ESPN 54th Annual Meeting

ESPN 2022


 
The diagnosis of intrarenal reflux using contrast enhanced voiding urosonography
ANDREA CVITKOVIC ROIC 1 IVA PALCIC 1 DANKO MILOSEVIC 2 DANIEL TURUDIC 3 GORAN ROIC 4

1- CLINIC FOR PEDIATRIC MEDICINE HELENA
2- UNIVERSITY OF ZAGREB MEDICAL SCHOOL
3- UNIVERSITY HOSPITAL CENTER ZAGREB
4- CHILDRENĀ“S HOSPITAL ZAGREB
 
Introduction:

 Contrast-enhanced urosonography (ceVUS) has shown capable diagnostic accuracy for the diagnosis of vesicoureteral refux (VUR) in children but the ability of ceVUS to detect intrarenal refux (IRR) is not yet sufficiently researched. The purpose of our study is to assess the ability of ceVUS to detect IRR as well as its association with age, gender, and the grade of VUR.

Material and methods:

 The study included 5153 children who were referred to our clinic for ceVUS. All children underwent sonographic examinations, which were performed on a LOGIQ S8 machine equipped with dedicated software for contrast-enhanced studies with harmonic imaging. Standard ultrasound of the urinary tract was followed by bladder catheterisation and instillation of physiological normal saline and the US contrast medium (SonoVue®, Bracco).

Results:

 VUR was diagnosed by ceVUS in 1959 out of 5153 children (38%), of whom IRR was found in 233 of 1959 children (11.9%). A total of 285 ureteral units showing IRR were found. High grades of VUR (IV+V) with IRR were found in a total of 235 of 285 (82.81%) renal units. Bilateral IRR was found in 53 patients, usually with a high-grade VUR on both sides. Most children had VUR grade IV, predominantly those younger than 1 year.  The younger the child, the higher the likehood of higher grade of VUR (p=0,02).

Conclusions:

 CeVUS, combined with harmonic imaging and second-generation ultrasound contrast media, enabled IRR detection in almost 12% of our patients with VUR. IRR is most commonly found in children under 1 year of age with VUR grades IV and V.