HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wong, D. C. Articles by Farnsworth, R. H. Search for Related Content PubMed PubMed Citation Articles by Wong, D. C. Articles by Farnsworth, R. H.

Diuretic Renography with the Addition of Quantitative Gravity-Assisted Drainage in Infants and Children

Department of Nuclear Medicine, The Prince of Wales and Sydney Children's Hospitals, Sydney, Australia

Correspondence: For correspondence or reprints contact: Monica A. Rossleigh, MD, Department of Nuclear Medicine, The Prince of Wales Hospital, High St., Randwick, New South Wales 2031, Australia.

ABSTRACT

The aim of this study was to evaluate the use of quantitative gravity-assisted drainage (GAD) using >50% residual activity as an indicator to confirm obstruction in diuretic renography in the investigation of hydronephrosis and hydroureteronephrosis in infants and children. This was evaluated in 2 groups: furosemide clearance half-time (t_1/2) > 20 min (obstructed range) and t_1/2 = 10–20 min (indeterminate range). Methods: Two hundred children (155 boys, 45 girts; age range, 2 d to 16 y; median age, 26 wk) were studied over a 2-y period. One hundred thirty-five F+20 (diuretic given 20 min after radiopharmaceutical) and 65 F+0 (simultaneous administration of diuretic and radiopharmaceutical) studies were performed with intravenous administration of ^99mTc-mercaptoacetyltriglycine (MAG3) and furosemide. At the end of the 20-min diuretic phase, a 5-min post-GAD image was obtained, and the percentage of residual activity was calculated by comparison with the last 5 min of the diuretic phase. All patients were monitored for 6–12 mo, and the final diagnoses were based on either surgical findings or conservative management with follow-up sonography or ^99mTc-MAG3 studies. Results of the diuretic renography using quantitative GAD were then compared with the final diagnoses. Results: A renal unit was defined as a kidney and its ureter. In the 200 patients studied, 256 hydronephrotic renal units were analyzed: 10 units showed no function, 1 unit showed poor function, 131 units had t_1/2 < 10 min, 62 units had t_1/2 > 20 min, and 52 units had t_1/2 = 10-20 min. Of the 131 renal units with t_1/2 < 10 min, there was only 1 case of obstruction. Using GAD > 50% residual activity for the diagnosis of obstruction in 62 renal units with t_1/2 > 20 min, the sensitivity was 88.4%, the specificity was 73.7%, and the accuracy was 83.9%. Similarly, using GAD > 50% residual activity for the diagnosis of obstruction in 52 units with t_1/2 = 10–20 min, the sensitivity was 100%, the specificity was 79.5%, and the accuracy was 82.7%. Conclusion: The quantitation of GAD > 50% residual activity in diuretic renography can help to differentiate between obstruction and nonobstruction in renal units with t_1/2 > 20 min and t_1/2 = 10–20 min. The quantitation of GAD when t_1/2 < 10 min is not useful because obstruction has already been excluded.

Key Words: diuretic renography • pediatrics • hydronephrosis

This article has been cited by other articles:

				M. L. Lessne, N. P. Shah, J. F. Stinchon, M. E. Cross, and M. E. Oates Optimal Scintigraphic Evaluation of a Hydronephrotic Horseshoe Kidney J. Nucl. Med. Technol., December 1, 2007; 35(4): 255 - 258. [Abstract] [Full Text] [PDF]

				R. D. Folks, E. V. Garcia, and A. T. Taylor Development and Prospective Evaluation of an Automated Software System for Quality Control of Quantitative 99mTc-MAG3 Renal Studies J. Nucl. Med. Technol., March 1, 2007; 35(1): 27 - 33. [Abstract] [Full Text] [PDF]

				E. V. Garcia, A. Taylor, D. Manatunga, and R. Folks A Software Engine to Justify the Conclusions of an Expert System for Detecting Renal Obstruction on 99mTc-MAG3 Scans J. Nucl. Med., March 1, 2007; 48(3): 463 - 470. [Abstract] [Full Text] [PDF]

				F. P. Esteves, A. Taylor, A. Manatunga, R. D. Folks, M. Krishnan, and E. V. Garcia 99mTc-MAG3 Renography: Normal Values for MAG3 Clearance and Curve Parameters, Excretory Parameters, and Residual Urine Volume. Am. J. Roentgenol., December 1, 2006; 187(6): W610 - W617. [Abstract] [Full Text] [PDF]

				M. A. Rossleigh Renal Cortical Scintigraphy and Diuresis Renography in Infants and Children J. Nucl. Med., January 1, 2001; 42(1): 91 - 95. [Abstract] [Full Text] [PDF]