The Northeastern Society of Plastic Surgeons

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Comparison of contrast-enhanced voiding urosonography (ceVUS) to conventional fluoroscopic voiding cystourethrography (VCUG) in infants and children: Preliminary results
Carol E. Barnewolt, MD1, Jeanne S. Chow, MD1, Stamoulis Catherine, Ph.D1, Stuart B. Bauer, MD1, David A. Diamond, MD1, Harriet J. Paltiel, MDCM2.
1Boston Children's Hospital, Boston, MA, USA, 2Radiology, Boston Children's Hospital, Boston, MA, USA.

Background
CeVUS is a radiation-free technique currently used in a number of European centers for diagnosis of vesicoureteral reflux (VUR) in children that has not yet been widely adopted in the USA. To date, there have been no reports on the use of Optison, a second-generation US contrast agent available in the USA, for the diagnosis of VUR. This study compares our early experience performing ceVUS with Optison to conventional VCUG.
Materials & Methods
We performed a retrospective review of 80 children who underwent ceVUS with Optison immediately followed by VCUG, for indications including fetal hydronephrosis (37), febrile UTI (32), solitary functioning kidney (7), posterior urethral valves (2) and family history of reflux (2). There were 39 males and 41 females ranging in age from 2 days to 10 years, median age 3 months, (25th, 75th) quartiles (1.0, 9.5 months). Optison doses ranging from 0.125 to 1.25 cc were injected into 250 cc of saline that was then instilled via gravity through a urethral catheter into the bladder. Image clips of the bladder, ureters and kidneys were obtained during bladder filling and voiding. Patients voided around the catheter to avoid re-catheterization for VCUG. Transperineal urethral images were obtained in 72/80 children. A conventional VCUG was subsequently performed in all patients. Studies were reviewed for the presence of VUR. VUR grading for ceVUS was into the ureter (grade 1), renal pelvis (grade 2), and upper tract dilation (grade 3); for VCUG the International Grading system (I-V) was used.
Results
No adverse events related to Optison occurred. Optimal visualization of the urethra, bladder and upper tracts during ceVUS was achieved with a contrast dose of 0.15 cc. Urethral anatomy was well-visualized in 72/80 patients (90%). Both studies were negative in 119/153 kidneys (78%), both positive in 18/153 kidneys (12%). In 14/153 kidneys (9%), ceVUS was positive and VCUG was negative. In 2/153 kidneys (1%), ceVUS was negative and VCUG was positive (grade I and grade II, respectively). VUR by ceVUS was grade 1 (0), grade 2 (8), and grade 3 (24). VUR by VCUG was grade I (2), grade II-III (9), grade IV-V (9). Compared to VCUG, ceVUS had a sensitivity for detection of VUR of 90% and a specificity of 89%.
Conclusions
CeVUS with Optison is easily performed and well tolerated, with high sensitivity and specificity compared to conventional VCUG.


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