Percutaneous direct radionuclide cystography in children: description of technique and early experience.
OBJECTIVE
To describe a new test for vesicoureteric reflux in children and assess patient preference compared to indirect radionuclide cystography.


METHODS
One hundred and three toilet-trained children aged between 2.1 and 15.6 years underwent percutaneous injection of 10-20 MBq of 99m-technetium-labelled mercapto-acetyl-triglycine (MAG3) into the full bladder after the application of anaesthetic cream. Gamma camera images of the bladder and renal areas were recorded during a 5-min resting period and during micturition.


RESULTS
All procedures were successful, 97 with a single stab. Fifty-four of the 66 children who expressed a preference preferred percutaneous suprapubic injection to intravenous injection. Images were easy to interpret and there were no indeterminate results. Of 200 renal units, 33 refluxed during the resting phase and 31 during micturition. In 24 renal units, reflux was only demonstrated during the resting phase. Reflux was significantly associated with abnormalities on dimercaptosuccinic acid (DMSA) scans ( P<0.001).


CONCLUSIONS
The new technique of direct percutaneous radionuclide cystography is described. It was well tolerated by patients. It detects reflux during the resting phase that would be missed on the indirect study and avoids doubt as to whether activity in the renal areas is due to reflux or excretion. Free pertechnetate could be used and would be much cheaper.
Wilkinson
A Graham
AG
Department of Radiology, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK.
D000283:Administration, Intravesical; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011877:Radionuclide Imaging; D017263:Technetium Tc 99m Mertiatide; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014546:Urinary Catheterization; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
D017263:Technetium Tc 99m Mertiatide