F+0 Renography in Neonates and Infants Younger Than 6 Months: An Accurate Method to Diagnose Severe Obstructive Uropathy

Journal of Nuclear Medicine

Angelika Bischof Delaloye¹  Cristian Antonescu¹  John Prior¹  Blaise Meyrat¹  Peter Frey¹  Ariane Boubaker¹ 

[1] Departments of Nuclear Medicine and Paediatric Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland Departments of Nuclear Medicine and Paediatric Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland Departments of Nuclear Medicine and Paediatric Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

关键词: diuretic renography;    hydronephrosis;    neonate;    function recovery;   

DOI  :  

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

We studied the response to F+0 renography and the relative and absolute individual kidney function in neonates and <6-mo-old infants before and after surgery for unilateral ureteropelvic junction obstruction (UJO). Methods: The results obtained at diagnosis and after pyeloplasty for 9 children (8 boys, 1 girl; age range, 0.8–5.9 mo; mean age ± SD, 2.4 ± 1.5 mo) with proven unilateral UJO (i.e., affected kidney [AK]) and an unremarkable contralateral kidney (i.e., normal kidney [NK]) were evaluated and compared with a control group of 10 children (6 boys, 4 girls; age range, 0.8–2.8 mo; mean age, 1.5 ± 0.7 mo) selected because of symmetric renal function, absence of vesicoureteral reflux or infection, and an initially dilated but not obstructed renal pelvis as proven by follow-up. Renography was performed for 20 min after injection of 123I-hippuran (OIH) (0.5–1.0 MBq/kg) immediately followed by furosemide (1 mg/kg). The relative and absolute renal functions and the response to furosemide were measured on background-subtracted and depth-corrected renograms. The response to furosemide was quantified by an elimination index (EI), defined as the ratio of the 3- to 20-min activities: An EI ≥ 3 was considered definitively normal and an EI ≤ 1 definitively abnormal. If EI was equivocal (1 < EI < 3), the response to gravity-assisted drainage was used to differentiate AKs from NKs. Absolute separate renal function was measured by an accumulation index (AI), defined as the percentage of 123I-OIH (%ID) extracted by the kidney 30–90 s after maximal cardiac activity. Results: All AKs had definitively abnormal EIs at diagnosis (mean, 0.56 ± 0.12) and were significantly lower than the EIs of the NKs (mean, 3.24 ± 1.88) and of the 20 control kidneys (mean, 3.81 ± 1.97; P < 0.001). The EIs of the AKs significantly improved (mean, 2.81 ± 0.64; P < 0.05) after pyeloplasty. At diagnosis, the AIs of the AKs were significantly lower (mean, 6.31 ± 2.33 %ID) than the AIs of the NKs (mean, 9.43 ± 1.12 %ID) and of the control kidneys (mean, 9.05 ± 1.17 %ID; P < 0.05). The AIs of the AKs increased at follow-up (mean, 7.81 ± 2.23 %ID) but remained lower than those of the NKs (mean, 10.75 ± 1.35 %ID; P < 0.05). Conclusion: In neonates and infants younger than 6 mo, 123I-OIH renography with early furosemide injection (F+0) allowed us to reliably diagnose AKs and to determine if parenchymal function was normal or impaired and if it improved after surgery.

【 授权许可】

Unknown