Comparison of contrast-enhanced voiding urosonography using second-generation contrast agents and voiding cystourethrogram

Voiding cystourethrogram (VCUG) has been considered the gold standard for detecting and evaluating vesicoureteral reflux (VUR) among children. However, ionizing radiation exposure is a concern for this diagnostic modality. Contrast-enhanced voiding urosonography (ceVUS) is an alternative technique for the detection of vesicoureteral reflux (VUR) using ultrasound and intravesical administration of an ultrasound (US) contrast agent. ceVUS is a radiation-free, effective, and safe method for identifying and grading VUR. We performed a study specifically for our hospital. The purpose of this study was to evaluate the diagnostic accuracy of contrast-enhanced voiding urosonography (ceVUS) in the detection of vesicoureteral reflux and its grading in children, compared to voiding cystourethrogram (VCUG). If we consider VCUG as the gold standard, the sensitivity of ceVUS in our study was 83%, specificity was 100% and accuracy was 94%. Our positive cases had Grade II to V reflux on ceVUS and Grade I to V reflux on VCUG. In our small sample of 18 patients, the detection of vesicoureteral reflux by ceVUS was comparable to that of VCUG. ceVUS can be used as a radiation-free alternative to VCUG for the detection of VUR in children. A benefit of ceVUS is the ability to do cyclical assessment without the fear of increasing radiation dose, as you would with VCUG.