Radionuclide imaging for vesico-renal reflux using intravenous 99mTc-D.T.P.A.

Abstract

This study shows that Radionuclide imaging provides a simple method for detecting vesico-renal reflux in children, when an intravenous dose of 99mTc-D. T. P. A. is used as radioactive tracer. Forty-eight patients have been studied, of these twenty-eight also had intravenous pyelography with post-micturition films, micturating cystography, and cystoscopy. In this group of 28 patients the radionuclide imaging technique detected 25 refluxing ureters and 9 cases of bilateral vesico-renal reflux. Micturating cystography detected 12 refluxing ureters and only 3 cases were bilateral. Cystoscopy revealed 20 abnormal ureteric orifices and 6 patients had bilaterally abnormal orifices. Radionuclide imaging agreed with both the micturating cystograms and cystoscopic findings that reflux was occuring in 6 ureters. Radionuclide imaging agreed with the impression at cystoscopy that reflux was present in 18 ureters. Only 6 of the ureters diagnosed by micturating cystography as having reflux had abnormal ureteric openings at cystoscopy. The intravenous radionuclide imaging technique avoids the unpleasantness of catheterisation and its attendant risk of introducing infection. A lower dose of radiation is received than during radiological techniques. A renogram is obtained as part of the test. We believe this intravenous radionuclide imaging technique is a more “physiologically correct” test for vesico-renal reflux than any of the methods using catheterisation. Its limitations are that it is not so easy to use in hyperactive toddlers, nor does it give the anatomical definition that radiological techniques provide although improvements are expected with the latest gamma cameras and their associated equipment.