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Detection of low-grade vesicoureteral reflux in children by color Doppler imaging mode
1Department of Pediatric Surgery, University of Graz, Medical School, Austria.
Insights
Color Doppler imaging-mode cystography (CDIMC) shows promise as an alternative to voiding cystourethrography for diagnosing low-grade vesicoureteral reflux (VUR) in children. This new method offers a potentially valuable screening tool for VUR, even in asymptomatic cases.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Nephrology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children with urinary tract infections (UTI), potentially leading to renal scarring or reflux nephropathy.
- Voiding cystourethrography (VCUG) has been the standard diagnostic tool for VUR.
- Evaluating low-grade VUR necessitates accurate and accessible diagnostic methods.
Purpose of the Study:
- To evaluate the efficacy of color Doppler imaging-mode cystography (CDIMC) as a diagnostic tool for low-grade VUR (grades 1 and 2) in children.
- To compare the diagnostic performance of CDIMC with the gold standard, VCUG.
- To assess the incidence of asymptomatic low-grade VUR in a non-infected pediatric population.
Main Methods:
- Seventy-seven children with suspected VUR underwent evaluation by both CDIMC and standard VCUG.
- A separate cohort of 38 children with normal urologic status and urine cultures were studied using CDIM to detect asymptomatic VUR.
- CDIMC was defined as the visualization of Doppler signals from the bladder to the ureter during bladder filling.
Main Results:
- CDIMC identified 31 refluxing ureters, while VCUG identified 30, demonstrating high concordance.
- CDIMC showed a sensitivity of 70% and a specificity of 92% for detecting VUR grades 1 and 2 when compared to VCUG.
- In a non-infected population, the incidence of asymptomatic low-grade VUR was found to be 10.5%.
Conclusions:
- CDIMC can serve as a viable alternative to VCUG for the screening and follow-up of low-grade VUR in children.
- The study suggests that asymptomatic grade 1 and 2 VUR may represent a physiological condition in some children.
- Further research may explore the long-term implications and management of asymptomatic low-grade VUR detected by CDIMC.
Abstract:
Vesicoureteral reflux (VUR) is common in children with urinary tract infections (UTI) and may result in renal scarring or reflux nephropathy. To date, the primary diagnostic tool has been voiding cystourethrography (VCUG). A new technique for evaluation of grade 1 and 2 VUR is described using color Doppler imaging-mode cystography (CDIMC): 77 children, aged 7 months to 14 years, were examined for VUR by CDIMC and standard VCUG. According to the established reflux sonography (US) using a real-time mode, all patients selected for this study had a normal urinary tract on conventional gray-scale US. We studied 154 ureters, and a total of 31 were found to be refluxing on CDIMC and 30 on VCUG. A positive sonogram was defined as visualization of Doppler signals from the bladder to the ureter during the course of bladder filling. Taking VCUG as the gold standard, we had ten false-positive findings. The false-positive rate of 18.5% may have been due to the shorter observation time of fluoroscopy. Comparison of the two methods shows CDIMC to be 70% sensitive with a specificity of 92% in the detection of VUR grade 1 and 2. To evaluate the incidence of asymptomatic low-grade VUR in a non-infected population, a second series of 38 children (19 males, 19 females) aged 3 to 15 years (mean 8.8 years) with normal urologic status and urine cultures were studied by color Doppler imaging mode (CDIM) for detection of asymptomatic low-grade VUR. Four children were found to have a unilateral refluxing ureter. The incidence of VUR in children with a normal urinary tract and no prior UTI was 10.5%. In conclusion, CDIMC can be used as a possible alternative to standard VCUG for the screening and follow-up of low-grade VUR. In addition, our study indicates that asymptomatic grade 1 and 2 reflux might be a physiological condition.