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Sonographic detection of vesicoureteral reflux with fluid and air cystography. Comparison with VCUG
D Siamplis1, K Vasiou, S Giarmenitis
1Department of Radiology, University of Patras.
Insights
Fluid and air cystorenography show promise as non-irradiating alternatives for diagnosing vesicoureteral reflux (VUR) in children. While not fully replacing voiding cystourethrography (VCUG), these methods offer valuable complementary diagnostic information.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Radiology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Voiding cystourethrography (VCUG) is the standard diagnostic method but involves radiation exposure.
- There is a need for effective, non-irradiating diagnostic alternatives for VUR.
Purpose of the Study:
- To evaluate fluid cystorenography (fluid-CRG) and air cystorenography (air-CRG) as alternative diagnostic methods for VUR in children.
- To compare the diagnostic accuracy of fluid-CRG and air-CRG with standard VCUG.
- To assess the potential of these methods as replacements or complements to VCUG.
Main Methods:
- Prospective comparative study involving 88 children (176 renal units).
- Sonographic examination of kidney morphology with an empty bladder.
- Sonographic examination after filling the bladder with fluid (fluid-CRG) or air (air-CRG).
- Standard VCUG performed within 2-5 days for comparison.
Main Results:
- Fluid-CRG demonstrated a sensitivity of 94.4%, specificity of 94.9%, and accuracy of 94.9% in detecting VUR.
- Air-CRG showed a sensitivity of 83.3%, specificity of 96.8%, and accuracy of 95.4%.
- VCUG identified VUR in 18/176 pelvicalyceal systems and/or ureters.
Conclusions:
- Fluid-CRG and air-CRG can serve as complementary methods to VCUG or for follow-up of known VUR cases.
- These sonographic methods cannot completely replace VCUG due to potential false negatives and inability to visualize the entire urinary tract.
- Further research may refine the role of these non-irradiating techniques in pediatric VUR diagnosis.
Purpose:
Attempt to find out an effective and reliable alternative method for the diagnosis of vesicoureteral reflux (VUR), without irradiation, in children, and the comparison of its results with those of voiding cystourethrography (VCUG).
Methods:
In a prospective comparative study we examined 88 children (176 units) (average age = 2.8 years) sonographically and with VCUG, in order to detect VUR. First we examined sonographically the kidney's morphology on an empty bladder. Then we examined them sonographically after filling the urinary bladder with fluid (fluid-cystorenography, fluid-CRG), and after filling it with air (air cystorenography, air CRG). Within the following 2-5 days the standard VCUG was performed. We compared the results of these three methods.
Results:
Fluid CRG showed fluid reflux to the pelvicalyceal system in 25/176 Kidneys (sensitivity = 94.4%, specificity = 94.9%, accuracy = 94.9%). Air CRG showed air reflux in 19/176 kidneys (sensitivity = 83.3%, specificity = 96.8%, accuracy = 95.4%). VCUG showed VUR in 18/176 pelvicalyceal systems and/or ureters.
Conclusion:
Fluid CRG and/or air CRG can be used as complementary methods to the VCUG, or during the follow up of patients with known VUR: VCUG cannot be replaced completely by fluid CRG or air CRG, especially the first and the last one, because of the false negative results of these methods and because none of them can show the renal collecting system, the urinary bladder and the urethra in the standard way.