Abstract:

Objective

To improve contrast-enhanced voiding urosonography (CeVUS) in pediatrics with regard to contrast medium dosage and examination method, and to preliminarily explore its effectiveness and clinical application value in improving the quality of contrast images.

Methods

A retrospective study was performed on 137 children who underwent CeVUS in the Department of Ultrasound of Children's Hospital of Fudan University from January 2019 to August 2023.Traditional contrast method(single dose) was used from January 2019 to December 2021, and improved contrast method (dose adjustment based on age, bladder capacity, etc.) was used from January 2022 to August 2023 to evaluate vesicoureteral reflux.The images of the bladder after injection of contrast agents were divided into levels I ~ III (the image quality of level I is the best, the outline of the bladder is complete and clear, and the back of the bladder is not obviously obscured by shadow).The classification of the developed images was compared between the traditional contrast method and the improved contrast method.The consistency between CeVUS and voiding cystouretrography (VCUG) was analyzed.

Results

Among the 137 cases, 100 were examined by the traditional CeVUS method and 37 by the modified CeVUS method.The classification of bladder images obtained by the traditional method was: 1 case at level I (1.0%, 1/100), 39 cases at level II (39.0%, 39/100),and 60 cases at level III (60.0%, 60/100); for bladder images obtained by the improved method, there were 17 cases at level I (45.9%, 17/37), 16 cases of level II (43.2%, 16/37), and 4 cases of level III (10.8%, 4/37).The image level obtained by the improved method was better than that of the traditional method (P＜0.01).A total of 22 children underwent radiology VCUG examination at a similar time to CeVUS, and the Kappa value of the two examinations was 0.449 (P=0.002).

Conclusion

The improved CeVUS method can optimize the examination process, make the image clearer, use less contrast agent dose, and have better safety, which is worthy of clinical application.

Key words: Contrast-enhanced voiding urosonography, Vesicoureteral reflux, Child;Improvement