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A prospective randomized trial comparing 2 diuresis renography techniques for evaluation of suspected upper urinary
M M Foda1, C T Gatfield, M Matzinger
1Department of Radiology, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
The timing of furosemide injection in diuresis renography significantly impacts diagnosing upper urinary tract obstruction in children. The F-15 scan detected more obstruction than the F+20 scan, aiding accurate diagnosis.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Upper urinary tract obstruction (UUTO) is a common concern in pediatric patients.
- Diuresis renography is a key imaging modality for evaluating suspected UUTO.
- Standardizing protocols is crucial for accurate interpretation.
Purpose of the Study:
- To compare the diagnostic impact of two diuresis renography techniques in children with suspected UUTO.
- To evaluate the effect of furosemide timing on renography outcomes.
Main Methods:
- A randomized study of 72 children with suspected UUTO.
- Two diuresis renography protocols were compared: furosemide (F) injected 20 minutes after radiotracer (F+20) versus 15 minutes before (F-15).
- Outcomes (obstructed, nonobstructed, equivocal) were analyzed, with the contralateral side serving as a control for unilateral cases.
Main Results:
- 88 scans were analyzed (44 F+20, 44 F-15).
- The F-15 scan identified significantly more cases of obstruction (7 times more) on the investigated side compared to the F+20 scan.
- No obstruction was detected on the contralateral side with either method.
Conclusions:
- Furosemide timing in diuresis renography critically influences the detection of upper urinary tract obstruction in children.
- The F-15 protocol demonstrates a higher sensitivity for detecting obstruction compared to the F+20 protocol.
Purpose:
We compare the diagnostic impact of 2 diuresis renography techniques for evaluation of suspected upper urinary tract obstruction in children.
Materials And Methods:
A total of 72 children were randomly assigned to 1 of 2 standardized diuresis renography protocols. The protocols were identical, except for the time of furosemide (F) injection. In the F+20 scans furosemide was given 20 minutes after the 99mtechnetium pentetic acid radiopharmaceutical. With the modified F-15 scans furosemide was injected 15 minutes before renography. Hydration, bladder catheterization, urine output determination, radiopharmaceutical injection and scan acquisition were identical. Renography outcomes (obstructed, nonobstructed or equivocal) were analyzed for the investigated side(s) and for the contralateral side, which was used as a control in children with suspected unilateral obstruction. Chi-square test was used to compare the percentage of obstructed and nonobstructed scans of both protocols. Fisher's exact test was used to compare the nonobstructed scans and equivocal results of both protocols.
Results:
Of the 96 scans performed 8 were excluded because of technical problems. The remaining scans included 44 F+20 and 44 F-15. Of the 88 scans 10 were used to evaluate possible bilateral obstruction. A total of 48 boys and 24 girls were evaluated. Because 2 children had a solitary kidney each, the total number of renal units studied for outcome was 174. The F-15 scan showed 7 times more obstruction than the F+20 scan on the investigated side, and this difference was statistically significant. No obstruction was diagnosed on the contralateral side with either technique when used to investigate cases of suspected unilateral obstruction.
Conclusions:
The timing of the furosemide injection (F-15 scan versus F+20) has a significant impact on the obstructive versus nonobstructive renography results when evaluating children with suspected upper urinary tract obstruction.