Color flow Doppler sonography: a reliable alternative to voiding cystourethrogram in the diagnosis of vesicoureteral reflux in children

Abstract

Objectives. In children with urinary tract infection, the incidence of vesicoureteral reflux (VUR) is nearly 30% to 40%. The standard for the diagnosis of VUR is voiding cystourethrography (VCUG). This study assessed the role of color flow Doppler sonography (CFDS) in the diagnosis of VUR and ureteral jets. Methods. CFDS imaging was performed in 36 patients aged 6 months to 13 years during a 4-year period. All patients underwent CFDS and VCUG within 24 to 48 hours, but the findings of the VCUG were not reported to the sonologist. The ultrasound examinations were done using a color Doppler real-time machine. Representative images of the bladder events were recorded with a multiformat camera and on VHS videotape. Results. The duration of the Doppler signal varied from 0.4 to 7.5 seconds. In 31 (86.1%) of 36 patients, the results of CFDS correlated well with VCUG findings. There were three false-negative and two false-positive results in the present study. Six patients underwent reimplantation during the course of their treatment. CFDS was used as a follow-up modality at the end of 6 months, and the results correlated well with standard VCUG in 4 of these patients. In the remaining 2 patients, only CFDS was performed and correlation with VCUG was not possible. VCUG was considered the reference standard in assessing the sensitivity of CFDS. Conclusions. CFDS of the bladder during the filling and micturating phases is a reliable and sensitive modality for identifying VUR and demonstrating ureteral jets. CFDS nullifies the danger of exposure to ionizing radiation and avoids the unpleasant catheterization many of these children fear.