoroscopic screening using iodinated contrast. Follow-up phone interviews were done up to 5 days after the examination.
Results: In total, 22 patients, including 18 male and four female patients (age range, 19 days to 24 months) were included, giving a total of 44 pelvi-ureteric units (PUUs) examined. VUR was detected in four out of the 44 PUUs. Except for one PUU which showed grade 2 VUR on ceVUS but grade 1 VUR on MCU, all other PUUs showed concordant findings on both examinations. Regarding detection of VUR irrespective of its severity, ceVUS showed sensitivity of 100% and specificity of 100% in our cohort. Other findings included: hydronephrosis (n=10), ureterocoele (n=1), multicystic dysplastic kidney (n=1), renal cysts (n=3), and urethral diverticulum (n=1). All the patients tolerated the procedures well with no significant complications from the procedures.
Conclusion: ceVUS is accurate, safe, and allows one-stop anatomical and functional assessment. Our unique case of urethral diverticulum detected on ceVUS also expanded our understanding in the utility of ceVUS for urethral pathology.
Author affiliation(s):
JAWK Tang, JCH Tse, AYT Lai, BMH Lai, KYK Tang, SY Luk, DPY Lai, KY Che,
WWC Wong, WK Kan: Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
中文摘要
第二代超聲造影劑進行的造影增強排尿性尿道超聲波 造影（ceVUS）與排尿性透視膀胱尿道攝影（MCU） 在膀胱輸尿管反流的診斷
鄧永健、謝志瀚、黎爾德、賴銘曦、鄧業勤、陸嬈、賴佩如、池嘉儀、黃慧中、簡偉權
目的：比較造影增強排尿性尿道超聲波造影（ceVUS）和排尿性透視膀胱尿道攝影（MCU）在診斷膀胱輸尿管反流（VUR）中的表現，並評估ceVUS的安全性和相關影像學特徵。
方法：我們回顧分析由2016年8月至2017年5月期間同時接受ceVUS和MCU的所有病人。所有ceVUS均採用Philips Affiniti 70超聲系統進行。SonoVue被用作ceVUS的造影劑，然後所有病人再以碘化造影劑在螢光透視儀下接受MCU。我們在病人完成檢查後5天內進行後續電話訪談。
結果：共納入22名病人，包括18名男性和4名女性（年齡介乎19天至24個月）。總共檢查44個腎盂輸尿管單位（PUU）。在44個PUU中，有4個檢測到VUR。除了一個PUU在ceVUS上顯示為2級VUR而在MCU上顯示為1級VUR外，其他PUU在兩次檢查的結果皆一致。因此，若撇除兩種檢查在評估VUR重度上的差異，本研究顯示ceVUS對於VUR的檢測達到100%的敏感性和100%的特異性。其他發現包括腎積水（n=10）、輸尿管囊腫（n=1）、腎臟多囊性發育不良（n=1）、腎囊腫（n=1）和尿道憩室（n=1）。所有病人對檢查的耐受性良好，亦無明顯併發症。
結論：ceVUS準確和安全，並容許一站式結構和功能評估。我們以ceVUS檢測到的尿道憩室獨特病例也擴展我們對ceVUS於檢測尿道病變的認識。