Mendichovszky Iosif, Solar Bernardita Troncoso, Smeulders Naima, Easty Marina, Biassoni Lorenzo
Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK.
Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Semin Nucl Med. 2017 May;47(3):204-228. doi: 10.1053/j.semnuclmed.2016.12.002. Epub 2017 Mar 6.
In the context of ante-natally diagnosed hydronephrosis, the vast majority of children with a dilated renal pelvis do not need any surgical treatment, as the dilatation resolves spontaneously with time. Slow drainage demonstrated at Tc-99m-mercaptoacetyltriglycine (MAG3) renography does not necessarily mean obstruction. Obstruction is defined as resistance to urinary outflow with urinary stasis at the level of the pelvic-ureteric junction (PUJ) which, if left untreated, will damage the kidney. Unfortunately this definition is retrospective and not clinically helpful. Therefore, the identification of the kidney at risk of losing function in an asymptomatic patient is a major research goal. In the context of renovascular hypertension a DMSA scan can be useful before and after revascularisation procedures (angioplasty or surgery) to assess for gain in kidney function. Renal calculi are increasingly frequent in children. Whilst the vast majority of patients with renal stones do not need functional imaging, DMSA scans with SPECT and a low dose limited CT can be very helpful in the case of complex renal calculi. Congenital renal anomalies such as duplex kidneys, horseshoe kidneys, crossed-fused kidneys and multi-cystic dysplastic kidneys greatly benefit from functional imaging to identify regional parenchymal function, thus directing further management. Positron emission tomography (PET) is being actively tested in genito-urinary malignancies. Encouraging initial reports suggest that F-18-fluorodeoxyglucose (FDG) PET is more sensitive than CT in the assessment of lymph nodal metastases in patients with genito-urinary sarcomas; an increased sensitivity in comparison to isotope bone scans for skeletal metastatic disease has also been reported. Further evaluation is necessary, especially with the promising advent of PET/MRI scanners. Nuclear Medicine in paediatric nephro-urology has stood the test of time and is opening up to new exciting developments.
在产前诊断为肾积水的情况下，绝大多数肾盂扩张的儿童不需要任何手术治疗，因为肾盂扩张会随着时间自发消退。锝-99m-巯基乙酰三甘氨酸（MAG3）肾动态显像显示的引流缓慢不一定意味着梗阻。梗阻的定义是肾盂输尿管交界处（PUJ）存在对尿流的阻力且有尿液潴留，如果不治疗，将会损害肾脏。不幸的是，这个定义是回顾性的，对临床帮助不大。因此，识别无症状患者中存在肾功能丧失风险的肾脏是一个主要的研究目标。在肾血管性高血压的情况下，在血管重建手术（血管成形术或手术）前后进行二巯基丁二酸（DMSA）扫描有助于评估肾功能的改善情况。儿童肾结石越来越常见。虽然绝大多数肾结石患者不需要功能成像，但对于复杂肾结石病例，SPECT的DMSA扫描和低剂量受限CT可能非常有帮助。先天性肾异常，如重复肾、马蹄肾、交叉融合肾和多囊性发育不良肾，通过功能成像来识别局部实质功能，从而指导进一步治疗，会大有裨益。正电子发射断层扫描（PET）正在积极用于泌尿生殖系统恶性肿瘤的检测。初步的令人鼓舞的报告表明，F-18-氟脱氧葡萄糖（FDG）PET在评估泌尿生殖系统肉瘤患者的淋巴结转移方面比CT更敏感；与同位素骨扫描相比，在检测骨骼转移疾病方面的敏感性也有所提高。还需要进一步评估，尤其是随着PET/MRI扫描仪的出现前景广阔。儿科肾泌尿学中的核医学已经经受住了时间的考验，并且正在迎来令人兴奋的新发展。
