Grades of Vesicoureteral Reflux on ceVUS: Capabilities of the Method
What is ceVUS
Contrast-enhanced voiding urosonography (ceVUS) is a technique in which microbubble contrast agents are introduced through a urethral catheter for sonographic assessment of vesicoureteral reflux (VUR) (Textbook of Diagnostic Sonography, 9th ed., 2023). This allows real-time visualization of contrast reflux from the bladder into the ureters and the renal collecting system.
Role of ceVUS in VUR Diagnosis
Vesicoureteral reflux is definitively diagnosed using voiding cystourethrography (VCUG) or ceVUS (Textbook of Diagnostic Sonography, 9th ed., 2023). Conventional ultrasound can often detect higher grades of VUR; however, a combination of pre- and post-void renal imaging may be useful for detecting lower grades.
Clinical Features of VUR in Children
VUR may be unilateral or bilateral, with sides potentially demonstrating different reflux levels (different degrees of urinary tract dilatation). Many cases, particularly in boys, and a significant proportion of moderate dilatations resolve spontaneously within the first 2 years of life (Textbook of Diagnostic Sonography, 9th ed., 2023).
Classification I–V
Detailed criteria for VUR grading according to grades I–V on ceVUS are not described in the provided source excerpts [to be clarified]. For accurate presentation of the five-point scale (level of contrast reflux, ureteral dilatation, and pelvicalyceal system dilatation), a primary source with corresponding grading criteria is required [to be clarified].
Method Safety
The safety profile of second-generation intravesical contrast administration in ceVUS was prospectively evaluated in children (Papadopoulou F. et al., Pediatr Radiol 2014; prospective safety assessment of contrast in 1010 children).
Frequently asked questions
How is contrast administered in ceVUS?
Microbubble contrast agent is introduced through a urethral catheter (intravesically) for sonographic assessment of reflux (Textbook of Diagnostic Sonography, 2023).
Can conventional ultrasound replace ceVUS?
Conventional ultrasound can often detect higher grades of VUR, but pre- and post-void renal images are useful for lower grades; definitive diagnosis is performed with VCUG or ceVUS.
Can reflux be different grades on both sides?
Yes, VUR may be unilateral or bilateral, and the sides can demonstrate different reflux levels (Textbook of Diagnostic Sonography, 2023).
How safe is contrast in ceVUS in children?
The safety of second-generation intravesical contrast was prospectively evaluated in 1010 children (Papadopoulou F. et al., Pediatr Radiol 2014).
Does VUR resolve spontaneously?
Many cases, particularly in boys, and a significant proportion of moderate dilatations resolve spontaneously within the first 2 years of life (Textbook of Diagnostic Sonography, 2023).