R. Farina et al., Vesico-ureteral reflux: diagnosis and staging with voiding color doppler US - Preliminary experience, EUR J RAD, 35(1), 2000, pp. 49-53
Introduction: The aim of this study is to assess the accuracy of a new US e
xamination: 'voiding color Doppler US' in the early diagnosis and staging o
f vesico-ureteral reflux (VUR). The contrast agent US was SH U 508A (Levovi
st, Schering, Berlin), which produces a chromatic accentuation of the signa
ls picked up by the color Doppler US. Eighteen patients (10 females, eight
males) were recruited for the study. In two patients a second examination w
as performed for follow-up after a VUR conservative therapy. All patients w
ere taken under examination for the evaluation of possible VUR. In all pati
ents the voiding color Doppler US was followed by voiding cystourethrograph
y (VCUG) and the data obtained were compared. Materials and methods: A tota
l of 18 patients aged between 3 months and 10 years, were recruited for the
study. The results of the examination were the following: urinary tract in
fections, follow-up of VUR after conservative or surgical therapy, miscella
neous indications. Voiding color Doppler US was performed, followed by a VC
UG. The voiding color Doppler US consists in the trans-catheter introductio
n of a contrast agent SHU 508 A (Levovist, Schering, Ag. Berlin) into the b
ladder and a subsequent test with the color Doppler US to show or exclude t
he presence of reflux into the ureters and/or into the pyelo-caliceal cavit
y of the kidneys. After the introduction of the contrast agent US the ultra
sound scanning of the bladder, the ureters and the pyelo-caliceal cavity wa
s performed to examine the reflux degree. The ultrasonographic investigatio
ns were perfomed with AU 590 asyncronus US (Esaote Biomedica, Geneva) with
a 3.5 MHz convex probe. Results: After the trans-catheter introduction of t
he contrast agent US, vesico-ureteral reflux occured in 13 patients (77.2%)
. The reflux degree was also measured by means of ultrasound and was later
confirmed by VCUG. The mean times of each examination were as follows: init
ial US, 10 min; catheterization, 8 min; voiding color Doppler US, 15 min; o
verall VCURG examination 10 min. The overall mean duration of the voiding c
olor Doppler US examination was 33 min. The comparable mean time for VCUG,
including the catheterization time, was 20 min. No reactions of intolerance
to the ultrasound contrast agent occurred. Discussion and conclusions: The
voiding color Doppler US test has evidenced in all patients the presence o
f the contrast agent US in the bladder after the introduction. In 13 patien
ts (77.2%) with presence of VUR, the voiding color Doppler US test has esta
blished the reflux degree confirmed by cystourethrography. The superimposab
ility of the data obtained with voiding color Doppler US and VCUG would see
m to confirm the importance of this new ultrasonographic technique in the d
iagnosis and staging of VUR. (C) 2000 Elsevier Science Ireland Ltd. All rig
hts reserved.