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Grading of vesicoureteral reflux by radionuclide cystography
Insights
Radionuclide cystography (RNC) effectively detects and grades vesicoureteral reflux (VUR) in children with urinary tract infections. This isotope technique offers reduced radiation exposure compared to conventional voiding cystourethrography (VCU).
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteral reflux (VUR) is a significant risk factor for recurrent UTIs and renal scarring.
- Conventional voiding cystourethrography (VCU) is the standard diagnostic tool for VUR but involves radiation exposure.
Purpose of the Study:
- To compare the efficacy of radionuclide cystography (RNC) and VCU in detecting and grading VUR in children.
- To assess the radiation dose associated with RNC compared to VCU.
- To evaluate RNC's ability to measure residual urine volume.
Main Methods:
- Sequential study of 36 children (6 months to 14 years) with UTIs.
- Both direct radionuclide cystography (RNC) and conventional voiding cystourethrography (VCU) were performed.
- Detection and grading of VUR, and measurement of residual urine were assessed.
Main Results:
- Vesicoureteral reflux (VUR) was detected equally well by both RNC and VCU.
- RNC identified 27 refluxing ureters, VCU identified 23, and 22 were identified by both.
- Radiologic grade of reflux can be approximated with RNC, with significantly decreased radiation exposure.
- Higher residual urine volumes were measured in children with VUR using RNC.
Conclusions:
- RNC is a reliable and effective method for detecting and grading VUR in children.
- RNC offers a substantial reduction in radiation exposure compared to VCU.
- RNC should be considered the preferred follow-up examination for VUR in pediatric patients.
Abstract:
Thirty-six children with urinary tract infection aged 6 months to 14 years (mean age 4 1/2 years) were studied sequentially using direct radionuclide (RNC) and conventional voiding cystourethrography (VCU). Vesicoureteral reflux (VUR) was detected equally well by both methods. Twenty-seven refluxing ureters were found by RNC, 23 by VCU and 22 by both methods. Radiologic grade of reflux may be determined approximately with the isotope technique from the volume of regurgitating urine and duration of reflux, at a much decreased radiation exposure. Residual urine was also measured by RNC and found to be higher in children with VUR. RNC is a reliable method for detecting and grading VUR and should effectively replace VCU as the follow-up examination of choice.