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Updated: Feb 11, 2026
Real-Time Void Spot Assay
Published on: February 10, 2023
Comparison of contrast-enhanced voiding urosonography with voiding cystourethrography in pediatric vesicoureteral
Narsing Mane1, Amit Sharma1, Abhijit Patil1
1TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.
Insights
Contrast enhanced-voiding urosonography (ce-VUS) is a radiation-free imaging technique that shows superior diagnostic performance for pediatric vesicoureteral reflux (VUR) compared to the traditional voiding cystourethrography (VCUG). ce-VUS identified VUR in 4 cases missed by VCUG.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Urology
Background:
- Voiding cystourethrography (VCUG) is the gold standard for diagnosing vesicoureteral reflux (VUR) in children.
- VCUG involves fluoroscopic guidance, exposing children to ionizing radiation.
- Voiding urosonography (VUS) offers a radiation-free alternative, analogous to VCUG.
Purpose of the Study:
- To evaluate the diagnostic efficacy of contrast enhanced-VUS (ce-VUS) compared to VCUG for pediatric VUR.
- To assess the feasibility and safety of ce-VUS in diagnosing VUR.
Main Methods:
- A study involving 30 children diagnosed with VUR over 3 years.
- All participants underwent both VCUG and ce-VUS on the same day.
- ce-VUS studies were performed and reviewed by a single sonologist.
Main Results:
- ce-VUS detected VUR in 16 patients, while VCUG identified it in 14.
- ce-VUS identified VUR in 21 kidney-ureter units (KUUs), compared to 17 detected by VCUG.
- ce-VUS identified 4 cases of VUR missed by VCUG, including 3 in right KUUs and discordant grading in left KUUs.
Conclusions:
- ce-VUS demonstrates superior diagnostic performance compared to VCUG for pediatric VUR.
- ce-VUS is a feasible and radiation-safe imaging modality for assessing pediatric VUR.
- ce-VUS offers improved detection rates for VUR, especially in cases missed by conventional methods.
Objective:
Voiding cystourethrography (VCUG) has been considered as the gold standard technique for the diagnosis of vesicoureteral reflux (VUR). But, it requires fluoroscopic guidance which expose children to radiation. Voiding urosonography (VUS) is technically analogous to VCUG and has the major advantage of zero radiation exposure. This study aims to determine the efficacy of contrast enhanced-VUS (ce-VUS) with respect to VCUG in diagnosing VUR.
Material And Methods:
This study involves 30 children over a period of 3 years. All patients underwent a VCUG followed by the ce-VUS on the same day. All VUS studies were done by the same sonologist in the sonography department. The images were recorded and reviewed by the same sonologist before reporting.
Results:
The median age of the patients was 51.53 months. There were 21 males and 9 females. On VCUG, 16 patients had no reflux, and 14 patients had reflux. On ce-VUS, 14 patients had no VUR, and 16 patients had VUR. Of the total 58 kidney-ureter units (KUUs), VUR was detected in 17 KUUs on VCUG and in 21 KUUs on ce-VUS. Thus, ce-VUS detected 4 refluxing units that were not seen on VCUG. In right KUUs, ce-VUS detected VUR in 3 units where no reflux was found in VCUG. In the 28 left KUUs, 25 units on ce-VUS showed concordance with the grade of VUR as detected by VCUG; 3 were discordant. Two units on ce-VUS showed a VUR one grade higher than the corresponding grade on VCUG and in one unit it was one grade lower. Thus, in total, ce-VUS picked up 4 cases which were missed by VCUG.
Conclusion:
ce-VUS is a good imaging modality when compared to voiding cystourethrography to assess pediatric vesicoureteral reflux, in view of its superior diagnostic performance, feasibility and radiation safety for children.
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