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Contrast-Enhanced Harmonic Imaging for the Diagnosis of Vesicoureteral Reflux in Pediatric Patients

¹ All authors: Department of Pediatric Radiology, Radiological Clinic, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 153, 69120 Heidelberg, Germany.

View larger version (122K): [in a new window]   Fig. 1A. —3-week-old girl with duplex kidney with upper segmental multicystic dysplastic kidney and lower refluxive moiety. Unenhanced sonogram in fundamental imaging shows renal pelvis (arrow).

View larger version (113K): [in a new window]   Fig. 1B. —3-week-old girl with duplex kidney with upper segmental multicystic dysplastic kidney and lower refluxive moiety. Unenhanced sonogram in tissue harmonic imaging (phase inversion) shows improved delineation of renal pelvis (arrow) and more clearly visualized multiple cysts in upper moiety than in A.

View larger version (136K): [in a new window]   Fig. 1C. —3-week-old girl with duplex kidney with upper segmental multicystic dysplastic kidney and lower refluxive moiety. Sonogram in fundamental mode after intravesical administration of contrast medium clearly shows microbubbles, indicating reflux, in renal pelvis (arrow).

View larger version (144K): [in a new window]   Fig. 1D. —3-week-old girl with duplex kidney with upper segmental multicystic dysplastic kidney and lower refluxive moiety. Contrast-enhanced sonogram in tissue harmonic imaging shows reflux into renal pelvis (arrow) as markedly more evident than in C.

View larger version (136K): [in a new window]   Fig. 2A. —4-year-old boy with vesicoureteral reflux. Images were taken successively, just seconds apart, after administration of contrast medium into bladder. Contrast-enhanced longitudinal sonogram shows bladder and dilated refluxive terminal ureter (arrows) in fundamental imaging mode. Reflux in ureter can be clearly seen.

View larger version (146K): [in a new window]   Fig. 2B. —4-year-old boy with vesicoureteral reflux. Images were taken successively, just seconds apart, after administration of contrast medium into bladder. Longitudinal sonogram of bladder and dilated refluxive terminal ureter (arrows) in contrast harmonic (phase inversion) imaging mode with image focus at level of ureter reveals strikingly obvious reflux. Selective, enhanced depiction of microbubbles in ureter is possible in this mode.

View larger version (159K): [in a new window]   Fig. 3A. —13-year-old boy with vesicoureteral reflux. Images were taken after intravesical contrast medium administration, only seconds apart. Unenhanced transverse sonogram of right kidney obtained in dorsal position using fundamental imaging shows echo-free renal pelvis (arrows).

View larger version (156K): [in a new window]   Fig. 3B. —13-year-old boy with vesicoureteral reflux. Images were taken after intravesical contrast medium administration, only seconds apart. Contrast-enhanced transverse sonogram of right kidney obtained in dorsal position using fundamental imaging clearly shows microbubbles in renal pelvis (arrows).

View larger version (143K): [in a new window]   Fig. 3C. —13-year-old boy with vesicoureteral reflux. Images were taken after intravesical contrast medium administration, only seconds apart. Contrast-enhanced transverse sonogram of right kidney obtained in dorsal position using tissue harmonic imaging shows very conspicuous reflux in renal pelvis (arrows).

View larger version (149K): [in a new window]   Fig. 3D. —13-year-old boy with vesicoureteral reflux. Images were taken after intravesical contrast medium administration, only seconds apart. Contrast-enhanced transverse sonogram of right kidney obtained in dorsal position using contrast harmonic imaging shows markedly visible microbubbles in renal pelvis (arrows). Renal parenchyma is more suppressed.

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