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Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms:
Maciej Piskunowicz1, Dominik Swieton1, Dorota Rybczynska1
1Department of Radiology, Medical University of Gdansk, Gdańsk, Poland.
Insights
Premature destruction of microbubbles during contrast-enhanced voiding urosonography (ce-VUS) in children limits evaluation. This occurs in anxious, crying infants and children, preventing assessment for vesicoureteric reflux (VUR).
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Ultrasound Contrast Agents
Background:
- Contrast-enhanced voiding urosonography (ce-VUS) is a key imaging technique for diagnosing vesicoureteric reflux (VUR) in children.
- Second-generation ultrasound contrast agents (UCA) are utilized to enhance visualization during ce-VUS.
Purpose of the Study:
- To describe the phenomenon of premature microbubble destruction with ce-VUS in pediatric patients.
- To hypothesize the underlying reasons for this observed limitation.
- To highlight the impact of this destruction on the diagnostic capability of ce-VUS.
Main Methods:
- Retrospective analysis of 141 pediatric ce-VUS examinations performed between 2011 and 2014.
- Observation and documentation of premature microbubble destruction during the voiding phase.
- Correlation of destruction events with patient factors such as age, anxiety, and crying.
Main Results:
- Premature destruction of UCA microbubbles was observed in 7.8% (11 out of 141) of the pediatric patients studied.
- This microbubble destruction precluded the performance of the voiding phase in all affected cases.
- The phenomenon was particularly noted in anxious, crying infants and children experiencing restricted voiding.
Conclusions:
- Premature destruction of ultrasound contrast agent during ce-VUS is an underreported limitation.
- This destruction prevents the crucial evaluation of the voiding phase and the diagnosis of VUR.
- Crying and anxiety in pediatric patients appear to be significant contributing factors to this limitation.
Abstract:
The aim of this study is to describe premature microbubbles destruction with contrast-enhanced voiding urosonography (ce-VUS) in children using 2nd-generation ultrasound contrast agents (UCA) and to hypothesize about the reason. 141 children (61 females and 80 males) were included in the study, with mean age of 3.3 years (range 4 weeks-16.0 years), who underwent ce-VUS examination between 2011 and 2014. Premature destruction of the microbubbles in the urinary bladder during ce-VUS was observed in 11 children (7.8%). In all these cases the voiding phase of ce-VUS examination could not be performed because of destroyed UCA microbubbles. This was noted in anxious, crying infants and children with restricted voiding. The premature destruction of ultrasound contrast agent during ce-VUS is an underreported, important limitation of ce-VUS, which prevents evaluation of the voiding phase and the establishment of vesicoureteric reflux (VUR). This was particularly noted in crying infants and children.
