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Purpose To compare the diagnostic accuracies of renal ultrasonography (US) and voiding cystourethrography (VCUG) for vesicoureteral reflux (VUR). Materials and Methods This retrospective study included infants and children (< 24 months of age) with urinary tract infections who underwent renal US and VCUG. The incidences of decreased or increased renal size, increased renal parenchymal echogenicity, ureteral dilation, ureteral wall thickening, renal pelvic dilation, pelvic wall thickening, and accentuated pelvic dilation in the prone position were compared. Grade 3 or higher VUR was classified as “highgrade.” A total of 138 patients (109 males; mean age, 3 months) were included. Multivariate logistic regression analysis was performed, and diagnostic accuracy was calculated. Results Fifty-three (38.4%) and 43 (31.2%) patients exhibited all-grade and high-grade VUR. Decreased renal size was significantly related to all-grade [odds ratio (OR): 16.6; 95% confidence interval (CI): 3.4–81.3; p = 0.001) and high-grade VUR (OR: 29.7; 95% CI: 5.7–155.3; p < 0.001). Accentuated pelvic dilation in the prone position, increased renal parenchymal echogenicity, and ureteral dilation were related to all-grade and high-grade VUR. Conclusion Decreased renal size showed the highest diagnostic accuracy for US-based diagnosis of all-grade and high-grade VUR. Accentuated pelvic dilation in the prone position, increased renal parenchymal echogenicity, and ureteral dilation may aid in the diagnosis of high-grade VUR.

Diagnostic Accuracy of Renal Ultrasonography for Vesicoureteral Reflux in Infants and Children Aged Under 24 Months with Urinary Tract Infections