Renal Radionuclide Imaging, an Evergreen Forty Years Old

Abstract

Urinary tract congenital abnormalities (UCA) and febrile infections (UTI) are, respectively, 2 of the commonest congenital and acquired health problems in childhood. In both, radionuclide imaging still represent a cornerstone of diagnostic imaging, although the involved techniques are more or less the same from the early ’80 s. During the last 2 decades, published papers focused on a deep revision about the optimal use and usefulness of such imaging tools in affected children, with the aim of reducing invasiveness, radiation burden and costs without losing efficacy. This approach leads to different results. In UCA, no consensus for a diagnostic algorithm was up to now reached, whilst, about febrile UTIs, guidelines were published in 2007 by the UK’s National Institute for Clinical Excellence (NICE) and by the European Society of Paediatric Radiology (ESPR), in 2011 by the American Academy of Paediatrics (AAP), and in 2012 by the Italian Society of Paediatric Nephrology (SINP). Nevertheless, new data continuously arise and the scientific debate always revives. Every imaging tool now available has its own strengths and weaknesses, and so all published guidelines. All this body of knowledge must be critically analysed for obtaining a complete, up-to-date and flexible overview about these “always hot” topics.

Zusammenfassung

Kongenitale Anomalien und fieberhafte Infektionen der Niere und ableitenden Harnwege gehören zu den häufigsten Erkrankungen im Kindesalter. Die Radionuklid-Bildgebung ist seit den frühen 80iger Jahren bis heute ein Eckpfeiler der Diagnostik dieser Erkrankungen. In den letzten 2 Jahrzehnten gab es tiefgreifende Diskussionen über den optimalen Einsatz und den Wert dieser Methoden insbesondere im Hinblick auf eine Verringerung der Invasivität, der Strahlenexposition und der Kosten ohne dabei die Effizienz zu gefährden. Dieser Prozess hat für die Diagnostik der Harntraktanomalien bis heute zu keinem Konsens geführt. Dagegen wurden für die nuklearmedizinische Diagnostik der fieberhaften Infekte der Niere und Harnwege neue Leitlinien 2007 durch das Nationale Institut für Klinische Exzellenz (NICE) in Großbritannien und durch die Europäische Gesellschaft für Pä­diatrische Radiologie (ESPR), sowie 2011 durch die Amerikanische Akademie für Pädiatrie (AAP) und 2012 durch die Italienische Gesellschaft für Pädiatrische Nephrologie (SINP) veröffentlicht. Die kontinuierlich aktualisierte Datenlage führt jedoch auch in diesem Gebiet zu einem ständigen Wiederaufleben der wissenschaftlichen Debatten. Jedes derzeit verfügbare bildgebende Verfahren hat – wie auch jede publizierte Leitlinie – ihre eigenen Stärken und Schwächen. Dieses Wissen muss kritisch analysiert werden, um einen komplexen, zeitgemäßen und flexiblen Überblick auf diesem vieldiskutierten Gebiet zu erhalten.

Key words

congenital uropathies - urinary tract infection - vesicoureteral reflux - dynamic renal scintigraphy - static renal scintigraphy - cystography

Schlüsselwörter

kongenitale Uropathie - Harntraktinfektion - vesikoureteraler Reflux - dynamische Nierenszintigrafie - statische Nierenszintigrafie - Zystografie

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