CYSTOSONOGRAPHY WITH ECHOCONTRAST - A NEW IMAGING MODALITY TO DETECT VESICOURETERAL REFLUX IN CHILDREN

Background. Conventionally, vesicoureteric reflux (VUR) is assessed by fluoroscopic micturating cystourethrography (MCU) or direct or indire ct radionuclide cystography (RNC). There is preliminary experience wit h contrast-enhanced sonography for the detection of VUR. Objective. To evaluate the usefulness of contrast-enhanced ultrasonography using ga lactose suspension as an echogenic contrast medium. Materials and meth ods. In this study a galactose suspension was instilled into the bladd er in 58 neonates? infants and children along with normal saline to de tect the presence and the severity of VUR through the enhanced US sign al. The results were compared with these of MCU and RNC. One ml/kg of echocontrast in the neonatal age group, and 0.5 ml/kg thereafter, were slowly instilled through a 4-F catheter after preliminary supine and prone urinary tract US. Indications for the investigation were antenat ally diagnosed pyelectasis (21 cases) and pyelonephritis (37 cases). I n 38 patients echocontrast cystosonography (ECS) was performed before, and in 20 patients after, MCU or RNC. Results. ECS detected 76 reflux ing units in 50 patients. In eight patients, no VUR was shown, and non e of these developed a urinary tract infection in 18 months of follow- up. In 43 patients, MCU or RNC detected 62 refluxing units, while in 1 5 no VUR was shown. Taking MCU as the gold standard and using the same grading scale, the sensitivity of ECS was 100%. No side effects were observed. Several urinary tract abnormalities were detected by ECS. Th e male urethra was studied by ECS, both by retrograde infusion and dur ing micturition. Conclusions. ECS is a promising imaging technique for detecting and grading VUR without exposing patients to ionising radia tion.