Vesicoureteral Reflux Grading using Different Imaging Techniques (MCUG, NM, and US): A Comparative Study

Abstract

The aim of this study was to compare the different imaging procedures (micturating cystourethrogram [MCUG], nuclear medicine [NM], and ultrasound [US]) in the evaluation of vesicoureteral reflux (VUR). Methods and Results: A retrospective study was conducted to compare different radiological investigations in the characterization and grading of VUR. In total, 93 patients (53 boys and 40 girls) with a mean age of 2.2 years were referred to the radiology department for exclusion or diagnosis of VUR. Age, sex, the pathway of obstruction, presence of VUR, degree of obstruction with VUR, presence of hydronephrosis, calcification, and grading according to MCUG were the main variables collected for US, NM, and MCUG. Our results show that according to the frequency distribution, MCUG showed a higher sensitivity for detecting VUR and the degree of obstruction than the other imaging tools. US showed a higher sensitivity for the presence of hydronephrosis. The grading of VUR was more effectively detected by MCUG than by US and NM grading. We revealed a statistical association between VUR grades and the gender of a study's population, with a higher frequency of grade 5 in boys than in girls (P=0.037). Grades 3-5 showed higher frequencies in MCUG, in which the younger patients (0–50 weeks old) were more affected by obstruction and VUR than the other age groups. Moderate hydronephrosis was higher in boys than in girls (P=0.006). Conclusion: The grading of VUR is more effectively detected by MCUG than by US and NM grading.