Voiding urosonography including urethrosonography: high-quality examinations with an optimised procedure using a second-generation US contrast agent

Abstract

Voiding urosonography (VUS) is established as a technique for detecting vesicoureteral reflux in children. To evaluate the quality of images of the entire urinary tract when using a second-generation US contrast agent and a modified VUS technique. We evaluated 307 VUS examinations performed using SonoVue® in 591 pelvi-ureter units in 295 children of mean age, 27.1 (S.D., 42.5) months, with 154 (50.2%) of the examinations performed in boys; 58 children also underwent VUS using Levovist®. Three criteria were used for quality assessment of the bladder image: (1) progressive incorporation of contrast material in the bladder, (2) homogeneous bladder-filling to maximum capacity, and (3) visualisation of the posterior bladder wall. Criterion 1 was fulfilled in 305 (99.3%), criterion 2 in 304 (99%) and criterion 3 in 304 (99%) studies. In children who underwent VUS with both contrast agents, the concordance between the two techniques was moderate for findings in the bladder (Cohen K = 0.487; P < 0001) and perfect for findings in the male urethra. By a modified technique we obtained high-quality images of the bladder with the second-generation contrast agent.