Purpose or Case Report: Contrast enhanced voiding urosonography (CEVUS) uses intravesically administered microbubble contrast to detect vesicoureteral reflux (VUR) and urethral anomalies with ultrasound. Multiple studies have suggested CEVUS can replace voiding cystourethrogram (VCUG) as a radiation free alternative. Analysis of ureterovesical junction (UVJ) and ureters on VCUG documenting UVJ position, ureteral duplication, periureteral diverticula and ureteroceles is important as anatomic variations may affect management and surgical approach. Our purpose was to assess UVJ region visualization in children with VUR detected on CEVUS.
Methods & Materials: CEVUS studies performed between 6/18 and 3/19 with reported VUR were retrospectively reviewed by 2 pediatric radiologists to confirm presence of VUR and to qualitatively assess UVJ region for each renal moiety using a 3 point scale for clear, limited or absent visualization of the distal ureter, ureterovesical junction, ureteral duplication, periureteral diverticula and ureteroceles.
Results: 34 studies with VUR on CEVUS were identified. 67 renal moieties were evaluated including a solitary kidney in 1 child. VUR was detected in 52 moieties by Reader 1 and in 53 by Reader 2. Single moiety with discrepancy between Readers regarding VUR was excluded from statistical analysis.

Distal ureteral visualization was described as absent in 22 and limited in 16 refluxing renal moieties by Reader 1 and as absent in 18 and limited in 7 by Reader 2. Weighted Kappa of 0.47 reveals moderate agreement between Readers for distal ureteral visualization.

Visualization of UVJ was described as absent in 33 and limited in 14 refluxing renal moieties by Reader 1 and as absent in 20 and limited in 21 by Reader 2. Weighted Kappa of 0.29 reveals low agreement between Readers for UVJ visualization.

Visualization of ureteral duplication was described as absent in 39 and limited in 4 refluxing renal moieties by Reader 1 and as absent in 42 and limited in 2 by Reader 2. Weighted Kappa of 0.88 reveals high agreement between Readers for ureteral duplication.

No diverticula were detected by either Reader and one ureterocele was detected by both readers.
Conclusions: We demonstrate limited distal ureteral and UVJ visualization in refluxing renal moieties on CEVUS. Awareness of this limitation is important as there may be implications when evaluating patients for surgical management of VUR.