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Contrast-enhanced voiding urosonography part 2: urethral imaging

  • Contrast-enhanced ultrasound (CEUS) in children
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Abstract

Ultrasound (US) has been increasingly used as an important imaging tool to assess the urethra in children. The earliest reports of pediatric urethral sonography involved imaging the urethra in a non-voiding state, during physiological voiding of urine, and after instillation of saline. The introduction of US contrast agents has continued to improve visualization of urethral anatomy. Contrast-enhanced US of the urethra can be performed during the voiding phase of a standard contrast-enhanced voiding urosonography (ceVUS) exam or with retrograde instillation of a contrast agent, depending on the exam indication. Both techniques are well tolerated by children and provide accurate information about urethral pathology and periurethral soft tissues. This article reviews the technical aspects and imaging findings of urethral pathologies in children using contrast-enhanced US, both by the voiding and retrograde instillation techniques.

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Acknowledgments

Dr. Maciej Piskunowicz was supported by the Kosciuszko Foundation.

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Authors and Affiliations

  1. Department of Radiology, Boston Children’s Hospital, Harvard University, 300 Longwood Ave., Boston, MA, 02115, USA

    Carol E. Barnewolt & Jeanne S. Chow

  2. Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Patricia T. Acharya

  3. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Patricia T. Acharya

  4. Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain

    Elisa Aguirre Pascual & David Coca Robinot

  5. Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan J. Back, Kassa Darge & Aikaterini Ntoulia

  6. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Susan J. Back & Kassa Darge

  7. Department of Radiology, Hospital Universitari Parc Taulí - Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain

    Vivian P. Beltrán Salazar & Carmina Duran

  8. Department of Radiology, Hong Kong Children’s Hospital, Hong Kong (SAR), People’s Republic of China

    Pui Kwan Joyce Chan

  9. Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia

    Damjana Ključevšek

  10. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jeannie K. Kwon

  11. Pediatric Ultrasound Center, Thessaloniki, Greece

    Frederica Papadopoulou

  12. Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland

    Magdalena M. Woźniak

  13. Department of Radiology, Medical University of Gdansk, Gdansk, Poland

    Maciej Piskunowicz

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  1. Carol E. Barnewolt
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Correspondence to Carol E. Barnewolt.

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Conflicts of interest

Drs. Back and Darge have received an educational grant from Bracco Diagnostics, Inc. Dr. Darge participates in educational activities and is part of the contrast-enhanced ultrasound course faculty at the Children’s Hospital of Philadelphia.

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Supplementary Information

Online Supplementary Material 1

Imaging in a 2-year-old boy with recurrent urinary tract infection. Two-dimensional contrast-enhanced voiding urosonography (ceVUS) image (left) and corresponding three-dimensional ceVUS (right) series in contrast-only modes demonstrate the normal male urethra from a sagittal transperineal approach. Same boy as in Fig. 2 (MP4 1725 kb)

Online Supplementary Material 2

Imaging in a 2.5-year-old girl with recurrent urinary tract infections. Four-dimensional contrast-enhanced voiding urosonography series shows a normal female urethra during voiding. Imaging obtained from a suprapubic approach in a coronal plane. Same girl as in Fig. 3 and Online Supplementary Material 3 (MP4 557 kb)

Online Supplementary Material 3

Imaging in a 2.5-year-old girl with recurrent urinary tract infections. Four-dimensional contrast-enhanced voiding urosonography series shows a normal female urethra during voiding. Imaging obtained from a suprapubic approach in a sagittal plane. Same girl as in Fig. 3 and Online Supplementary Material 2 (MP4 644 kb)

Online Supplementary Material 4

Imaging in a 2-year-old boy with recurrent urinary tract infection. Contrast-enhanced voiding urosonography with dual display of contrast (left) and gray-scale (right) images in sagittal plane. Normal urethra is visualized through a transperineal approach (MP4 10,549 kb)

Online Supplementary Material 5

Imaging in a 1-month-old boy with posterior urethral valves. Sagittal transperineal contrast-only series during the voiding phase of contrast-enhanced voiding urosonography (ceVUS) shows dilation of the posterior urethra and a decreased diameter of the anterior urethra. Note that during early voiding the urethra is not well distended and appears more normal. It is not until full distention that the abnormality becomes apparent (MP4 3,421 kb)

Online Supplementary Material 6

Anterior valve with urethral diverticulum in a 1-month-old boy. Sagittal transperineal cinematic clip of the urethra with dual display of gray-scale (left) and contrast-only (right) modes during the voiding phase of contrast-enhanced voiding urosonography (ceVUS). There is focal, saccular dilation of the anterior urethra. Same boy as in Fig. 16 (M4V 857 kb)

Online Supplementary Material 7

Prostatic utricle in a 2-year-old boy. Sagittal transperineal cinematic clip of the urethra with dual display of gray-scale (left) and contrast (right) modes during the voiding phase of contrast-enhanced voiding urosonography (ceVUS) shows a focal outpouching from the midline of the prostatic urethra. Same boy as in Fig. 17 (MP4 2,955 kb)

Online Supplementary Material 8

Stricture of the anterior urethra in a 15-year-old boy with history of treated hypospadias as a toddler, now presenting with repeated urinary tract infections and epididymo-orchitis. Sagittal transperineal cinematic clip of the urethra with dual display of the gray-scale (right) and contrast (left) modes during the voiding phase of contrast-enhanced voiding urosonography (ceVUS) shows stenosis in the penile urethra with dilation of the bulbar urethra. These findings were confirmed on cystoscopy. Same boy as in Fig. 19 (MP4 12,030 kb)

Online Supplementary Material 9

Urethral stricture in a 31-year-old man with difficulty urinating. Cinematic clip from a voiding contrast-enhanced urosonography in contrast-only mode. Segmental narrowing of the anterior urethra is seen on sagittal transpenile voiding images following retrograde filling of the urinary bladder with US contrast agent. Same patient as in Fig. 20 (MP4 15,693 kb)

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Barnewolt, C.E., Acharya, P.T., Aguirre Pascual, E. et al. Contrast-enhanced voiding urosonography part 2: urethral imaging. Pediatr Radiol 51, 2368–2386 (2021). https://doi.org/10.1007/s00247-021-05116-6

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  • DOI: https://doi.org/10.1007/s00247-021-05116-6

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