The learning curve of contrast-enhanced 'microbubble' voiding urosonography-validation study.

Area of Science:

• Pediatric Urology
• Diagnostic Imaging
• Radiology

Background:

• Vesicoureteral reflux (VUR) is a common pediatric condition linked to urinary tract infections.
• Diagnosis traditionally relies on fluoroscopic voiding cystourethrogram (VCUG), which involves radiation exposure.
• Contrast-enhanced voiding ultrasonography (ceVUS) offers a radiation-free alternative, with its contrast agents recently FDA-approved for US use.

Purpose of the Study:

• To optimize a protocol for ceVUS.
• To compare the diagnostic performance of ceVUS against fluoroscopic VCUG.
• To evaluate ceVUS in an academic medical center new to the technology.

Main Methods:

• Thirty-nine pediatric patients with suspected VUR were enrolled.
• Patients underwent both ceVUS using Lumason and fluoroscopic VCUG.
• Pediatric radiologists performed comparative grading of reflux on-site.

Main Results:

• Reflux was detected in 16 of 39 patients (20 renal units).
• VCUG and ceVUS showed moderate concordance (Cohen's kappa = 0.72).
• Minor discrepancies in reflux detection and grading were observed between the two methods.

Conclusions:

• ceVUS is a feasible alternative to VCUG for diagnosing pediatric VUR.
• A learning curve exists for ceVUS implementation, but technical aspects are correctable.
• ceVUS can eliminate radiation exposure associated with VCUG, making it a valuable clinical tool.