Increasing the Reliability of the Grading System for Voiding Cystourethrograms Using Ultrasonography: An Inter-Rater...

Area of Science:

• Pediatric Urology
• Diagnostic Imaging
• Medical Classification Systems

Background:

• Current vesicoureteral reflux (VUR) grading systems, specifically the International Classification of VUR (ICVUR), require assessment for effectiveness.
• Investigating the utility of renal ultrasonography (RU), as per the Society for Fetal Urology (SFU) grading system, to enhance VUR grading accuracy is crucial.

Purpose of the Study:

• To evaluate the inter-rater reliability of the current voiding cystourethrogram (VCUG) staging system among pediatric radiologists and urologists.
• To determine if incorporating RU findings improves the accuracy of VCUG grading, particularly for cases lacking consensus.

Main Methods:

• 120 VCUGs were independently graded by four pediatric urologists and four pediatric radiologists.
• VUR grades III and IV were categorized into consensus (grade III, grade IV) and non-consensus groups.
• Comparison of these groups was performed using hydronephrosis grading via RU.

Main Results:

• Good inter-rater reliability was observed (Intraclass Correlation Coefficient [ICC] 0.86–0.89), with lowest agreement for middle grades (III and IV).
• Sensitivity varied significantly between consensus grade III (35%) and grade IV (95%) when indexed by SFU hydronephrosis grade.
• Findings suggest that non-consensus grade III/IV cases with SFU scores of 0 or 1 could be classified as grade III, while scores of 2-4 could be considered grade IV.

Conclusions:

• Renal ultrasonography (USG) can enhance inter-rater accuracy for middle-grade VUR classifications.
• Improved accuracy through USG can foster better communication and consensus among pediatric radiologists and urologists.
• Standardizing VUR grading with imaging aids can lead to more consistent patient management.