Abstract
Nuclear medicine techniques are widely used in pediatric nephrology, particularly because they can evaluate separately the function of each kidney, which is an information not easily obtained by other diagnostic modalities. This information is obtained noninvasively, with a low radiation burden and usually with no need for sedation or anesthesia, whatever the age of the patient. Scintigraphic data are usually combined with morphologic imaging, particularly ultrasound, in order to obtain a full perspective of the anatomical and functional situation, allowing for a tailored diagnostic workup.
The combination of morphological and functional data finds typical application in the diagnosis and follow-up of pediatric hydronephrosis, where the decision to operate or not depends in many cases on scintigraphic assessment of differential renal function and echographic evaluation of pelvi-calyceal dilatation. Modern tubular tracers (99mTc-mercaptoacetyltriglycine, 123I-hippuran, 99mTc-etylen-cistein) make possible to study renal function even in small infants with immature renal function; therefore, scintigraphy can be used as early as required in all kinds of neonatal hydronephrosis.
Nuclear medicine techniques are very well suited also for the follow-up of upper urinary tract infections and vesicoureteral reflux, where the combination of DMSA scintigraphy and cystoscintigraphy can be used to confirm the diagnosis of acute pyelonephritis, to detect long-term sequelae (renal scarring), and to monitor the persistence of the associated vesicoureteral reflux, if present.
The safety, reproducibility, and diagnostic efficacy of nuclear medicine techniques support their use in every field of pediatric nephro-urology requiring a noninvasive assessment of the different functional compartments.
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Rambaldi, P.F., Zucchetta, P. (2016). Nuclear Medicine in Pediatric Nephro-urology. In: Mansi, L., Lopci, E., Cuccurullo, V., Chiti, A. (eds) Clinical Nuclear Medicine in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-319-21371-2_10
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DOI: https://doi.org/10.1007/978-3-319-21371-2_10
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