Pitfalls of Radionuclide Renal Imaging in Pediatrics.

Renal radionuclide imaging has been a mainstay in the pediatric nuclear medicine field for many years. A better understanding of the pathophysiological basis of renal obstruction has led to a shift in the approach to image interpretation of diuresis renography. The clinical background, images, curves and drainage parameters are interpreted as a whole. To correctly interpret the scan the reporting physician should be aware of possible technical pitfalls and all the pitfalls of image interpretation, differential renal function measurements and drainage parameters. Recent changes in the clinical approach to the imaging investigations of urinary tract infections have shifted the focus of these investigations in order to identify children at higher risk of complications. Therefore the number of [99mTc]Tc-DMSA scans performed are decreasing on the one hand while the probability of having an abnormal scan is increasing on the other. The decrease in number of scans may lead to a loss of reporting proficiency. The most frequently pitfall is the incorrect interpretation of normal variants. The use of [99mTc]Tc-DMSA SPECT is technically challenging and usually the child needs to be heavily sedated. The advantage of using [99mTc]Tc-DMSA SPECT is still not clear. The interpretation of [99mTc]Tc-DMSA SPECT images may be difficult due to the underlying heterogenous distribution of tracer in the normal renal cortex. A systematic approach to identifying potential pitfalls and reporting studies is essential to avoid errors. Presenting and discussing complex cases as part of the multidisciplinary team is the final step to help minimize pitfalls in the communication and interpretation of results.