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Percutaneous direct radionuclide cystography in children: description of technique and early experience
1Department of Radiology, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK.
Insights
A new percutaneous radionuclide cystography test for pediatric vesicoureteric reflux is well-tolerated and preferred by children. This direct method detects resting phase reflux missed by indirect studies, improving diagnostic accuracy.
Area of Science:
- Pediatric Urology
- Nuclear Medicine Imaging
- Diagnostic Techniques
Background:
- Vesicoureteric reflux (VUR) is a common condition in children.
- Indirect radionuclide cystography is a standard diagnostic tool.
- Limitations exist in detecting VUR during the resting phase with indirect methods.
Purpose of the Study:
- To introduce and describe a novel direct percutaneous radionuclide cystography (PRC) technique.
- To evaluate patient preference for PRC compared to indirect methods.
- To assess the diagnostic performance of PRC in pediatric VUR detection.
Main Methods:
- 103 children underwent percutaneous injection of 99m-technetium-labelled MAG3 into the bladder.
- Gamma camera imaging was performed during resting and micturition phases.
- Patient preference was assessed between percutaneous suprapubic and intravenous injections.
Main Results:
- The PRC procedure was successful in 97% of cases with a single injection.
- 54 out of 66 children preferred the percutaneous suprapubic injection.
- PRC identified VUR during the resting phase in 24 renal units, which would be missed by indirect studies.
- Reflux findings were significantly associated with dimercaptosuccinic acid (DMSA) scan abnormalities (P<0.001).
Conclusions:
- Direct percutaneous radionuclide cystography is a well-tolerated and effective new technique for diagnosing VUR in children.
- PRC offers improved diagnostic yield by detecting resting phase reflux.
- The technique avoids ambiguity between reflux and excretion, with potential for cost reduction using free pertechnetate.
Aims:
To describe a new test for vesicoureteric reflux in children and assess patient preference compared to indirect radionuclide cystography.
Materials And Methods:
One hundred and three toilet-trained children aged between 2.1 and 15.6 years underwent percutaneous injection of 10-20 MBq of 99m-technetium-labelled mercapto-acetyl-triglycine (MAG3) into the full bladder after the application of anaesthetic cream. Gamma camera images of the bladder and renal areas were recorded during a 5-min resting period and during micturition.
Results:
All procedures were successful, 97 with a single stab. Fifty-four of the 66 children who expressed a preference preferred percutaneous suprapubic injection to intravenous injection. Images were easy to interpret and there were no indeterminate results. Of 200 renal units, 33 refluxed during the resting phase and 31 during micturition. In 24 renal units, reflux was only demonstrated during the resting phase. Reflux was significantly associated with abnormalities on dimercaptosuccinic acid (DMSA) scans ( P<0.001).
Conclusions:
The new technique of direct percutaneous radionuclide cystography is described. It was well tolerated by patients. It detects reflux during the resting phase that would be missed on the indirect study and avoids doubt as to whether activity in the renal areas is due to reflux or excretion. Free pertechnetate could be used and would be much cheaper.