Indirect radionuclide renocystography for determination of vesico-ureteral reflux in children

Abstract

Indirect radionuclide renocystography (IRRCG) is a method for the detection of vesico-ureteral reflux by analysis of the activity-time curves over the kidneys and bladder during voiding of urine about 30 min after intravenous administration of a radioactive indicator. This paper presents a new method for detection of reflux by a statistical test, the magnitude of the reflux is evaluated by the reflux volume per 1.73 m2 body surface area. Residual urine volume and urine voiding efficiency are also calculated. In a retrospective study of 154 children examined for renal and urological diseases consisting mainly of urinary tract infections, vesico-ureteral reflux was found by IRRCG in 16% of the kidneys (23% of the children). Reflux volumes were below 10 ml/1.73 m2 in 90% of the children with reflux. The mode value of the reflux volume was 2 ml/1.73 m2. For a subgroup of 97 children, the results were compared with micturating cysto-urethrography (MCU). This showed that a negative IRRCG in conjunction with the renal mean transit time of the radioactive indicator determined by gamma camera renography could be used as a screening test for vesico-ureteral reflux when MCU was considered a true reference method. Hence, about 75% of the invasive and high radiation dose MCU can be replaced by the non-invasive and low radiation dose IRRCG. The discrepancies between the two methods and the reasons for them are discussed.

How good is technetium-99m mercaptoacetyltriglycine indirect cystography?

“…Moreover, this series shows, like our own study, that IRC performed with MAG3 is generally unable to detect reflux not seen on MCUG. This was not the case in the publications dealing with DTPA [1][2][3][4][5][6][7][8].…”

“…These overall results are better than those produced in the present work. However, there is a wide variation in the published data, the percentage of false-negative cases on IRC varying from 22% to 51% [1][2][3][4][5][6][7][8]231.…”

“…Most of the Correspondence to: C. De Sadeleer earlier studies on IRC were performed with technetium99m diethylene triamine penta-acetic acid and showed variable levels of sensitivity [1][2][3][4][5][6][7][8]. In recent years, 99mTC mercaptoacetyltriglycine (MAG3) has been advocated as a useful tracer for renographic studies in children, owing to its high extraction rate and the favourable signal to noise ratio.…”

Urinary tract infection in paediatrics: the role of diagnostic imaging

“…The results of the DRC may also be quantified (Willi & Treves, 1985). The DRC has a high sensitivity compared with the MCUG (Conway & Kruglik, 1976;Willi & Treves, 1985), as does the IRC (Handmaker et al, 1973;Pollet et al, 1981;Bower et al, 1985;Nielsen et al, 1985;Carlsen et al, 1986;Chapman et al, 1988). Few studies have been reported with poor results of the IRC (Majd, 1986).…”