Ljiljana Jaukovic

Impact of micturating cystourethrography and DMSA renal scintigraphy on the investigation scheme in children with urinary tract infection

ObjectiveThe relationships among urinary tract infection (UTI), vesicoureteral reflux (VUR), and permanent renal damage in children are not fully understood. The aim of this study was to evaluate the incidence of renal scarring in children with a history of UTI and to determine the change in the probability of permanent renal damage owing to the presence of VUR documented on micturating cystourethrography (MCU).MethodsWe analyzed 201 children (400 renal units, two children with solitary kidney). Seventy-four boys and 127 girls (aged 7 months to 7 years, median 2.5 years) with culture verified UTI were referred for technetium-labeled dimercaptosuccinic (DMSA) renal scintigraphy 4-6 months after acute UTI. MCU was also performed mostly 1 month prior to DMSA. Statistical analysis was performed using χ2 test or Fisher’s exact test. Likelihood ratio (LR) positive and negative, diagnostic odds ratio (DOR), and post-test probability of (no) disease were calculated for VUR on MCU versus scarring on DMSA.ResultsVesicoureteral reflux was found in 158 (39.5%) kidneys, and evaluated as grades I, II, III, IV, and V in 3, 70, 43, 25, and 17 refluxing renal units (RRU), respectively. Permanent renal damage according to DMSA was seen in 15.2% (61/400) kidneys. Scarring was shown in 29.7% (47/158) of kidneys with VUR and in 5.8% (14/242) kidneys without VUR (P < 0.0001). LR positive was 2.353 (95% CI 1.889, 2.865), LR negative 0.341 (95% CI 0.209, 0.523), and DOR 6.895 (95% CI 3.533, 14.093). Rate of scarring significantly increased with VUR of grades III, IV, and V. There was no significant difference in the incidence of scarring in kidneys without VUR and RRU with low-grade (I and II) VUR (P = 0.306). The presence of VUR on MCU increased the chance of renal damage on DMSA by about 15%, whereas negative MCU increased the chance of no-renal involvement by 9%.ConclusionsMicturating cystourethrography should not be used as a first-line test to rule out the permanent renal damage owing to UTI. The priority of imaging strategy should be focused on early identification of renal lesions to prevent further deterioration.

90Y-Labeled Tin Fluoride Colloid as a Promising Therapeutic Agent: Preparation, Characterization, and Biological Study in Rats

In this study, tin fluoride colloid (SnF-c) was prepared, labeled with yttrium-90 ((90)Y), and characterized with respect to its physicochemical properties and biological behavior in an animal model. Particle size of SnF-c, at constant concentration of SnF(2), was dependent on pH, concentration of sodium fluoride (NaF), temperature, and time. The particle size of SnF-c decreased with an increase in NaF concentration and a decrease in reaction mixture pH. Radiolabeling yield of (90)Y-SnF-c at higher temperature increased and it was greater than 98% for the preparation at 95 °C. The (90)Y-SnF-c demonstrated high in vitro stability both in human serum and human synovial fluid at 37 °C up to 7 days. In vivo distribution studies in healthy male Wistar rats of (90)Y-SnF-c (particles <1 μm), following intravenous administration, revealed that the localization takes place preferably in the liver. The (90)Y-SnF-c (particles >1 μm) was well retained in the synovial space for 96 h after intra-articular injection, whereas leakage of (90)Y from the joint was 1.96% over this period. Because of high labeling yield and stability, (90)Y-SnF-c might be a promising agent for radiosynovectomy or therapy of liver malignancies.

Five benign myoskeletal diseases in paediatrics and the role of nuclear medicine. Do they differ from those in adults

In this paper we discuss trauma, osteomyelitis, fibrous dysplasia, Legg-Calvé-Perthes disease and osteopetrosis in children. Pathophysiology, incidence, clinical signs, diagnosis and specific trteatment of these diseases are described. We have focused on diagnostic imaging techniques which can be applied in children: X-rays, magnetic resonance imaging bone scintigraphy with technetium- 99m-methylene diphosphonate ((99m)Tc-MDP) and positron emission tomography (PET) with fluorine-18 fluorodesoxyglucose ((18)F-FDG) and fluorine-18 fluoro sodium fluoride ((18)F-NaF). In conclusion, bone scintigraphy with (99m)Tc-MDP and better with PET ((18)F-FDG and (18)F-NaF) can support diagnosis of most of these myoskeletal diseases in children. Radiology is usually applied for local lesions examinations. Magnetic resonance imaging can be used in specific cases in periosteal and bone marrow lesions and CT may be avoided due to its radiation burden, in children.

Renal Scintigraphy in Children with Vesicoureteral Reflux

ObjectiveTo determine the incidence and pattern of abnormal scintigraphy findings in children with UTI and VUR.MethodsData of 118 children who underwent micturating cystourethrography (MCU) and late Tc-99m dimercaptosuccinic acid (DMSA) scan were evaluated. Findings were categorized under the image appearance and relative kidney uptake (RKU) and related to the grade of VUR, sex and child’s age.ResultsMCU revealed VUR (78 unilateral and 40 bilateral) of grades I, II, III, IV and V in 2, 47, 35, 19 and 15 patients respectively. There were 52 children with normal and 66 with abnormal DMSA finding. Scarring rate was significantly associated with high grade VUR (p=0.0023) and male gender ( p=0.0412). Bilateral scarring was seen exclusively in children with bilateral VUR. No significant difference was found between renal scarring and child’s age in the same gender group. Poor kidney function was shown in 5 patients.ConclusionRenal scarring highly correlated with grade of VUR. A strategy to perform MCU only on patients with abnormal DMSA finding is proposed.

99mTc-MDP bone scintigraphy in the diagnosis of stress fracture of the metatarsal bones mimicking oligoarthritis.

BACKGROUND Stress fractures are the injuries of soft tissues and bones caused by intensive and repeated stress on a bone. Repeated submaximal stress disturbs the balance between the processes of bone production and resorption that results in fracture. CASE REPORT We presented a case of a patient with stress fracture of metatarsal bone. The patient was diagnosed and treated as having reactive oligoarthritis caused by Chlamydia trachomatis and administered antibiotics. Initial plain radiography was negative for bone fracture. Tc-99m bone scintigraphy suggested stress fracture of the second metatarsal. Plain radiography was became positive three weeks later, showing callus formation in the proximal part of the second metatarsal. CONCLUSION Bone scintigraphy is a diagnostic test of choice in early diagnosis of stress fracture, and it is important to apply it timely in order to include the entire therapy and prevent complications, as well as to let a patient return to previous daily activities.

Incidence and imaging characteristics of skeletal metastases detected by bone scintigraphy in lung cancer patients

BACKGROUND/AIM Detection of metastatic bone disease by skeletal scintigraphy is a classical application of nuclear medicine in cancer patients. Detection of bone metastases in patients with lung cancer is necessary for an appropriate treatment modality. The aim of this study was to report the frequency and imaging characteristics of bone metastases detected by bone scintigraphy (BS) using technetium-99m phosphonates in patients with lung cancer. METHODS We retrospectively analyzed a total of one hundred patients (78 males and 22 females), mean age of 63.3 years, with the diagnosis of lung cancer, who underwent BS during a three-year-period (2003-2005). Scintiscans were classified as positive, negative and suspicious with regard to the presence of bone metastases. RESULTS The incidence of positive, negative and suspicious findings were 57%. 32% and 11%, respectively. Out of 57 patients with bone metastases, 51 had multiple asymmetric foci of increased tracer activity localized in the ribs, spine, extremities, pelvis, sternum, scapula and skull in 72%, 54%, 49%, 37%, 12%, 9% and 5% of scans, respectively. BS revealed solitary metastases in 6 of the patients. The lesions were located in the lower limbs in three patients and in the upper limbs, pelvis and sternum in the remaining three patients. CONCLUSION Bone scintigraphy plays a significant role in staging and selecting of patients for curative lung surgery. Due to the fact that metastatic involvment of the extremities was frequently shown, our study suggests that systematic inclusion of the limbs in BS acquisition should be obligatory.

Renal scintigraphy in infants with antenatally diagnosed renal pelvis dilatation

BACKGROUND/AIM Ureteropelvic junction obstruction and vesicoureteral reflux are the most frequent entities identified on the basis of antenatal hydronephrosis. The aim of this study was to determine the incidence and pattern of abnormal renal scintigraphy findings in postnatal investigation of children with antenatal hydronephrosis. METHODS Twenty-four infants (19 boys and five girls) presented with antenatal hydronephrosis and mild to moderate hydronephrosis on ultrasound in newborn period were referred for renal scintigraphy. Ten patients with vesicoureteral reflux documented on micturating cystoureterography underwent 99mTc-DMSA renal scintigraphy and 14 patients were subjected to 99mTc-DTPA scintigraphy. RESULTS Anteroposterior pelvic diameter on ultrasound ranged from 11 to 24 mm. Renal DMSA scans identified congenital scars in two boys with bilateral reflux of grade V and unilateral reflux of grade III. Relative kidney uptake (RKU) less than 40% was found in three, and poor kidney function (RKU less than 10%) in two patients. Significant obstruction was shown on DTPA diuretic renal scintigraphy in 6/14 patients. Some slowing in dranaige (T1/2 greater than 10 minutes) with no reduction in differential renal function was identified in three patients. Differential renal function less than 10% was obtained in one case. CONCLUSION A high percent of abnormal renal scintigraphy findings was obtained. Renal scintigraphy was useful in determination of underlying cause of antenatally detected hydronephrosis.