Evaluating the accuracy of simplified VCUG in comparison with traditional VCUG for diagnosis of urinary-reflux in children: Radiation dose reduction

J Med Imaging Radiat Sci. 2022 Mar;53(1):102-106. doi: 10.1016/j.jmir.2021.10.006. Epub 2021 Nov 18.

Abstract

Introduction: Voiding cystourethrogram (VCUG) is an imaging technique for diagnosing urinary-reflux. VCUG requires X-ray exposure, increasing the risk of malignancies induced by ionizing radiation, especially in children. Considering the importance of early diagnosis of urinary-reflux using VCUG to prevent kidney complications and the significance of reducing the radiation dose during this imaging, this study intends to reduce the imaging views of VCUG and evaluate the urinary-reflux, using a reduced number of images.

Material and methods: Children referred to a University hospital who underwent VCUG participated in this study. The routine VCUG procedure contained five images. Two images of full-bladder and post-void of each patient were considered a simplified procedure and were evaluated by two radiologists to determine reflux and its grade. The sensitivity and specificity of simplified VCUG were determined.

Results: 182 patients with a mean age of 5.36±4.95 years old participated in this study. There were 90% and 82% agreement between routine and simplified VCUG results in the left and right kidneys. The simplified VCUG had 87.2% and 100% sensitivity and specificity in detecting the left-side reflux, 83 .9% and 100%, to detect the right-side reflux.

Conclusion: The results showed that using two images instead of five can effectively diagnose and grade urinary-reflux. The simplified VCUG had a relatively good and acceptable agreement in comparison to the routine cystourethrogram. It can effectively reduce the patient's radiation dose, especially in patients who need to perform serial bladder imaging for follow-up after operation.

MeSH terms

  • Child
  • Child, Preschool
  • Cystography / methods
  • Drug Tapering*
  • Humans
  • Infant
  • Radiography
  • Urinary Bladder / diagnostic imaging
  • Vesico-Ureteral Reflux* / complications
  • Vesico-Ureteral Reflux* / diagnostic imaging