Contrast-enhanced ultrasound (CEUS) provides real-time, radiation-free imaging of the urinary tract using microbubble agents with no renal toxicity, yet it remains underutilized in the United States. This enduring webinar will review two clinical applications: characterization of complex cystic and indeterminate solid renal masses, where CEUS overcomes the volume averaging and contrast timing limitations of CT and MRI, and contrast-enhanced voiding urosonography (ceVUS) for the detection and grading of vesicoureteral reflux and evaluation of the urethra in children. Faculty will present enhancement patterns that predict malignancy, the role of CEUS in guiding renal mass biopsy, ceVUS technique and intravesical dosing, the five-grade reflux classification, and urethral pathologies including posterior urethral valves. Faculty will also discuss the advantages of CEUS compared with contrast-enhanced CT, MRI, and fluoroscopic voiding cystourethrography.

After completing this activity, participants should be better able to:

• Explain how volume averaging and contrast timing on CT and MRI lead to both over-diagnosis and under-diagnosis of cystic renal masses, and how the thin slice thickness and real-time imaging of CEUS overcome these limitations
• Recognize CEUS enhancement patterns of cystic renal lesions, including benign bubble flow within thin septations, enhancing septal nodularity, and the early arterial enhancement and washout of papillary renal cell carcinoma
• Describe the technique for ceVUS in children, including patient selection, contrast preparation and intravesical dosing, bladder filling, and scanning of the kidneys
• Detect and grade vesicoureteral reflux on ceVUS using the five-grade classification, and recognize intrarenal reflux and reflux in duplicated collecting systems
• Evaluate the urethra with transperineal and transabdominal ceVUS during voiding and identify common pathologies, including posterior urethral valves, anterior urethral valves, strictures, and prostatic utricle

The content of this webinar is intended for radiologists, pediatric radiologists, urologists, and other physicians, sonographers, imaging nurses, administrators, researchers, and others involved in imaging of the kidneys, bladder, and urinary tract in adult and pediatric patients.

This CME activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. Northwest Imaging Forums is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. NWIF designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release Date: TBD | Expiration Date TBD

Participants may claim only one type of credit for this educational activity.

Faculty and Planner Disclosures:
As an accredited provider of continuing medical education, Northwest Imaging Forums, Inc. (NWIF) ensures balance, independence, objectivity, and scientific rigor in all its educational activities. In accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education, all faculty and planners are required to disclose all financial relationships with ineligible companies within the last 24 months. All relevant financial relationships have been mitigated by NWIF to ensure the integrity of the CME activity. The planner has nothing to disclose.

Richard G. Barr, MD, PhD

Professor of Radiology
Northeast Ohio Medical University
Director, Southwoods Imaging
Department of Radiology
Surgical Hospital at Southwoods
Youngstown, Ohio

Aikaterini Ntoulia, MD, PhD

Department of Radiology
The Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania