The Evaluation of Cystosonography accuracy in diagnosis of Vesicoureteral Reflux in children

Background: Vesicoureteral reflux (VUR) affects approximately 1% of children. It is a risk factor for acute pyelonephritis. Reflux has been identified in 30-50% of children following urinary tract infection. Reflux nephropathy is one of the causes of hypertension and end stage renal disease in children. The primary diagnostic procedure for evaluation of VUR in children is fluoroscopic voiding cystography (VCUG) and radionuclide cystography (RNC). Many investigators have used voiding urosonography (VUS) for the diagnosis of reflux in an effort to eliminate the radiation exposure especially during follow-up period.
Methods: We analyzed 25 children with suspected VUR who underwent RNC and VUS concurrently in Labbafi Nejad Hospital in Tehran. Reflux was diagnosed in 8 patients by RNC and in 9 patients by VUS. One case with reflux in RNC was not detected by VUS, and 2 cases with reflux in VUS were not detected by RNC.
Findings: The diagnosis of reflux by these two procedures (RNC and VUS) was comparable (p=0.000, r=0.728). In addition, grades of reflux reported by these procedures were also comparable (p=0.000, r=0.724). We considered RNC as the method of choice for reflux diagnosis. The specifity of VUS was 88% and its sensitivity 87%. Accuracy of this imaging was 88% (PPV=77%, NPV=94%).
Conclusions: These results showed that VUS is a valuable procedure in follow-up and screening of patients with vesicoureteral reflux.

Keywords
Reflux, Cystosonography, Radionuceide cystography Sensitivity, Specifity