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Comparison of two different periods of renal cortical activity ratios in the evaluation of ureteropelvic junction obstruction by dynamic renal scintigraphy

Year 2014, Volume: 36 Issue: 1, 34 - 41, 28.03.2014

Zekiye Hasbek Semra Özdemir Bülent Turgut Taner Erselcan Levent Cankorkmaz Demet Alaygut

https://doi.org/10.7197/cmj.v36i1.1008002535

Abstract

Abstract

Aim. The aim of this retrospective study is to investigate whether the renal cortical activity at 1st and 20th minutes in renal scintigraphy can be used as a following parameter to determine the presence of obstruction in pediatric patients group with ureteropelvic junction obstruction. Method. The consecutive 322 kidney renograms were included in the study. Standardized diuretic renograms were visually classified into three groups as non-obstructive, obstructive and indetermined according to their responses to the diuretic. In addition, the cortical regions of interest (ROI) were drawn manually at 1st and 20th min for each kidney and the cortical counts were obtained. Apart from this, kidneys were divided into three major sub-groups based on clearance half-time (T1/2); T1/2<10 min was defined as non-obstruction, T1/2>20 min as obstruction and T1/2 with a value between 10 and 20 minutes as an indeterminate result. Afterwards visual obstruction patterns and 1st/20th min. cortical activity ratios were compared. Results. When the cortical activity ratios are compared to visual obstructive pattern(non-obstructive, obstructive and indeterminate); on the Tc-99 mDTPA renograms the cortical activity ratios which were greater than 82.8% were obstructive, ranging from 59.3% to 82.8% were found indeterminate. On the Tc-99 mMAG-3 renograms the cortical activity ratios which were greater than 74.2% were obstructive, ranging from 44.6% to74.2% were found indeterminate. As a result of the comparison of T1/2 parameter with the obstruction patterns of the kidneys, T1/2 was in indeterminate group in 124 (41.5%) out of 299 kidneys visually evaluated as non-obstructive while in 7 (2.3%) kidneys T1/2 was in obstructive group. In 4 (23.5%) out of 17 kidneys which were visually evaluated as indeterminate, T1/2 was in normal group, in 5 (29.4%) of them T1/2 was in indeterminate group and in 8 (47.15) of the 17 kidneys T1/2 was in obstructive group. Conclusion. We think that the use of 1st/20th min. cortical activity ratios on the diuretic renogram are helpful in establishing a diagnosis of obstruction in pediatric patient group.

Keywords: Pelviureteric junction obstruction, children, Tc 99m-DTPA, Tc 99m-MAG3

 

Özet

Amaç. Retrospektif olan bu çalışmada amacımız, üreteropelvik bileşkede darlığı olan çocuk hasta grubunda, renal sintigrafilerde, 1’inci ve 20’nci dakikalardan elde edilen kortikal aktivite oranının, obstrüksiyonun varlığının belirlenmesinde takip parametresi olarak kullanılabilirliğini araştırmaktır. Yöntem. Çalışmaya toplam 322 renogram dahil edildi. Standart renogram eğrileri diüretiğe verdiği cevaba göre vizüel olarak nonobstrüktif, obstrüktif ve şüpheli olarak sınıflandırıldı. Ayrıca her bir böbrek için 1’inci ve 20’nci dakikalarda kortikal ROI’ler çizildi ve kortikal sayımlar elde edildi. Bunun dışında renogram ile hesaplanan T1/2 10 dakikanın altında olan böbrekler normal, 10-20 dakika indetermine, >20 dakika kötü drenaj olarak kabul edildi. Obstrüksiyon paternleri ile 1’inci ve 20’nci dakikalardaki kortikal aktivite oranları karşılaştırıldı. Bulgular. Kortikal aktivite sayımlarının oranları ile vizüel olarak belirlenen obstrüktif patern (nonobstrüktif, obstrüktif ve şüpheli) karşılaştırıldığında, Tc-99m DTPA renogramında, 1’inci/20’nci dak. kortikal aktivite oranı %82,8’in üzerinde olan hastalar obstrüktif, %59,3 ile %82.8 olan hastalar obstrüksiyon açısından şüpheli olarak bulundu. Tc-99 m MAG-3 ile yapılan sintigrafilerde ise, 1’inci/20’nci dak. kortikal aktivite oranı %74,2’nin üzerinde olan hastalar obstrüktif, 44,6% ile 74,2 olan hastalar obstrüksiyon açısından şüpheli olarak bulundu. T½ parametresinin böbreklerin obstrüksiyon paterni ile karşılaştırılması sonucunda; vizüel değerlendirmeye göre non-obstrüktif olan 299 böbreğin 124’ünde (41,5%) T½ indetermine grupta, 7’sinde (2,3%) ise T½ obstrüktif gruptaydı. Vizüel değerlendirmede şüpheli grupta yer alan 17 böbreğin 4’ünde (23,5%) T½ normal grupta, 5’inde (29,4%) T½ indetermine grupta ve 8’inde (47,1%) T½ obstrüktif grupta yer almaktaydı. Sonuç. Biz çocuk hasta grubunda 1’inci/20’nci dakika kortikal aktivite oranlarının kullanılmasının da obstrüksiyon tanısının konulmasında yardımcı olduğunu düşünmekteyiz.

Anahtar sözcükler: Üreteopelvik bileşke darliği, çocuklar, Tc 99m-DTPA, Tc 99m-MAG3

Keywords

Pelviureteric junction obstruction children Tc99m-DTPA Tc99m-MAG3

References

  • Koff SA. Requirements for accurately diagnosing chronic partial upper urinary tract obstruction in children with hydronephrosis. Pediatr Radiol 2008; 38: S41-8. Onen A, Jayanthi VR, Koff SA. Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively. J Urol 2002; 168: 1118-20.
  • Treves ST, Harmon WE, Packard AB, Kuruc A. Kidneys in: Treves ST, eds. Pediatric Nuclear Medicine/PET. USA: Springer Science+Business Media 2007: 239-8
  • Schlotmann A, Clorius JH, Clorius SN. Diuretic renography in hydronephrosis: renal tissue tracer transit predicts functional course and thereby need for surgery. Eur J Nucl Med Mol Imaging 2009; 36: 1665-73.
  • Kıratlı PO, Orhan D, Gedik GK, Tekgül S. Relation between radionuclide imaging and pathologic findings of ureteropelvic junction obstruction in neonatal hydronephrosis. Scand J Urol Nephrol 2008; 42: 249-56.
  • Aktaş GE, İnanır S. Relative renal function with MAG-3 and DMSA in children with unilateral hydronephrosis. Ann Nucl Med 2010; 24: 691-95.
  • Piepsz A, Nogarède C, Tondeur M. Is normalized residual activity a good marker of renal output efficiency? Nucl Med Commun 2011; 32: 824-8.
  • Durand E, Blaufox MD, Britton KE, Carlsen O, Cosgriff P, Fine E, Fleming J, Nimmon C, Piepsz A, Prigent A, Samal M; International Scientific Committee of Radionuclides in Nephrourology (ISCORN). International Scientific Committee of Radionuclides in Nephrourology (ISCORN) consensus on renal transit time measurements.Semin Nucl Med 2008; 38: 82-102.
  • Piepsz A, Ham HR. Pediatric applications of renal nuclear medicine. Semin Nucl Med 2006; 36: 16-35.
  • Taylor AT, Blaufox MD, De Palma D, Dubovsky EV, Erbaş B, Eskild-Jensen A, Frİkiær J, Issa MM, Piepsz A, Prigent A. Guidance document for structured reporting of diuresis renography. Semin Nucl Med 2012; 42: 41-8.
  • Gordon I. Diuretic renography in infants with prenatal unilateral hydronephrosis: An explanation for the controversy about poor drainage. BJU Int 2001; 87: 551-5. Taylor A.T. Kidney. Chapter 7. In: Biersack HJ, Freeman LM, Zuckier LS, Grünwald F (eds). Clinical Nuclear Medicine. Springer; Germany 2007; 172-95. Saha GP. Diagnostic uses of radiopharmaceuticals in Nuclear Medicine. Chapter In: Saha GP (eds). Fundamentals of Nuclear Pharmacy. 5th ed. Springer; USA 2003; 247-327.
  • Alberti C. Congenital ureteropelvic junction obstruction: physiopathology, decoupling of tout court pelvic dilatation-obstruction semantic connection, biomarkers to predict renal damage evolution. Eur Rev Med Pharmacol Sci 2012; 16: 213-9.
  • Piepsz A, Gordon I, Brock J 3rd, Koff S. Round table on the management of renal pelvic dilatation in children. J Pediatr Urol 2009; 5: 437-44.
  • Koff SA. The beneficial and protective effects of hydronephrosisAPMIS Suppl 2003; 109: 7-12.
  • İşlek A, Güven AG, Koyun M, Akman S, Alimoğlu E. Probability of urinary tract infection in infants with ureteropelvic junction obstruction: Is antibacterial prophylaxis really needed? Pediatr Nephrol 2011; 26: 1837-41.
  • Baek M, Park K, Choi H. Long-term outcomes of dismembered pyeloplasty for midline-crossing giant hydronephrosis caused by ureteropelvic junction obstruction in children. Urology 2010; 76: 1463-7.
  • Dissing TH, Eskild-Jensen A, Mikkelsen MM, Pedersen M, Frİkiaer J, Djurhuus JC, Gordon I. Normal differential renal function does not indicate a normal kidney after partial ureteropelvic obstruction and subsequent relief in 2-week-old piglets. Eur J Nucl Med Mol Imaging 2008; 35: 1673-80.
  • Wang TM, Chang PL, Kao PF, Hsieh ML, Huang ST, Tsui KH. The role of diuretic renography in the evaluation of obstructed hydronephrosis after pediatric pyeloplasty. Chang Gung Med J 2004; 27: 344-50.
  • Rossleigh MA. Renal cortical scintigraphy and diuresis renography in infants and children. J Nucl Med 2001; 42: 91-5.
  • Barron BJ, Kim EE, Lamki LM. Renal Nuclear Medicine. Chapter 42. In: Sandler MP, Coleman RE, Patton JA, Wackers FJTH, Gottschalk A (eds). Diagnostic Nuclear Medicine. 5th ed. Philadelphia: Lippincott Williams & Wilkins 2003; 865-90
  • Kaselas C, Papouis G, Grigoriadis G, Klokkaris A, Kaselas V.Pattern of renal function deterioration as a predictive factor of unilateral ureteropelvic junction obstruction treatment. Eur Urol 2007; 51: 551-5.
  • Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I, Farkas A. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: Lessons learned after 16 years of follow-up. Eur Urol 2006; 49: 734-8.
  • Piepsz A. The predictive value of the renogram. Eur J Nucl Med Mol Imaging 2009; 36: 1661-4.
  • Whitaker RH. Methods of assessing obstruction in dilated ureters. Br J Urol 1973; 45: 15-22.
  • Ueno S, Suzuki Y, Murakami T, Yokoyama S, Hirakawa H, Tajima T, Makuuchi H. Quantitative analysis of infantile ureteropelvic junction obstruction by diuretic renography. Ann Nucl Med 2001; 15: 131-6.
  • Ross SS, Kardos S, Krill A, Bourland J, Sprague B, Majd M, Pohl HG, Gibbons MD, Belman AB, Rushton HG. Observation of infants with SFU Grades 3-4 hydronephrosis: Worsening drainage with serial diuresis renography indicates surgical intervention and helps prevent loss of renal function. J Pediatr Urol 2011; 7: 266-71.
  • Piepsz A, Tondeur M, Nogarède C, Collier F, Ismaili K, Hall M, Dobbeleir A, Ham H. Can severely impaired cortical transit predict which children with pelviureteric junction stenosis detected antenatally might benefit from pyeloplasty? Nucl Med Commun 2011; 32: 199-205.
  • Gordon I, Piepsz A, Sixt R; Auspices of Paediatric Committee of European Association of Nuclear Medicine. Guidelines for standard and diuretic renogram in children. Eur J Nucl Med Mol Imaging 2011; 38: 1175-88.
  • Zaknun JJ, Rajabi H, Piepsz A, Roca I, Dondi M. The International Atomic Energy Agency software package for the analysis of scintigraphic renal dynamic studies: a tool for the clinician, teacher, and researcher. Semin Nucl Med 2011; 41: 73-80.

Original research-Orijinal araştırma

Year 2014, Volume: 36 Issue: 1, 34 - 41, 28.03.2014

Zekiye Hasbek Semra Özdemir Bülent Turgut Taner Erselcan Levent Cankorkmaz Demet Alaygut

https://doi.org/10.7197/cmj.v36i1.1008002535

Abstract

Amaç. Retrospektif olan bu çalışmada amacımız, üreteropelvik bileşkede darlığı olan çocuk hasta grubunda, renal sintigrafilerde, 1’inci ve 20’nci dakikalardan elde edilen kortikal aktivite oranının, obstrüksiyonun varlığının belirlenmesinde takip parametresi olarak kullanılabilirliğini araştırmaktır. Yöntem. Çalışmaya toplam 322 renogram dahil edildi. Standart renogram eğrileri diüretiğe verdiği cevaba göre vizüel olarak nonobstrüktif, obstrüktif ve şüpheli olarak sınıflandırıldı. Ayrıca her bir böbrek için 1’inci ve 20’nci dakikalarda kortikal ROI’ler çizildi ve kortikal sayımlar elde edildi. Bunun dışında renogram ile hesaplanan T1/2 10 dakikanın altında olan böbrekler normal, 10-20 dakika indetermine, >20 dakika kötü drenaj olarak kabul edildi. Obstrüksiyon paternleri ile 1’inci ve 20’nci dakikalardaki kortikal aktivite oranları karşılaştırıldı. Bulgular. Kortikal aktivite sayımlarının oranları ile vizüel olarak belirlenen obstrüktif patern (nonobstrüktif, obstrüktif ve şüpheli) karşılaştırıldığında, Tc-99m DTPA renogramında, 1’inci/20’nci dak. kortikal aktivite oranı %82,8’in üzerinde olan hastalar obstrüktif, %59,3 ile %82.8 olan hastalar obstrüksiyon açısından şüpheli olarak bulundu. Tc-99 m MAG-3 ile yapılan sintigrafilerde ise, 1’inci/20’nci dak. kortikal aktivite oranı %74,2’nin üzerinde olan hastalar obstrüktif, %44,6 ile %74,2 olan hastalar obstrüksiyon açısından şüpheli olarak bulundu. T½ parametresinin böbreklerin obstrüksiyon paterni ile karşılaştırılması sonucunda; vizüel değerlendirmeye göre non-obstrüktif olan 299 böbreğin 124’ünde (41,5%) T½ indetermine grupta, 7’sinde (2,3%) ise T½ obstrüktif gruptaydı. Vizüel değerlendirmede şüpheli grupta yer alan 17 böbreğin 4’ünde (23,5%) T½ normal grupta, 5’inde (29,4%) T½ indetermine grupta ve 8’inde (47,1%) T½ obstrüktif grupta yer almaktaydı. Sonuç. Biz çocuk hasta grubunda 1’inci/20’nci dakika kortikal aktivite oranlarının kullanılmasının da obstrüksiyon tanısının konulmasında yardımcı olduğunu düşünmekteyiz.

Keywords

Üreteopelvik bileşke darliği çocuklar Tc99m-DTPA Tc99m-MAG3

References

  • Koff SA. Requirements for accurately diagnosing chronic partial upper urinary tract obstruction in children with hydronephrosis. Pediatr Radiol 2008; 38: S41-8. Onen A, Jayanthi VR, Koff SA. Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively. J Urol 2002; 168: 1118-20.
  • Treves ST, Harmon WE, Packard AB, Kuruc A. Kidneys in: Treves ST, eds. Pediatric Nuclear Medicine/PET. USA: Springer Science+Business Media 2007: 239-8
  • Schlotmann A, Clorius JH, Clorius SN. Diuretic renography in hydronephrosis: renal tissue tracer transit predicts functional course and thereby need for surgery. Eur J Nucl Med Mol Imaging 2009; 36: 1665-73.
  • Kıratlı PO, Orhan D, Gedik GK, Tekgül S. Relation between radionuclide imaging and pathologic findings of ureteropelvic junction obstruction in neonatal hydronephrosis. Scand J Urol Nephrol 2008; 42: 249-56.
  • Aktaş GE, İnanır S. Relative renal function with MAG-3 and DMSA in children with unilateral hydronephrosis. Ann Nucl Med 2010; 24: 691-95.
  • Piepsz A, Nogarède C, Tondeur M. Is normalized residual activity a good marker of renal output efficiency? Nucl Med Commun 2011; 32: 824-8.
  • Durand E, Blaufox MD, Britton KE, Carlsen O, Cosgriff P, Fine E, Fleming J, Nimmon C, Piepsz A, Prigent A, Samal M; International Scientific Committee of Radionuclides in Nephrourology (ISCORN). International Scientific Committee of Radionuclides in Nephrourology (ISCORN) consensus on renal transit time measurements.Semin Nucl Med 2008; 38: 82-102.
  • Piepsz A, Ham HR. Pediatric applications of renal nuclear medicine. Semin Nucl Med 2006; 36: 16-35.
  • Taylor AT, Blaufox MD, De Palma D, Dubovsky EV, Erbaş B, Eskild-Jensen A, Frİkiær J, Issa MM, Piepsz A, Prigent A. Guidance document for structured reporting of diuresis renography. Semin Nucl Med 2012; 42: 41-8.
  • Gordon I. Diuretic renography in infants with prenatal unilateral hydronephrosis: An explanation for the controversy about poor drainage. BJU Int 2001; 87: 551-5. Taylor A.T. Kidney. Chapter 7. In: Biersack HJ, Freeman LM, Zuckier LS, Grünwald F (eds). Clinical Nuclear Medicine. Springer; Germany 2007; 172-95. Saha GP. Diagnostic uses of radiopharmaceuticals in Nuclear Medicine. Chapter In: Saha GP (eds). Fundamentals of Nuclear Pharmacy. 5th ed. Springer; USA 2003; 247-327.
  • Alberti C. Congenital ureteropelvic junction obstruction: physiopathology, decoupling of tout court pelvic dilatation-obstruction semantic connection, biomarkers to predict renal damage evolution. Eur Rev Med Pharmacol Sci 2012; 16: 213-9.
  • Piepsz A, Gordon I, Brock J 3rd, Koff S. Round table on the management of renal pelvic dilatation in children. J Pediatr Urol 2009; 5: 437-44.
  • Koff SA. The beneficial and protective effects of hydronephrosisAPMIS Suppl 2003; 109: 7-12.
  • İşlek A, Güven AG, Koyun M, Akman S, Alimoğlu E. Probability of urinary tract infection in infants with ureteropelvic junction obstruction: Is antibacterial prophylaxis really needed? Pediatr Nephrol 2011; 26: 1837-41.
  • Baek M, Park K, Choi H. Long-term outcomes of dismembered pyeloplasty for midline-crossing giant hydronephrosis caused by ureteropelvic junction obstruction in children. Urology 2010; 76: 1463-7.
  • Dissing TH, Eskild-Jensen A, Mikkelsen MM, Pedersen M, Frİkiaer J, Djurhuus JC, Gordon I. Normal differential renal function does not indicate a normal kidney after partial ureteropelvic obstruction and subsequent relief in 2-week-old piglets. Eur J Nucl Med Mol Imaging 2008; 35: 1673-80.
  • Wang TM, Chang PL, Kao PF, Hsieh ML, Huang ST, Tsui KH. The role of diuretic renography in the evaluation of obstructed hydronephrosis after pediatric pyeloplasty. Chang Gung Med J 2004; 27: 344-50.
  • Rossleigh MA. Renal cortical scintigraphy and diuresis renography in infants and children. J Nucl Med 2001; 42: 91-5.
  • Barron BJ, Kim EE, Lamki LM. Renal Nuclear Medicine. Chapter 42. In: Sandler MP, Coleman RE, Patton JA, Wackers FJTH, Gottschalk A (eds). Diagnostic Nuclear Medicine. 5th ed. Philadelphia: Lippincott Williams & Wilkins 2003; 865-90
  • Kaselas C, Papouis G, Grigoriadis G, Klokkaris A, Kaselas V.Pattern of renal function deterioration as a predictive factor of unilateral ureteropelvic junction obstruction treatment. Eur Urol 2007; 51: 551-5.
  • Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I, Farkas A. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: Lessons learned after 16 years of follow-up. Eur Urol 2006; 49: 734-8.
  • Piepsz A. The predictive value of the renogram. Eur J Nucl Med Mol Imaging 2009; 36: 1661-4.
  • Whitaker RH. Methods of assessing obstruction in dilated ureters. Br J Urol 1973; 45: 15-22.
  • Ueno S, Suzuki Y, Murakami T, Yokoyama S, Hirakawa H, Tajima T, Makuuchi H. Quantitative analysis of infantile ureteropelvic junction obstruction by diuretic renography. Ann Nucl Med 2001; 15: 131-6.
  • Ross SS, Kardos S, Krill A, Bourland J, Sprague B, Majd M, Pohl HG, Gibbons MD, Belman AB, Rushton HG. Observation of infants with SFU Grades 3-4 hydronephrosis: Worsening drainage with serial diuresis renography indicates surgical intervention and helps prevent loss of renal function. J Pediatr Urol 2011; 7: 266-71.
  • Piepsz A, Tondeur M, Nogarède C, Collier F, Ismaili K, Hall M, Dobbeleir A, Ham H. Can severely impaired cortical transit predict which children with pelviureteric junction stenosis detected antenatally might benefit from pyeloplasty? Nucl Med Commun 2011; 32: 199-205.
  • Gordon I, Piepsz A, Sixt R; Auspices of Paediatric Committee of European Association of Nuclear Medicine. Guidelines for standard and diuretic renogram in children. Eur J Nucl Med Mol Imaging 2011; 38: 1175-88.
  • Zaknun JJ, Rajabi H, Piepsz A, Roca I, Dondi M. The International Atomic Energy Agency software package for the analysis of scintigraphic renal dynamic studies: a tool for the clinician, teacher, and researcher. Semin Nucl Med 2011; 41: 73-80.
There are 28 citations in total.

Details

Primary Language English
Journal Section Medical Science Research Articles
Authors

Zekiye Hasbek

Semra Özdemir

Bülent Turgut

Taner Erselcan

Levent Cankorkmaz

Demet Alaygut

Publication Date March 28, 2014
Published in Issue Year 2014Volume: 36 Issue: 1

Cite

AMA Hasbek Z, Özdemir S, Turgut B, Erselcan T, Cankorkmaz L, Alaygut D. Comparison of two different periods of renal cortical activity ratios in the evaluation of ureteropelvic junction obstruction by dynamic renal scintigraphy. CMJ. March 2014;36(1):34-41. doi:10.7197/cmj.v36i1.1008002535