Contrast-enhanced gray-scale and color doppler voiding urosonography versus voiding cystourethrography in the diagnosis and grading of vesicoureteral reflux

Purpose The purpose of this study was to compare contrast‐enhanced gray‐scale voiding urosonography (CE‐VUS) and contrast‐enhanced color Doppler voiding urosonography (CE‐CDVUS) with voiding cystourethrography (VCUG) to verify whether the use of color Doppler imaging improves the diagnosis and grading of vesicoureteral reflux (VUR). Methods In 74 patients, CE‐VUS and CE‐CDVUS were compared with VCUG, which was used as the gold standard. SHU 508 A (Levovist) was used as the echo‐enhancing contrast agent. VUR was diagnosed if hyperechoic dots or color signals were visualized in the ureter on sonograms. VUR grading was based on morphologic and dynamic findings on CE‐VUS and morphologic and color findings on CE‐CDVUS. VCUG was performed conventionally, and grading by VCUG was in accordance with the international system of radiographic VUR grading. Patients who voided during 1 examination only (either CE‐VUS and CE‐CDVUS or VCUG) were excluded from the study. Agreement between the results of CE‐VUS and VCUG and between those of CE‐CDVUS and VCUG in diagnosing VUR was calculated by κ statistics. CE‐VUS and CE‐CDVUS were compared for diagnostic accuracy by the McNemar test. Results The agreement between CE‐VUS and VCUG in predicting VUR was 90% (κ score, 0.77; p < 0.001). The agreement between CE‐CDVUS and VCUG was 96% (κ score, 0.91; p < 0.001). CE‐CDVUS showed a significantly higher diagnostic accuracy than did CE‐VUS (96% versus 90% of cases correctly classified; McNemar χ2 = 4; p < 0.05). This was mainly related to the lower number of false‐negative results for grade I and grade II VUR when CE‐CDVUS was used. Conclusions The use of color Doppler imaging significantly improves the accuracy of contrast voiding urosonography in the detection and grading of VUR. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:65–71, 2001.