Diagnosis of vesicoureteral reflux with echo-enhanced voiding urosonography

Aim: To ascertain the diagnostic efficacy of reflux sonography with the application of the echo-enhancing agent Levovist(R) in comparison with X-ray voiding cystourethrography (VCUG). Patients and methods: Echo-enhanced voiding urosonography (VUS) and VCUG were performed successively in one examination session in 114 children referred for the investigation of possible vesicoureteral reflux (VUR). After sonography of the urinary tract the bladder was filled with normal saline and Levovist(R) was administered. Reflux was diagnosed when hyperechogenic,floating microbubbles appeared in the ureters or renal pelvises. Results: A total of 226 kidney-ureter units were available for analysis. Reflux was diagnosed in 80 units. All grades of reflux were represented. In 15 kidney-ureter units VUR was diagnosed with echo-enhanced VUS but was not seen at VCUG. The contrary was true in 3 units. High sensitivity and specificity in comparison to the VCUG could be attributed to the echo-enhanced VUS. The long imaging window attainable with Levovist(R) makes the documentation of convincing images possible, contributing to the high diagnostic efficacy. Conclusion: Echo-enhanced VUS is comparable to VCUG in the diagnosis of reflux.