Benya Ellen,  Prendergast Francis,  Liu Dennis,  Wyers Mary

Final Pr. ID: Paper #: 001

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. Read More

Authors:  Benya Ellen , Prendergast Francis , Liu Dennis , Wyers Mary

Keywords:  contrast enhanced voiding urosonography, vesicoureteral reflux, ureterovesical junction

Mccauley Robert,  Sinha Vikash,  Pierre Kevin,  Morgan Amber,  Yekeler Ensar,  Rodero Cardoso Mariana,  Sharma Priya

Final Pr. ID: Poster #: EDU-046

Fluoroscopic voiding cystourethrograms (VCUG) play a crucial role in pediatric radiology, enabling real-time visualization of the lower genitourinary tract. This educational exhibit summarizes the clinical indications, technique, clinically significant findings, and potential complications associated with VCUG, aiming to provide a strong foundational review for radiologists-in-training.

The lower genitourinary tract, comprising the ureters, bladder and urethra, is implicated in various pediatric pathologies that can lead to long-term morbidity if left undiagnosed or untreated. VCUG is a dynamic study, allowing for visualization of the lower genitourinary tract bladder and urethra during filling and voiding, making it an invaluable tool in pediatric radiology for detection of both functional and structural pathologies.

In this presentation we will review the most common indications for VCUG in the pediatric population as well as use a case-based approach to the discuss the following pathologies associated with the lower genitourinary tract and related conditions of surgical interest.

●Vesicoureteral reflux and its grading
●Congenital Abnormalities
-Posterior Urethral Valves
-Diverticula
-Anorectal malformations
-Prune belly syndrome
-Duplicated renal collecting system
-Congenital Megaureter
●Trauma
-Urethral disruption
-Urethral stricture
-Bladder injury/disruption
●Post-operative evaluation
-Ureteral reimplantation

We will also discuss tips and tricks for the performance of the pediatric VCUG. Additionally, in the face of complications, prompt recognition and intervention remain crucial. We will review commonly encountered challenges faced by the performing radiologist.

Fluoroscopic VCUG remains an invaluable diagnostic tool in pediatric radiology. For radiologists-in-training, mastering the technique, understanding clinical indications, and being able to interpret findings accurately are essential. With patient-centered care and adherence to best practices, VCUG can provide vital insights into pediatric lower urinary tract pathologies. Read More

Authors:  Mccauley Robert , Sinha Vikash , Pierre Kevin , Morgan Amber , Yekeler Ensar , Rodero Cardoso Mariana , Sharma Priya

Keywords:  VCUG, Vesicoureteral Reflux, Fluoroscopy

Lee Samantha,  Amodio John

Final Pr. ID: Poster #: EDU-026

The investigation of vesicoureteral reflux (VUR) has been a long standing practice in pediatric radiology, traditionally accomplished using voiding cystourethrogram (VCUG). However, our institution demonstrates that the days of lead aprons and iodinated radiation may be behind us. Contrast-enhanced voiding urosonography (CeVUS) offers a safer, more sensitive alternative to VCUG in the diagnosis of VUR. Residents practicing at this children’s hospital are exposed to and assist with CeVUS at an early stage in their training, enabling their familiarity and understanding of the modality to facilitate medical society’s shift from fluoroscopic technique.

Residents on their pediatric radiology rotation are expected to engage in the performance of CeVUS exams and in the dictation of associated reports. They quickly learn that the technical aspects of VCUG and CeVUS are very similar involving aseptic bladder catheterization, intravesicular instillation of contrast, and subsequent imaging of the urinary tract system. The sonographic contrast agent of choice is Lumason, a safe second generation microbubble formulation. Trainees also learn that the international grading system of VUR is maintained across the two modalities. Most importantly, however, is the lesson that CeVUS more frequently captures the clinically significant grades of VUR. This concept may be two fold. Firstly, the reflux of microbubbles into the kidney has greater visibility than that of its iodinated counterpart on fluoroscopy. Secondly, in order to reduce radiation-associated adverse effects of VCUG, radiologists will perform “pulse sequencing”, which potentiates missed episodes of VUR.

The field of pediatrics is certainly amidst a cultural shift with increasing awareness of the benefits and utility of contrast-enhanced ultrasonography. CeVUS is simply one example. Radiology residents at this institution are actively involved with this newer modality early in their training. This report demonstrates radiology residents performing these exams with supervision by the attending radiologist. CeVUS has been added to the teaching curriculum in pediatric radiology at our institution. Read More

Authors:  Lee Samantha , Amodio John

Keywords:  vesicoureteral reflux

Chauhan Ankita,  Dillard Roger

Final Pr. ID: Poster #: EDU-040

We will discuss how to perform voiding cystourethrography (VCUG). We will illustrate typical imaging features of genitourinary pathologies in a neonate. Read More

Authors:  Chauhan Ankita , Dillard Roger

Keywords:  Vesicoureteral Reflux, Genitourinary, Neonate