Guidelines for standard and diuretic renogram in children

Gordon, Isky; Piepsz, Amy; Sixt, Rune

doi:10.1007/s00259-011-1811-3

Cited by 169 publications

(125 citation statements)

References 45 publications

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“…The standard tracer for examining the latter is 99m Tc-MAG3 [2]. Tc-MAG3 scans are often indicated for renal function examinations in infants because of the minimum recommended age (1 month), the short physical half-life of 99m Tc (6.01 h), the high extraction rate of the radiopharmaceutical (60% in the first filtration), and the high kidney uptake (97%), providing a good image quality even for infants [2]. Therefore, renal scans with 99m Tc-MAG3 are among the most frequent urinary tract exams performed on infants and toddlers [3].…”

Section: Introductionmentioning

confidence: 99%

“…Nuclear medicine renography for pediatric patients is one of the standard non-invasive diagnostic methods with advantages such as a potential detection of diseases in early stages and information on physiology with a high sensitivity [2,3]. The standard tracer for examining the latter is 99m Tc-MAG3 [2]. Tc-MAG3 scans are often indicated for renal function examinations in infants because of the minimum recommended age (1 month), the short physical half-life of 99m Tc (6.01 h), the high extraction rate of the radiopharmaceutical (60% in the first filtration), and the high kidney uptake (97%), providing a good image quality even for infants [2].…”

Section: Introductionmentioning

confidence: 99%

“…Cases as urine reflux/blockage and infections are related with the infants' immature urinary system and/or malformation by birth [1]. Nuclear medicine renography for pediatric patients is one of the standard non-invasive diagnostic methods with advantages such as a potential detection of diseases in early stages and information on physiology with a high sensitivity [2,3]. The standard tracer for examining the latter is 99m Tc-MAG3 [2].…”

Section: Introductionmentioning

confidence: 99%

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Biokinetics, dosimetry, and radiation risk in infants after 99mTc-MAG3 scans

et al. 2018

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Background: Renal scans are among the most frequent exams performed on infants and toddlers. Due to the young age, this patient group can be classified as a high-risk group with a higher probability for developing stochastic radiation effects compared to adults. As there are only limited data on biokinetics and dosimetry in this patient group, the aim of this study was to reassess the dosimetry and the associated radiation risk for infants undergoing

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biokinetics, dosimetry, and radiation risk in infants after 99mTc-MAG3 scans

et al. 2018

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“…1,5 Both ultrasound and nuclear radiography have many variables which affect their interpretations, and thus, reduce their accuracy. [6][7][8] Therefore, we focused on those patients who had undergone surgery and compared their indications. This is fundamentally different from most data, as it did not attempt to predict outcomes.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic versus asymptomatic pyeloplasties: A single institution review

Metcalfe

Assmus

Kiddoo

2014

CUAJ

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Introduction: Historically, pyeloplasties have been performed after symptoms and radiographic confirmation of an ureteropelvic junction obstruction (UPJO). However, with prenatal ultrasonography, the approach to patients has fundamentally changed. Increasingly, patients are diagnosed and treated before the advent of morbidity, based on imaging findings alone. However, optimum screening strategies and thresholds for intervention vary significantly, are controversial, and are not founded on outcome-based evidence. We examined all pyeloplasties performed at our institution and reviewed their indication for surgery. We hypothesized that, despite ubiquitous screening for UPJO, most pyeloplasties had been performed secondary to symptoms and did not benefit from antenatal screening. Methods: A retrospective chart review was performed of all pyeloplasties performed at the Stollery Children's Hospital, Edmonton, Alberta, over the past 8 years. Patients were categorized according to indication for surgery: symptomatic or asymptomatic. Results: Most (60%) of our pyeloplasties were performed for symptomatic indications. Furthermore, 12% of these patients had antenatally detected hydronephrosis that was thought to have resolved spontaneously during follow-up. Of our symptomatic patients, 37% were undergoing surveillance with the expectation for spontaneous resolution. Of the 29 patients who underwent pyeloplasty, 8 suffered a preoperative loss of function on renal scans; however, only 50% returned to within 90% of their original function. Conclusion: Despite active surveillance of antenatally detected hydronephrosis, most pyeloplasties at our institution were performed for de-novo symptoms. We believe that this simple observation reinforces that our current surveillance strategies are unable to predict and eliminate all morbidity from UPJO.

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“…[1]. It is true that there are discrepancies between the SNMMI [2] and EANM [3] guidelines for diuretic renography in children. Both we and our North American colleagues are aware of this problem, and the SNMMI and EANM paediatric committees began to discuss harmonisation a couple of years ago, starting with the injected activities.…”

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confidence: 99%

SNMMI and EANM guidelines for diuretic renography in children

Palma

2014

Eur J Nucl Med Mol Imaging

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Dear Sir, I read the interesting letter by De Man K al. [1]. It is true that there are discrepancies between the SNMMI [2] and EANM [3] guidelines for diuretic renography in children. Both we and our North American colleagues are aware of this problem, and the SNMMI and EANM paediatric committees began to discuss harmonisation a couple of years ago, starting with the injected activities. The goal of having common guidelines for all procedures is drawing closer to realisation with every day that passes; indeed, we expect to begin publishing common updated guidelines next year. Coming to letter, I would like to comment on the background to the guidelines and to address differences in respect of hydration and catheterisation. First, it must be underlined that the SNMMI guidelines (whose newest reference date is 2006) are more technically driven (and were published in the J Nucl Med Technol), whilst the EANM guidelines are more evidence based/evidence oriented; this probably reflects differences in working organisation. The preference of the SNMMI for intravenous hydration and catheterisation is very likely related to their desire for reproducible mathematical analysis of the drainage pattern. A large body of literature now demonstrates that, even in a highly standardised setting, the positive diagnosis of obstruction is impossible with a single diuretic renogram and can be achieved only during integrated instrumental follow-up. This is why the EANM guidelines suggest the lowest degree of invasiveness (oral hydration and no catheterisation) and the necessity for (and reliability of) the post-micturition acquisition and calculation of output efficiency/normalised residual activity. In conclusion, on behalf of the EANM Paediatric Committee, we still recommend use of our guidelines, in conjunction with continuing clinical cooperation with the referring urologist, which is indispensable.

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Guidelines for standard and diuretic renogram in children

Cited by 169 publications

References 45 publications

Biokinetics, dosimetry, and radiation risk in infants after 99mTc-MAG3 scans

Biokinetics, dosimetry, and radiation risk in infants after 99mTc-MAG3 scans

Symptomatic versus asymptomatic pyeloplasties: A single institution review

SNMMI and EANM guidelines for diuretic renography in children

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