[Value and indication for isotope reflux cystography in children]

Area of Science:

• Pediatric Nephrology
• Nuclear Medicine
• Diagnostic Imaging

Background:

• Recurrent urinary infections in children often indicate underlying vesicoureteral reflux (VUR).
• Traditional X-ray reflux-cystography, while effective, involves significant radiation exposure.
• Minimizing radiation exposure in pediatric diagnostics is a critical clinical concern.

Purpose of the Study:

• To evaluate the efficacy of 99mTc labelled millimicrospheres radionuclide reflux-cystography for diagnosing VUR in children.
• To compare the radiation dose of this novel method with conventional X-ray reflux-cystography.
• To establish the role of radionuclide reflux-cystography in the diagnostic workup and follow-up of pediatric VUR.

Main Methods:

• Sixty-five children with recurrent urinary infections underwent radionuclide reflux-cystography using 99mTc labelled millimicrospheres.
• The diagnostic accuracy of the radionuclide method was assessed.
• Patient radiation exposure was quantified and compared to X-ray reflux-cystography.

Main Results:

• Radionuclide reflux-cystography provided clinically sufficient diagnosis of VUR in pediatric patients.
• Radiation exposure was 50-200 times lower compared to X-ray reflux-cystography.
• The severity or stage of VUR could not be determined by the radionuclide method alone.

Conclusions:

• 99mTc labelled millimicrospheres radionuclide reflux-cystography is recommended as a primary investigation and for follow-up of pediatric VUR due to its safety profile.
• X-ray reflux-cystography remains essential for precise grading of VUR when reflux is detected by the radionuclide method.
• This combined approach optimizes diagnosis while minimizing radiation burden in children.