Pitfalls and Limitations of Radionuclide Renal Imaging in Pediatrics

Biassoni, Lorenzo

doi:10.1053/j.semnuclmed.2015.04.001

Cited by 14 publications

(11 citation statements)

References 8 publications

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“…of patients with reported radiation injuryNo. of patients with reported follow-upMost severe injury reported[8–17]33218F-FDG00[18–31]2584 99m Tc bone tracers00[32]3 99m Tc-MAA00[33]1 99m Tc-DMSA00[34, 35]10 99m Tc-DTPA00[36]1 99m Tc-HMPAO00[37]1 99m Tc-MAG300[19, 38, 39]15 99m Tc-pertechnetate00[40, 41]2 99m Tc-sestamibi00[19]38 99m Tc-sulfurcolloid00[19]16 99m Tc-microspheres00[42]1 131 I-iodocholesterol11Erythematous plaque and pruritus.[43–45]12 201 Tl-thallous chloride22Radiation ulcerTotal301633 …”

Section: Resultsmentioning

confidence: 99%

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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PurposeRadiopharmaceutical extravasation can potentially lead to severe soft tissue damage, but little is known about incidence, medical consequences, possible interventions, and effectiveness of these. The aims of this study are to estimate the incidence of extravasation of diagnostic and therapeutic radiopharmaceuticals, to evaluate medical consequences, and to evaluate medical treatment applied subsequently to those incidents.MethodsA sensitive and elaborate literature search was performed in Embase and PubMed using the keywords “misadministration”, “extravasation”, “paravascular infiltration”, combined with “tracer”, “radionuclide”, “radiopharmaceutical”, and a list of keywords referring to clinically used tracers (i.e. “Technetium-99m”, “Yttrium-90”). Reported data on radiopharmaceutical extravasation and applied interventions was extracted and summarised.ResultsThirty-seven publications reported 3016 cases of diagnostic radiopharmaceutical extravasation, of which three cases reported symptoms after extravasation. Eight publications reported 10 cases of therapeutic tracer extravasation. The most severe symptom was ulceration. Thirty-four different intervention and prevention strategies were performed or proposed in literature.ConclusionsExtravasation of diagnostic radiopharmaceuticals is common. 99mTc, 123I, 18F, and 68Ga labelled tracers do not require specific intervention. Extravasation of therapeutic radiopharmaceuticals can give severe soft tissue lesions. Although not evidence based, surgical intervention should be considered. Furthermore, dispersive intervention, dosimetry and follow up is advised. Pharmaceutical intervention has no place yet in the immediate care of radiopharmaceutical extravasation.

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Section: Resultsmentioning

confidence: 99%

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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“…Sandbags, Velcro straps on either side of the child or a vacuum cushion can also be used as external aids for comfortable, yet effective, immobilization. Many of the pitfalls and limitations encountered in paediatric radionuclide studies can be avoided by gaining the patient's and family's cooperation, limiting the child's movements (by employing distraction techniques and immobilisation devices) and using an optimal technical setup for image acquisition (17).…”

Section: Patient Preparationmentioning

confidence: 99%

“…Image interpretation should consider several pitfalls, such as normal variants (pear-shaped kidney, foetal lobulation, kidney axis rotation), ectopic kidneys, crossed-fused ectopia, the influence of motion, high background activity, activity in the renal collecting system and tracer contamination (17). The DMSA images should ideally be assessed with the benefit of renal ultrasound images, if available.…”

Section: Static Cortical Renal Scintigraphymentioning

confidence: 99%

“…This method is accurate only when drainage is good, but fails to differentiate poor drainage due to obstruction from poor drainage due to a dilated non-obstructed collecting system. Lack of protocol standardization (especially for post-micturition images), tracer extravasation, motion, high background activity, bladder status, poor renal function, degree of renal pelvic dilatation, can all pose interpretation challenges (17).…”

Section: Evaluation Of Drainagementioning

confidence: 99%

“…The most common pitfalls in radionuclide micturating cystography are too early micturition, before the radiographer has commenced images acquisition (often because the child is not really toilet trained), and a dilated renal collecting system with persisting urinary stasis from the immediately previous dynamic renography (17). These can be mitigated by performing IRC in children who are continent and by furosemide administration before the start of the first IRC to clear the upper tracts (17). Knowledge of the expected functional bladder capacity is useful for evaluation of VUR in children.…”

Section: Indirect Isotope Cystography (Irc)mentioning

confidence: 99%

See 2 more Smart Citations

Nuclear Medicine in Pediatric Nephro-Urology: An Overview

Mendichovszky

Solar

Smeulders

et al. 2017

Seminars in Nuclear Medicine

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In the context of ante-natally diagnosed hydronephrosis, the vast majority of children with a dilated renal pelvis do not need any surgical treatment, as the dilatation resolves spontaneously with time. Slow drainage demonstrated at Tc-99m-mercaptoacetyltriglycine (MAG3) renography does not necessarily mean obstruction. Obstruction is defined as resistance to urinary outflow with urinary stasis at the level of the pelvic-ureteric junction (PUJ) which, if left untreated, will damage the kidney. Unfortunately this definition is retrospective and not clinically helpful. Therefore, the identification of the kidney at risk of losing function in an asymptomatic patient is a major research goal. In the context of renovascular hypertension a DMSA scan can be useful before and after revascularisation procedures (angioplasty or surgery) to assess for gain in kidney function. Renal calculi are increasingly frequent in children. Whilst the vast majority of patients with renal stones do not need functional imaging, DMSA scans with SPECT and a low dose limited CT can be very helpful in the case of complex renal calculi. Congenital renal anomalies such as duplex kidneys, horseshoe kidneys, crossed-fused kidneys and multi-cystic dysplastic kidneys greatly benefit from functional imaging to identify regional parenchymal function, thus directing further management. Positron emission tomography (PET) is being actively tested in genito-urinary malignancies. Encouraging initial reports suggest that F-18-fluorodeoxyglucose (FDG) PET is more sensitive than CT in the assessment of lymph nodal metastases in patients with genito-urinary sarcomas; an increased sensitivity in comparison to isotope bone scans for skeletal metastatic disease has also been reported. Further evaluation is necessary, especially with the promising advent of PET/MRI scanners. Nuclear Medicine in paediatric nephro-urology has stood the test of time and is opening up to new exciting developments.

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Genitourinary System

Elgazzar,

Sarikaya

2024

Nuclear Medicine Companion

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Pitfalls and Limitations of Radionuclide Renal Imaging in Pediatrics

Cited by 14 publications

References 8 publications

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Nuclear Medicine in Pediatric Nephro-Urology: An Overview

Genitourinary System

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