Renal Radionuclide Imaging, an Evergreen Forty Years Old

 

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Abstract

Urinary tract congenital abnormalities (UCA) and febrile infections (UTI) are, respectively, 2 of the commonest congenital and acquired health problems in childhood. In both, radionuclide imaging still represent a cornerstone of diagnostic imaging, although the involved techniques are more or less the same from the early ’80 s. During the last 2 decades, published papers focused on a deep revision about the optimal use and usefulness of such imaging tools in affected children, with the aim of reducing invasiveness, radiation burden and costs without losing efficacy. This approach leads to different results. In UCA, no consensus for a diagnostic algorithm was up to now reached, whilst, about febrile UTIs, guidelines were published in 2007 by the UK’s National Institute for Clinical Excellence (NICE) and by the European Society of Paediatric Radiology (ESPR), in 2011 by the American Academy of Paediatrics (AAP), and in 2012 by the Italian Society of Paediatric Nephrology (SINP). Nevertheless, new data continuously arise and the scientific debate always revives. Every imaging tool now available has its own strengths and weaknesses, and so all published guidelines. All this body of knowledge must be critically analysed for obtaining a complete, up-to-date and flexible overview about these “always hot” topics.

Zusammenfassung

Kongenitale Anomalien und fieberhafte Infektionen der Niere und ableitenden Harnwege gehören zu den häufigsten Erkrankungen im Kindesalter. Die Radionuklid-Bildgebung ist seit den frühen 80iger Jahren bis heute ein Eckpfeiler der Diagnostik dieser Erkrankungen. In den letzten 2 Jahrzehnten gab es tiefgreifende Diskussionen über den optimalen Einsatz und den Wert dieser Methoden insbesondere im Hinblick auf eine Verringerung der Invasivität, der Strahlenexposition und der Kosten ohne dabei die Effizienz zu gefährden. Dieser Prozess hat für die Diagnostik der Harntraktanomalien bis heute zu keinem Konsens geführt. Dagegen wurden für die nuklearmedizinische Diagnostik der fieberhaften Infekte der Niere und Harnwege neue Leitlinien 2007 durch das Nationale Institut für Klinische Exzellenz (NICE) in Großbritannien und durch die Europäische Gesellschaft für Pä­diatrische Radiologie (ESPR), sowie 2011 durch die Amerikanische Akademie für Pädiatrie (AAP) und 2012 durch die Italienische Gesellschaft für Pädiatrische Nephrologie (SINP) veröffentlicht. Die kontinuierlich aktualisierte Datenlage führt jedoch auch in diesem Gebiet zu einem ständigen Wiederaufleben der wissenschaftlichen Debatten. Jedes derzeit verfügbare bildgebende Verfahren hat – wie auch jede publizierte Leitlinie – ihre eigenen Stärken und Schwächen. Dieses Wissen muss kritisch analysiert werden, um einen komplexen, zeitgemäßen und flexiblen Überblick auf diesem vieldiskutierten Gebiet zu erhalten.

• References

• 1 American Academy of Pediatrics . Steering Committee on Quality Improvement, Subcommittee on Urinary Tract Infection: Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics 2011; 128: 595-610
  CrossrefPubMedGoogle Scholar
• 2 Ammenti A, Cataldi L, Chimenz R et al. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Italian Society of Pediatric Nephrology. Acta Paediatr 2012; 101: 451-457
  CrossrefPubMedGoogle Scholar
• 3 Arant Jr BS. Vesicoureteric reflux and renal injury. Am J Kidney Dis 1991; 17: 491-511
  CrossrefPubMedGoogle Scholar
• 4 Brandström P, Nevéus T, Sixt R et al. The Swedish reflux trial in children: IV. Renal damage. J Urol 2010; 184: 292-297
  CrossrefPubMedGoogle Scholar
• 5 Brandström P, Sillén U, Jodal U et al. The Swedish reflux trial: review of a randomized, controlled trial in children with dilating vesicoureteral reflux. J Pediatr Urol 2011; 7: 594-600
  CrossrefPubMedGoogle Scholar
• 6 Coulthard MG. Is reflux nephropathy preventable and will the NICE childhood UTI guidelines help?. Arch Dis Child 2008; 93: 196-199
  CrossrefPubMedGoogle Scholar
• 7 Coulthard MG, Verber I, Jani JC et al. Can prompt treatment of childhood UTI prevent scarring?. Pediatr Nephrol 2009; 24: 2059-2063
  CrossrefPubMedGoogle Scholar
• 8 De Palma D, Manzoni GA. The detection of vesicoureteral reflux in the nonfunctioning lower half of an ‘occult’ duplex kidney by Tc-99m MAG3 indirect radionuclide cystography. Clin Nucl Med 2000; 25: 628-629
  CrossrefPubMedGoogle Scholar
• 9 De Sadeleer C, De Boe V, Keuppens F et al. How good is technetium-99m mercaptoacetyltriglycine indirect cystography?. Eur J Nucl Med 1994; 21: 223-227
  CrossrefPubMedGoogle Scholar
• 10 Durand E, Blaufox MD, Britton KE et al. International Scientific Committee of Radionuclides in Nephrourology (ISCORN) consensus on renal transit time measurements. Semin Nucl Med 2008; 38: 82-102
  CrossrefPubMedGoogle Scholar
• 11 Duong HP, Piepsz A, Collier F et al. Predicting the Clinical Outcome of Antenatally Detected Unilateral Pelviureteric Junction Stenosis. Urol 2013; 82: 691-696
  CrossrefPubMedGoogle Scholar
• 12 Eskild-Jensen A, Gordon I, Piepsz A et al. Interpretation of the renogram: problems and pitfalls in hydronephrosis in children. BJU Int 2004; 94: 887-892
  CrossrefPubMedGoogle Scholar
• 13 Farhat W, Traubici J, Sherman C et al. Reliability of contrast enhanced sonography with harmonic imaging for detecting early renal scarring in experimental pyelonephritis in a porcine model: preliminary results. J Urol 2002; 168: 1114-1117
  CrossrefPubMedGoogle Scholar
• 14 Fettich J, Colarinha P, Fischer S et al. Guidelines for direct radionuclide cystography in children. Eur J Nucl Med Mol Imaging 2003; 30: B39-B44
  CrossrefPubMedGoogle Scholar
• 15 Furth C, Genseke P, Amthauer H et al. Evaluation of functional MR-urography in complex obstructive uropathy of infants: comparison to the conventional diagnostic algorithm – a pilot study. Klin Padiatr 2012; 224: 296-302
  Article in Thieme ConnectPubMedGoogle Scholar
• 16 Garin EH, Olavarria F, Garcia Nieto V et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 2006; 117: 626-632
  CrossrefPubMedGoogle Scholar
• 17 Garin EH, Olavarria F, Araya C et al. Diagnostic significance of clinical and laboratory findings to localize site of UTI. Ped Nephrol 2007; 22: 1002-1006
  CrossrefPubMedGoogle Scholar
• 18 Gordon I, Piepsz A, Sixt R. Auspices of Paediatric Committee of European Association of Nuclear Medicine. Guidelines for standard and diuretic renogram in children. Eur J Nucl Med Mol Imaging 2011; 38: 1175-1188
  CrossrefPubMedGoogle Scholar
• 19 Hadjidekov G, Hadjidekova S, Tonchev Z et al. Assessing renal function in children with hydronephrosis – additional feature of MR urography. Radiol Oncol 2011; 45: 248-258
  PubMedGoogle Scholar
• 20 Hansson S, Dhamey M, Sigström O et al. Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J Urol 2004; 172: 1071-1074
  CrossrefPubMedGoogle Scholar
• 21 Hashim H, Woodhouse CRJ. Ureteropelvic Junction Obstruction. Eur Urology Suppl 2012; 11: 25-32
  PubMedGoogle Scholar
• 22 Herz D, Merguerian P, McQuiston L et al. 5-years prospective results of DMSA imaging in children with febrile urinary tract infections: proof that the top-down approach works. J Urol 2010; 184: 1703-1709
  CrossrefPubMedGoogle Scholar
• 23 Hewitt IK, Montini G. Pediatric febrile urinary tract infections: the current state of play. Ital J Pediatr 2011; 37: 57 DOI: 10.1186/1824-7288-37-57.
  CrossrefPubMedGoogle Scholar
• 24 Hoberman A, Charron M, Hickey RW et al. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003; 348: 195-202
  CrossrefPubMedGoogle Scholar
• 25 Hohenfellner K, Seemayer S, Stolz G et al. Pre- and postpartum ultrasound examinations for diagnosis of urogenital abnormalities. Klin Padiatr 2000; 212: 320-325
  Article in Thieme ConnectPubMedGoogle Scholar
• 26 Ismaili K, Piepsz A. The antenatally detected pelvi-ureteric junction stenosis: advances in renography and strategy of management. Pediatr Radiol 2013; 43: 428-435
  CrossrefPubMedGoogle Scholar
• 27 Keren R, Chan E. Short versus standard duration antibiotic treatment for UTIs: a comparison of two meta-analyses. Arch Dis Child 2003; 88: 89-91
  CrossrefPubMedGoogle Scholar
• 28 Khrichenko D, Darge K. Functional analysis in MR urography – made simple. Pediatr Radiol 2010; 40: 182-199
  CrossrefPubMedGoogle Scholar
• 29 La Scola C, De Mutiis C, Hewitt IK et al. Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics 2013; 131: 665-671
  CrossrefPubMedGoogle Scholar
• 30 Majd M, Nussbaum Blask AR, Markle BM et al. Acute pyelonephritis: comparison of diagnosis with 99mTc DMSA SPECT, spiral CT, MR imaging and power doppler US in an experimental pig model. Radiology 2001; 218: 101-108
  CrossrefPubMedGoogle Scholar
• 31 Marra G, Oppezzo C, Ardissino G et al. Severe vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the ItalKid Project. J Pediatr 2004; 144: 677-681
  CrossrefPubMedGoogle Scholar
• 32 Nguyen HT, Herndon CDA, Cooper C et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediat Urol 2010; 6: 212-231
  PubMedGoogle Scholar
• 33 Onen A, Jayanthi VR, Koff SA. Long-term follow-up of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively. J Urol 2002; 168: 1118-1120
  CrossrefPubMedGoogle Scholar
• 34 Ording Müller LS. Imaging in urinary tract infection: top-down or down-up?. Pediatr Radiol 2011; 41 (Suppl. 01) S96-S98
  CrossrefPubMedGoogle Scholar
• 35 Payabvash S, Kajbafzadeh AM, Saeedi P et al. Application of magnetic resonance urography in diagnosis of congenital urogenital anomalies in children. Pediatr Surg Int 2008; 24: 979-986
  CrossrefPubMedGoogle Scholar
• 36 Piepsz A. Antenatal Detection of Pelviureteric Junction Stenosis: Main Controversies. Semin Nucl Med 2011; 41: 11-19
  CrossrefPubMedGoogle Scholar
• 37 Piepsz A, Colarinha P, Gordon I et al. Paediatric Committee of the European Association of Nuclear Medicine. Guidelines for glomerular filtration rate determination in children. Eur J Nucl Med 2001; 28: BP31-BP36
  PubMedGoogle Scholar
• 38 Piepsz A, Colarinha P, Gordon I et al. Guidelines for 99mTc-DMSA scintigraphy in children. Eur J Nucl Med 2001; 28: BP37-BP41
  PubMedGoogle Scholar
• 39 Piepsz A, Gordon I, Brock J et al. Round table on the management of renal pelvic dilatation in children. J Pediatric Urol 2009; 5: 437-444
  PubMedGoogle Scholar
• 40 Preda I, Jodal U, Sixt R et al. Imaging strategy for infants with urinary tract infection: a new algorhythm. J Urol 2011; 185: 1046-1052
  CrossrefPubMedGoogle Scholar
• 41 Riccabona M, Avni FE, Blickman JG et al. Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 2008; 38: 138-145
  CrossrefPubMedGoogle Scholar
• 42 Riccabona M, Avni FE, Blickman JG et al. Imaging recommendations in paediatric uroradiology. Minutes of the ESPR uroradiology task force session on childhood obstructive uropathy, high-grade fetal hydronephrosis, childhood haematuria, and urolithiasis in childhood. Pediatr Radiol 2009; 39: 891-898
  CrossrefPubMedGoogle Scholar
• 43 Riccabona M, Lobo ML, Papadopoulou F et al. ESPR uroradiology task force and ESUR paediatric working group: imaging recommendations in paediatric uroradiology, part IV: Minutes of the ESPR uroradiology task force mini-symposium on imaging in childhood renal hypertension and imaging of renal trauma in children. Pediatr Radiol 2011; 41: 939-944
  CrossrefPubMedGoogle Scholar
• 44 Ring E, Petritsch P, Riccabona M et al. Prenatal diagnosis of primary megaureter. Klin Padiatr 1992; 204: 382-385
  Article in Thieme ConnectPubMedGoogle Scholar
• 45 Schindele D, Furth C, Liehr UB et al. Magnetic resonance urography in pediatric urology. Urologe A 2012; 51: 1708-1713
  CrossrefPubMedGoogle Scholar
• 46 Shaikh N, Ewing AL, Bhatnagar S et al. Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review. Pediatrics 2010; 126: 1084-1091
  CrossrefPubMedGoogle Scholar
• 47 Sillén U, Brandström P, Jodal U et al. The Swedish reflux trial in children: v. Bladder dysfunction. J Urol 2010; 184: 298-304
  CrossrefPubMedGoogle Scholar
• 48 Sinha MD, Gibson P, Kane T et al. Accuracy of ultrasonic detection of renal scarring in different centres using DMSA as the gold standard. Nephrol Dial Transplant 2007; 22: 2213-2216
  CrossrefPubMedGoogle Scholar
• 49 Sinha A, Bagga A, Krishna A et al. Revised guidelines on management of antenatal hydronephrosis. Indian Pediatr 2013; 50: 215-231
  CrossrefPubMedGoogle Scholar
• 50 Smith EA. Pyelonephritis, renal scarring and reflux nephropathy: a pediatric urologist’s perspective. Pediatr Radiol 2008; 38 (suppl.1) s76-s82
  PubMedGoogle Scholar
• 51 Timberlake MD, Herndon CDA. Mild to moderate postnatal hydronephrosis-grading systems and management. Nat Rev Urol www.nature.com/nrurol/ Published online 20 August 2013 DOI: 10.1038/nrurol.2013.172.
  PubMedGoogle Scholar
• 52 Tullus K, Jadresic L, Lakhanpaul M et al. on behalf of urinary tract infection in children guideline development group . A new imaging strategy for children following UTI: results of an evidence based approach to guideline development carried out for the National Institute for Health and Clinical Excellence (NICE) UK. Pediatr Nephrol 2008; 23: 1596
  PubMedGoogle Scholar
• 53 Unver T, Alpay H, Biyikli NK et al. Comparison of direct radionuclide cystography and voiding cystourethrography in detecting vesicoureteral reflux. Pediatr Int 2006; 48: 287-291
  CrossrefPubMedGoogle Scholar
• 54 Yamaçake KGR, Nguyen HT. Current management of antenatal hydronephrosis. Pediatr Nephrol 2013; 28: 237-243
  CrossrefPubMedGoogle Scholar
• 55 Yoo JM, Han CH, Lee SL et al. Diagnosing of acute pyelonephritis with CT, Tc-DMSA SPECT, and Doppler ultrasound: A comparative study. Korean J Urol 2010; 51: 260-265
  CrossrefPubMedGoogle Scholar