Indian Journal of Radiology Indian Journal of Radiology  

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Year : 2003  |  Volume : 13  |  Issue : 1  |  Page : 45-52
Saline Cystosonography versus micturating cystourethrography in the detection of vesicoureteral reflux

Departments of Radiodiagnosis and Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
S Chaudhry
701, Cheviot Court, Freeman hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, United Kingdom

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Source of Support: None, Conflict of Interest: None

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Objective : We prospectively compared echocontrast cystosonography (ECS) using 'agitated saline' with micturating cystourethrography (MCU) for the detection of vesicoureteral reflux (VUR). Subjects and methods : Fifty-one children (39 boys and 12 girls) ranging from nine days to twelve years underwent ECS followed by MCU for the evaluation of VUR. Both procedures were performed on the same day and by the same radiologist throughout the study. After confirming the absence of urinary infection, children were catheterized under strict aseptic conditions. Baseline renal and bladder sonograms were obtained. The bladder was filled to capacity by slow injection of normal saline. Five to ten ml of air was then injected to generate microbubbles 'in vivo'. The sonographic criteria used for the diagnosis of reflux were (1) increase in dilatation and (II) visualization of moving microbubbles within the collecting system. No attempt at grading the reflux was made. The findings were compared with the 'gold standard' micturating cystourethrogram. Results : Of the hundred kidney-ureter units studied, twenty-two showed reflux at MCU. ECS could detect reflux in twenty (100 percent of grade I, 67 percent of grade II, 86 percent of grade III, 100 percent of grade IV and V reflux) of these units. 'Visualization of moving microbubbles' as a sonographic criterion of reflux was 91 percent sensitive, 100 percent specific and 98 percent accurate, whereas 'increase in dilatation' was less sensitive (77 percent), specific (83 percent) and accurate (82 percent). Conclusion : ECS using 'agitated saline' is a sensitive, accurate and safe imaging technique for the detection of VUR. The 'visualization of moving microbubbles' within the collecting system is a definitive sonographic sign of reflux. The observation of 'increase in dilatation' alone should be viewed with suspicion. MCU continues to be the primary diagnostic tool in view of its ability to grade reflux and reveal bladder and urethral anatomy. Cystosonography obviatesexposure to radiation and is therefore recommended for follow-up examinations and screening of asymptomatic siblings.

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