Contrast enhanced Gray-scale and Color-Doppler Voiding Urosonography vs. Voiding Cystourethrography in the diagnosis and grading of vesicoureteral reflux.JCU2001;29:65-71/IF=0.596

Purpose. The purpose of this study was to\r\ncompare contrast-enhanced gray-scale voiding urosonography\r\n(CE-VUS) and contrast-enhanced color\r\nDoppler voiding urosonography (CE-CDVUS) with\r\nvoiding cystourethrography (VCUG) to verify whether\r\nthe use of color Doppler imaging improves the diagnosis\r\nand grading of vesicoureteral reflux (VUR).\r\nMethods. ln 74 patients, CE-VUS and CE-CDVUS\r\nwere compared with VCUG, which was used as the\r\ngold standard. SHU 508 A (Levovist) was used as the\r\necho-enhancing contrast agent. VUR was diagnosed if\r\nhyperechoic dots or color signals were visualized in\r\nthe ureter on sonograms. VUR grading was based on\r\nmorphologic and dynamic findings on CE-VUS and\r\nmorphologic and color findings on CE-CDVUS. VCUG\r\nwas performed conventionally, and grading by VCUG\r\nwas in accordance with the international system of\r\nradiographic VUR grading. Patients who voided during\r\n1 examination only (either CE-VUS and CE-CDVUS\r\nor VCUG) were excluded from the study. Agreement\r\nbetween the results of CE-VUS and VCUG and between\r\nthose of CE-CDVUS and VCUG in diagnosing\r\nVUR was calculated by rc statistics. CE-VUS and CECDVUS\r\nwere compared for diagnostic accuracy by the\r\nMcNemar test.\r\nResults. The agreement between CE-VUS and\r\nCorrespondence to: A. L. Valentini\r\n@ 2001 John Wiley & Sons, Inc.\r\nVOL. 29, NO, 2, FEBRUARY 2OO1\r\nVCUG in predicting VUR was 90% (rc score,0.77; p <\r\n0.001). The agreement between CE-CDVUS and VCUG\r\nwas 96% (rc score, 0.91; p < 0.001). CE-CDVUS showed\r\na significantly higher diagnostic accuracy than did CEVUS\r\n(96% versus 90% of cases correctly classified;\r\nMcNemar X2 = 4; p < 0.05). This was mainly related to\r\nthe lower number of false-negative results for grade I\r\nand grade ll VUR when CE-CDVUS was used.\r\nConclusions. The use of color Doppler imaging significantly\r\nimproves the accuracy of contrast voiding\r\nurosonography in the detection and grading of VUR.