Harisankar Chidambaram Natrajan Balasubramanian, Mittal Bhagwant Rai, Bhattacharya Anish, Sunil Hejjaji Venkataramarao, Singh Baljinder, Rao Katragadda Lakshmi Narasimha
Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Hell J Nucl Med. 2009 Sep-Dec;12(3):260-5.
Urological problems are the leading associated anomalies in patients with anorectal malformation (ARM). In this study, we evaluated the role of scintigraphy in managing patients with high ARM. The records of infants with urologic anomalies on abdominal ultrasound and referred for scintigraphic evaluation were retrospectively analyzed. Diuretic renography in these patients was performed using (99m)Tc-diethyl triamine penta-acetic acid ((99m)Tc-DTPA) or (99m)Tc-ethylene cysteine ((99m)Tc-EC) while cortical scintigraphy was performed with (99m)Tc-dimercaptosuccinate (DMSA). Whenever available, EC was preferred in children of age less than 1 year. Forty patients (38 males, 2 females) were analyzed. The mean age of the population was 25 months (range 15 days-21 years). Eighteen of the forty patients were less than 3 months of age. Twenty seven of the patients were less than one year of age. The most common renal anomaly was unilaterally non-visualized kidney affecting 15 out of the 40 patients. The visualised kidney was abnormal in 8/15 patients. Hydronephrotic changes were noticed in 12 of 40 patients of whom 2 had pelvi ureteric junction obstruction that was confirmed and treated surgically. Horse shoe kidney was present in 1 patient while 2 had an ectopic kidney. Scarring/ pyelonephritic changes were found in 7/40 patients. Five patients had already progressed to chronic renal failure at the time of scintigraphy. Only 8 patients of the 40 had bilaterally normal kidneys. In conclusion, this study suggests that urologic abnormalities often found in infants with high ARM may remain clinically silent and eventually lead to chronic renal failure. Proper evaluation by diuretic renography and cortical scintigraphy can lead to early identification of potentially treatable conditions hence reducing the likelihood of developing severe renal damage.
泌尿系统问题是肛门直肠畸形（ARM）患者中最主要的相关异常情况。在本研究中，我们评估了闪烁扫描术在处理高位ARM患者中的作用。对腹部超声检查发现有泌尿系统异常并接受闪烁扫描评估的婴儿记录进行了回顾性分析。这些患者使用（99m）锝 - 二乙三胺五乙酸（（99m）Tc - DTPA）或（99m）锝 - 乙烯半胱氨酸（（99m）Tc - EC）进行利尿肾图检查，而使用（99m）锝 - 二巯基丁二酸（DMSA）进行皮质闪烁扫描。只要条件允许，1岁以下儿童优先使用EC。分析了40例患者（38例男性，2例女性）。总体平均年龄为25个月（范围15天至21岁）。40例患者中有18例年龄小于3个月。27例患者年龄小于1岁。最常见的肾脏异常是单侧肾不显影，40例患者中有15例受影响。15例中8例显影的肾脏异常。40例患者中有12例发现肾盂积水改变，其中2例经证实有肾盂输尿管连接部梗阻并接受了手术治疗。1例患者有马蹄肾，2例有异位肾。40例患者中有7例发现瘢痕形成/肾盂肾炎改变。闪烁扫描时5例患者已进展为慢性肾衰竭。40例患者中只有8例双侧肾脏正常。总之，本研究表明，高位ARM婴儿中经常发现的泌尿系统异常在临床上可能无症状，最终导致慢性肾衰竭。通过利尿肾图和皮质闪烁扫描进行适当评估可早期识别潜在可治疗的情况，从而降低发生严重肾损害的可能性。
