Society of Nuclear Medicine Procedure Guideline for Radionuclide Cystography in Children

Urinary tract infection is a common problem in the pediatric population. The signs and symptoms are nonspecific, particularly in the younger child. The role of vesicoureteral reflux in the pathogenesis of pyelonephritis is incompletely understood. Approximately 40% of patients with upper urinary tract infection have vesicoureteral reflux. Urinary tract infection, unrecognized and inadequately treated, can lead to hypertension and chronic renal failure. A. RNC is a method to evaluate for vesicoureteral reflux, which results in significantly less gonadal radiation when compared with conventional radiographic technique (VCUG). In addition, RNC has a sensitivity for detection of vesicoureteral reflux equal to that of VCUG. RNC does not provide the same anatomic detail as VCUG. B. Direct radionuclide cystography (DRC) requires catheterization of the bladder and instillation of radionuclide and fluid for maximum distension of the bladder, allowing imaging during filling, voiding, and after voiding. C. Indirect radionuclide cystography (IRC) does not require bladder catheterization but does require the intravenous injection of the radiopharmaceutical for evaluation of renal function, urine drainage, and detection of vesicoureteral reflux. III. Common Indications