Guidelines for direct radionuclide cystography in children

  • Jure Fettich
  • Paula Colarinha
  • Sibylle Fischer
  • Jörgen Frökier
  • Isky Gordon
  • Klaus Hahn
  • Levent Kabasakal
  • Mike Mann
  • Mercedes Mitjavila
  • Pierre Olivier
  • Amy Piepsz
  • Ute Porn
  • Isabel Roca
  • Rune Sixt
  • Jeannette van Velzen
Blue Pages


These guidelines, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They contain information on the indications, acquisition, processing and interpretation of direct radioisotope cystography in children. The guidelines should be taken in the context of "good practice" and any local/national rules which apply to nuclear medicine examinations.


Direct radioisotope cystography Indications Acquisition Processing Interpretation 


  1. 1.
    Mandell GA, Eggli DF, Gilday DL, Heyman S, Leonard JC, Miller JH, Nadel HR, Treves ST. Procedure guideline for radionuclide cystography in children. Society of Nuclear Medicine. J Nucl Med 1997; 38:1650–1654.Google Scholar
  2. 2.
    International Reflux Study Committee. Medical versus surgical treatment of primary vesicoureteral reflux. J Urol 1981; 125:277–283.Google Scholar
  3. 3.
    Savage DCL, Wilson MI, McHardy M. Covert bacteriuria in childhood: a clinical and epidemiological study. Arch Dis Child 1973; 48:8–20.Google Scholar
  4. 4.
    Edwards B, White RHR, Maxted H. Screening methods for covert bacteriuria in schoolgirls. Br Med J 1975; 2:463–467.Google Scholar
  5. 5.
    Bisset GS III, Strife JL, Dunbar JS. Urography and voiding cystoureterography. Finding in girls with urinary tract infection. AJR 1987; 148:479–482.Google Scholar
  6. 6.
    Eggli DF, Tulchinsky M. Scintigraphic evaluation of pediatric urinary tract infection. Semin Nucl Med 1993; 23:199–218.Google Scholar
  7. 7.
    Edwards D, Normand ICS, Prescod N. Disappearance of vesicoureteral reflux during long term prophylaxis of urinary tract infection in children. Br Med J 1977; 2:285–288.Google Scholar
  8. 8.
    Kenda RB, Zupancic Z, Fettich J, Meglic A. A follow-up study of vesicoureteral reflux and renal scars in asymptomatic siblings of children with reflux. Nucl Med Commun 1997; 18:27–31.Google Scholar
  9. 9.
    Noe HN. The long term results of prospective sibling reflux screening. J Urol 1992; 148:1739–1742.Google Scholar
  10. 10.
    Noe HN, Wyatt RJ, Peeden JN, Rivas ML. The transmission of vesicoureteral reflux from parent to child. J Urol 1992; 148:1869–1871.Google Scholar
  11. 11.
    Canivet E, Wampach H, Brandt B, Toupance O, Lavaud S, Lardennois B, Liehn JC, Chanard J. Assessment of radioisotopic micturating cystography for the diagnosis of vesicoureteric reflux in renal transplant recipients with acute pyelonephritis. Nephrol Dial Transplant 1997; 12:67–70.Google Scholar
  12. 12.
    Rothwell DL, Constable AR, Albrecht M. Radionuclide cystography in the investigation of vesico-ureteric reflux in children. Lancet 1977; 1:1072–1075.Google Scholar
  13. 13.
    Maizels M, Weiss S, Conway JJ, Firlit CF. The cystometric nuclear cystogram. J Urol 1979; 121:203–205.Google Scholar
  14. 14.
    Nasrallah PF, Conway JJ, King LR, Belman AB, Weiss S. The quantitative nuclear cystogram: an aid in determining the spontaneous resolution of vesicoureteral reflux. Trans Am Assoc Genitourin Surg 1978; 70:52–55.Google Scholar
  15. 15.
    Saraga M, Stanicic A, Markovic V. The role of direct radionuclide cystography in evaluation of vesicoureteral reflux. Scand J Urol Nephrol 1996; 30:367–371.Google Scholar
  16. 16.
    Nasrallah PF, Sreeramulu N, Crawford J. Clinical applications of nuclear cystography. J Urol 1982; 128:550–553.Google Scholar
  17. 17.
    Kogan SJ, Siger L, Levitt SB. Elusive vesicoureteral reflux in children with normal contrast cystograms. J Urol 1986; 136:325–328.Google Scholar
  18. 18.
    Conway JJ, King LR, Belman AB. Detection of vesicoureteral reflux with radionuclide cystography. Am J Roengenol Radium Ther Nucl Med 1972; 115:720–727.Google Scholar
  19. 19.
    Willi U, Treves S. Radionuclide voiding cystography. Urol Radiol 1983; 5:161–173.Google Scholar
  20. 20.
    Kenda RB, Novljan G, Kenig A, Hojker S, Fettich JJ. Echo enhanced ultrasound voiding cystography in children: a novel approach. Pediatr Nephrol 2000; 14:39–41.Google Scholar
  21. 21.
    Bosio M. Cystosonography with echocontrast: a new imaging modality to detect vesicoureteric reflux in children. Pediatr Radiol 1998; 28:250–255.Google Scholar
  22. 22.
    Treves ST, Zurakowski D, Bauer SB, Mitchell KD, Nichols DP. Functional bladder capacity measured during radionuclide cystography in children. Radiology 1996; 198:269–272.Google Scholar
  23. 23.
    Godley ML, Ransley PG, Parkhouse HF, Gordon I, Evans K, Peters AM. Quantitation of vesico-ureteral reflux by radionuclide cystography and urodynamics. Pediatr Nephrol 1990; 4:485–490.Google Scholar
  24. 24.
    van der Vis Melsen MJE, Baert RJM, Rajnherc JR. Scintigraphic assessment of lower urinary tract function in children with and without outflow obstruction. Br J Urol 1989; 64:263–269.Google Scholar
  25. 25.
    Dugal B, Nerdrum HJ. Vesicoureteric reflux at the end of renography. Clin Nucl Med 1991; 16:364.Google Scholar
  26. 26.
    Gordon I, Peters AM, Morony S. Indirect radionuclide cystography: a sensitive technique for the detection of vesico-ureteral reflux. Pediatr Nephrol 1990; 4:604–606.Google Scholar
  27. 27.
    Peters AM, Morony S, Gordon I. Indirect radionuclide cystography demonstrates reflux under physiological conditions. Clin Radiol 1990; 41:44–47.Google Scholar
  28. 28.
    Gordon I. Indirect radionuclide cystography-the coming of age. Nucl Med Commun 1989; 10:457–458.Google Scholar
  29. 29.
    De Sadeleer C, De Boe V, Keuppens F, Desprechins B, Verboven M, Piepsz A. How good is technetium-99m mercaptoacetyltriglycine indirect cystography? Eur J Nucl Med 1994; 21:223–227.Google Scholar
  30. 30.
    Majd M, Kass EJ, Belman AB. Radionuclide cystography in children: comparison of direct (retrograde) and indirect (intravenous) techniques. Ann Radiol (Paris) 1985; 28:322–328.Google Scholar
  31. 31.
    Fettich JJ, Kenda RB. Cyclic direct radionuclide voiding cystography: increasing reliability in detecting vesicoureteral reflux in children. Pediatr Radiol 1992; 22:337–338.Google Scholar
  32. 32.
    Tromholt N, Hesse B, Munck S, Veje B. Fallacy in direct cystourethrography. Clin Nucl Med 1991; 16:741–742.Google Scholar
  33. 33.
    Cremin BJ. Observations on vesico-ureteric reflux and intrarenal reflux. A review and survey of material. Clin Radiol 1979; 30:607–621.Google Scholar
  34. 34.
    Conway JJ. Radionuclide cystography. In: Tauxe WN, Dubovsky EV, eds. Nuclear medicine in clinical urology. East Norwalk: Appleton, Century and Crofts; 1985:305–320.Google Scholar
  35. 35.
    Lowe B, Barnes WF, Leonard JC. Absorbtion of 99m-Tc pertechnetate from augmented bladder during direct nuclear cystography. Clin Nucl Med 1989; 14:347–349.Google Scholar
  36. 36.
    Padhy AK, Gopinath PG, Mitra DK, Bhatnagar V. Direct radionuclide cystogram (DRCG) and urine flowmetry (UFMT) in the evaluation of patients with vesicoureteral reflux (VUR) and/or associated obstructive or neurogenic pathology of the lower urinary tract. Indian J Pediatr 1989; 56:483–492.Google Scholar
  37. 37.
    Stabin MG, Gelfand MJ. Dosimetry of pediatric nuclear medicine procedures. Q J Nucl Med 1998; 42:93–112.Google Scholar
  38. 38.
    Smith T, Gordon I. An update of radiopharmaceutical schedules in children. Nucl Med Commun 1998; 19:1023–1036.Google Scholar
  39. 39.
    Dimitriou P, Fretzayas A, Nicolaidou P. Estimates of dose to the bladder during direct radionuclide cystography. Concise communication. J Nucl Med 1984; 25:792–795.Google Scholar
  40. 40.
    Zhang G, Day DL, Loken M. Grading of reflux by radionuclide cystography. Clin Nucl Med 1987; 12:106–109.Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Jure Fettich
    • 1
  • Paula Colarinha
    • 2
  • Sibylle Fischer
    • 3
  • Jörgen Frökier
    • 4
  • Isky Gordon
    • 5
  • Klaus Hahn
  • Levent Kabasakal
    • 6
  • Mike Mann
    • 7
  • Mercedes Mitjavila
    • 8
  • Pierre Olivier
    • 9
  • Amy Piepsz
    • 10
  • Ute Porn
    • 3
  • Isabel Roca
    • 11
  • Rune Sixt
    • 12
  • Jeannette van Velzen
    • 13
  1. 1.Department for Nuclear MedicineUniversity Medical Centre LjubljanaLjubljanaSlovenia
  2. 2.Instituto Português de OncologiaLisboaPortugal
  3. 3.Department for Nuclear MedicineUniversity of MunichGermany
  4. 4.Aarhus University Hospital–SkejbyDenmark
  5. 5.Great Ormond Street Hospital for ChildrenLondonUK
  6. 6.Cerraphasa Tip FakultesiNukleer Tip Ana Bilim DaliAksarayTurkey
  7. 7.Institute of Child Health, RondeboshRed Cross HospitalCapetownSouth Africa
  8. 8.Hospital Universitário de GetafeMadridSpain
  9. 9.CHU NancyFrance
  10. 10.CHU St PierreBrusselsBelgium
  11. 11.Hospital Vall d'HebronBarcelonaSpain
  12. 12.The Queen Silvia Children's HospitalGöteborgSweden
  13. 13.Liaison personARPES

Personalised recommendations