A recent study was conducted to report the experience of using voiding urosonography (VUS) in a routine clinical setting over 6-years from one institution as the first step in the diagnosis of vesicoureteric reflux (VUR) in children.

Participants
610 children were included based on an abnormal ultrasound of the urinary tract, a history of recurrent urinary tract infections, or acute pyelonephritis.

Methodology
The children were divided into 2 groups.

Group A was comprised of 224 children with abnormalities on prenatal or postnatal ultrasound, including pyelectasis, kidney length discrepancy, and unilateral renal dysplasia.

Group B was comprised of 386 children affected by recurrent UTI or >=1 episode of acute pyelonephritis.

Over the course of 6 years, 2 different ultrasonographic contrast solutions were used. The bladder was infused with the solutions via a catheter, with subsequent examination of the full bladder via ultrasound and voiding after removal of catheter via real time ultrasound.

Grading of reflux was defined using the International Reflux Grading System.

Two groups of children referred to the center performing the study from 4 years previously, who underwent voiding cystourethrography (VCUG) were used as control groups.

These groups were also divided into group A and group B using the aforementioned criteria.

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Results
In group A, VUS examinations showed reflux in 85 kidney-ureter units, while in group B, 180 kidney-ureter units demonstrated reflux.

As a second-level step, VCUG was performed in only 60 of 610 children. Diagnostic disagreement was recorded in only 3 of 60 children examined with VCUG.

Conclusions
Although the diagnostic accuracy of VUS with respect to VCUG has been described elsewhere, this study furthers the notion that VUS is an accurate alternative to VCUG as a first-line tool in assessing VUR.

The main limitation cited by the authors is its poor ability to document male urethral pathology. The advantages include the elimination of ionizing radiation, which is an area of increasing concern, particularly in the pediatric patient population.

Reviewer’s Comments
It is clear that the authors have extensive experience with VUS as a modality for assessing VUR. The broader conclusion to be drawn from this article is that the evaluation of VUR is not limited to one modality. There are options that can be considered that may aid in addressing patient-specific limitations, which include VUS, VCUG, and radionuclide cystography.

Author: Basil Hubbi, MD

Reference:
Giordano, Mario; Marzolla, Rocco, et al. Voiding Urosonography as First Step in the Diagnosis of Vesicoureteral Reflux in Children: A Clinical Experience. Pediatric Radiology. Volume 37, Number 7. (July 2007) pp. 674-677.
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A recent study which was conducted to assess whether transperineal sonography is valid and accurate in discriminating different types of imperforate anus in neonates has proved useful in introducing a simple value for separating the high and intermediate type of imperforate anus from the low type, and in diagnosing imperforate anus more accurately.

The Study
Over a 10-year period, infants were examined with transperineal ultrasound after clinically being diagnosed with imperforate anus.

Methodology
On ultrasound, the distal rectal pouch was identified and its distance to the perineum was recorded.

Thereafter, the distance and the type of imperforate anus were confirmed on the basis of surgical findings.

The type of imperforate anus is classified as high, intermediate, or low, depending on the relation of the distal rectum to the puborectalis sling of the levator ani muscle.

High type is defined as a rectum that terminates above the level of the puborectalis.

Intermediate type terminates within the puborectalis.

Low type passes through the levator ani muscle group and through the central puborectalis, terminating below the sling.

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Results
54 patients were included in the study. A final diagnosis of imperforate anus was made for 22 patients.

The mean distance between the distal rectal pouch and the perineum in this group was 10.4 mm. For intermediate imperforate anus, 17 patients were identified. They had a mean pouch-to-perineum distance of 23.6 mm.

For the patients identified as a high imperforate anus, of which there were 17 patients, the mean pouch-to-perineum distance was 25.5 mm.

Conclusions
As can be seen from the results, there was considerable overlap for the pouch-to-perineum distance for those patients diagnosed with intermediate or high imperforate anus. After thorough statistical analysis, the cutoff value for the distance from the distal rectal pouch to the perineum was determined to be 15 mm. This cutoff value yielded a sensitivity estimated to be 100% and a specificity of 86% when diagnosing low imperforate anus. This cutoff value correctly diagnosed 19 of the 22 infants with low imperforate anus, with the remaining 3 infants diagnosed on the findings of anocutaneous fistula. All 34 cases of intermediate or high imperforate anus were correctly classified at sonographic examination using this cutoff value, with no reliable value for separating those diagnosed with high imperforate anus from those with indeterminate type.

Reviewer’s Comments
The study introduces a simple value for separating the high and intermediate type of imperforate anus from the low type.

The authors only briefly touch on the importance of taking into account the presence and type of fistula on clinical grounds, which also aids in diagnosis.

This proved valuable with the 3 infants diagnosed with low imperforate anus based on an anocutaneous fistula–something to keep in mind when putting this data into practice.

Author: Basil Hubbi, MD).

Reference:

Haber, Hans P., Seitz, Guido, et al. Transperineal Sonography for Determination of the Type of Imperforate Anus. AJR 2007; 189:1525-1529

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[headline_style_3r deck="Obstetric Ultrasound CME just got a little easier..." headline="A Free Special Report From Radiology Daily is available for you to download now: Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma " subheadline="Claim your free copy from Oakstone Medical Publishing, the reliable source for continuing medical education, musculoskeletal imaging courses and reports on the latest musculoskeletal imaging research." headlinetext="" ]
Interested in the latest news in the field of Obstetric Ultrasound?

If you are, we have good news!

A new free Special Report is now available:

Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma

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Dear concerned radiology professional,

If you’re a practising radiologist, radiology resident or internist, you know how far Obstetric Ultrasound has advanced in recent years—even in the past few months, with newer and better imaging and more effective techniques emerging all the time.

So, what’s a busy radiologist to do?

First and foremost, stay on top of the latest research, and your CME requirements, particularly those Obstetric Ultrasound courses that address the latest technology and how to use it correctly and safely, as well as how to interpret your findings to aid in treatment decisions in the hope of the best patient outcome.

Radiology Daily was launched to help you stay on top of your CME requirements, bringing you the latest news on Obstetric Ultrasound. This is news you can use in your practice to stay on the cutting edge, or even ahead of the curve.

Radiology Daily, from Oakstone Medical Publishing, which produces the landmark Practical Reviews in Radiology, brings you the latest news in the world of radiology from over 40 journals around the globe.

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Every professional caregiver has dedicated themselves to a lifetime of learning.

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In this special report, you will learn:

• How to Identify Ectopic Pregnancy:
• Who is at risk;
• The main reasons for ectopic pregnancies;
• The 4 key observations to detect normal pregnancy on ultrasound and rule out ectopic pregnancy;
• Evaluating ovarian masses on ultrasound;
• Why size matters when it comes to ovarian masses;
• How to approach ovarian masses in pre-menopausal women;
• How to approach ovarian masses in post-menopausal women;
• The main ovarian masses you will encounter on ultrasound;
• The main types of ovarian cysts;
• The characteristic appearance on a sonograph of the main types of ovarian cysts;
• How to approach ovarian masses if you locate them on ultrasound;
• Which types of ovarian cysts can be ruled benign upon ultrasound;
• Why practice is key when it comes to evaluating ovarian masses on ultrasound;
• Evaluating endometrial thickness with ultrasound;
• What is considered normal endometrial thickness in pre-menopausal women;
• Evaluating endometrial thickness in postmenopausal women;
• How your evaluation should differ if bleeding is present;
• Why it is important to identify atrophic endometrium with ultrasound;
• The appearance of endometrial carcinoma on ultrasound;
• Why focal thickenings of the endometrium are also important;
• The difference in appearance on ultrasound between endometrial polyps and submucous myomas.
• Further resources and suggested reading;
• And more…

Oakstone Medical Publishing is your reliable source for Obstetric Ultrasound CME.

Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma now, and download in minutes.

Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about Obstetric Ultrasound and Obstetric Ultrasound CME courses to the Radiology Daily website.

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Your time is very valuable.

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With kind regards,

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Medical Director

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P.S. As any radiologist knows, when it comes to Obstetric Ultrasound, experience is key in detecting and treating disease. So is keeping up to date with the latest technologies, techniques, and procedures, in the hopes of gaining the best patient outcomes.

If you agree, I’m sure you’ll want to read Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma. Just enter your email address, download your free report, and start reading in minutes.

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This series of articles is  going to look at issues in the female pelvis, particularly ectopic pregnancy, ovarian masses and abnormal endometrium, and how they are identified through the use of ultrasound.

Welcome to the Obstetric Ultrasound Section of Radiology Daily.

In the Obstetric Imaging section, we will be keeping you up to date on the latest information in the field of Obstetric ultrasound and other obstetrical screenings.
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Welcome to the Musculoskeletal Radiology Section of Radiology Daily.

In the Musculoskeletal Radiology section, we will be keeping you up to date on the latest information in the field of Musculoskeletal Radiology, including x-ray, ultrasound, Bone Scintigraphy, CT, MRI, and Arthrography.

We will also include news on the current clinical challenges in Musculoskeletal Radiology, up-to-date imaging protocols, as well as imaging pitfalls.
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Welcome to the Gastrointestinal Imaging Section of Radiology Daily.

In the Gastrointestinal Imaging section, we will be keeping you up to date on the latest information in the field of Gastrointestinal Imaging, including x-ray, ultrasound, endoscopy, Colonoscopy, Endoscopic Retrograde Cholangiopancreatography (ERCP), Flexible Sigmoidoscopy, Lower GI Series and Upper GI Series.

We will also include news on the current clinical challenges in Gastrointestinal Imaging, and how to interpret imaging studies.
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Welcome to the Diagnostic Imaging Section of Radiology Daily.

In the Diagnostic Imaging section, we will be keeping you up to date on the latest technology  in the field of Diagnostic Imaging, including x-ray, ultrasound, mammography, CT, CT/MR angiography, MRI, PET and more.

We will also include information on current clinical challenges, as well as case studies and how to interpret them, for better diagnosis in the hope of better patient outcomes.

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Welcome to the Cardiac Imaging Section of Radiology Daily.

In the Cardiac Imaging section, we will be keeping you up to date on the latest information in the field of Cardiac Imaging, including cardiac CT, MRI, ultrasound, and CT angiography.

We will also include news on the current clinical challenges in Cardiac Imaging, including interpreting imaging studies, and how to choose and use the various imaging technologies in the hope of better patient outcomes.
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Welcome to the Breast Imaging Section of Radiology Daily.

In the Breast Imaging section, we will be keeping you up to date on the latest information in the field of Breast Imaging, including mammogram, MRI, ultrasound, PACS, digital mammography and tomosynthesis.

We will also include news on the current clinical challenges in Breast Imaging, including interpreting imaging studies, and the latest advances being utilized in the detection and diagnosis of breast cancer. We will discuss how to choose and use the various imaging technologies in the hope of better patient outcomes.
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