Department of Nuclear Medicine, Cristo Re Hospital, 25 Via delle, Calasanziane, 00167, Rome, Italy.
Department of Urology, A. Gemelli Hospital IRCCS-Catholic University of Sacred Heart, Rome, Italy.
Ann Nucl Med. 2021 Oct;35(10):1127-1135. doi: 10.1007/s12149-021-01648-x. Epub 2021 Jul 8.
Radical cystectomy with permanent urinary diversion is the gold standard treatment for invasive muscle bladder cancer. Hydronephrosis is common in these patients, but Ultrasound (US) or Computed Tomography Urography (CTU) scan are unable to discriminate obstructive from non-obstructive hydronephrosis. We used Diuresis Renography (DR) with F + 10 in seated position (sp) method in the identification of patients with a Uretero-ileal Anastomosis Stricture (UAS) who would benefit from surgical therapy.
We studied 39 asymptomatic patients, who underwent radical cystectomy and urinary diversion. Based on radiological findings (US, CTU) 44 kidneys were hydronephrotic. All patients underwent a Tc-MAG3 DR with F + 10(sp) method. We acquired a DR for 20 min with the patient in a seated position. Patient drank 400-500 mL of water at 5 min after tracer injection and received a 20 mg bolus of Furosemide at 10 min during dynamic acquisition. The indices Time to peak, diuretic half time, and 20 min/peak ratio have been evaluated. Retrograde pyelography confirmed UAS in all patients with DR obstructive findings. We repeated DR as follow-up in two subgroups of patients.
DR with F + 10(sp) method showed obstructive findings in 36 out of 44 hydronephrotic kidneys. 6 patients showed non-obstructive findings. 32 patients showed obstructive findings (20 out of 32 developed UAS within 12 months after surgery). Fifteen pts underwent a surgical treatment of UAS. In 1 patient with equivocal findings, we observed an ileo-ureteral reflux.
The DR with F + 10(sp) method in the seated position has a lower uncertain diagnostic rate, compared to the radiological findings of US or CTU, in management of bladder cancer patients with urinary diversion. The semiquantitative indices diuretic half time and 20 min/peak ratio evaluated in a condition of favorable gravity reduce uncertain responses improving interobserver concordance.
根治性膀胱切除术伴永久性尿流改道是浸润性肌层膀胱癌的金标准治疗方法。这些患者常伴有肾积水，但超声（US）或尿路 CT 造影（CTU）检查无法区分梗阻性和非梗阻性肾积水。我们使用 F+10 坐位利尿肾动态显像（DR）来识别行根治性膀胱切除术和尿流改道术的患者中存在输尿管-回肠吻合口狭窄（UAS）并需要手术治疗的患者。
我们研究了 39 例无症状患者，他们均接受了根治性膀胱切除术和尿流改道术。根据放射学发现（US、CTU），44 个肾脏存在肾积水。所有患者均接受了 Tc-MAG3 DR 加 F+10（坐位）检查。患者在坐位时进行 20 分钟 DR 采集。在示踪剂注射后 5 分钟，患者饮用 400-500ml 水，在动态采集时 10 分钟给予呋塞米 20mg 推注。评估了达峰时间、利尿半时间和 20 分钟/峰比等指标。逆行肾盂造影证实所有 DR 显示梗阻性发现的患者均存在 UAS。我们对两组患者进行了 DR 随访。
44 个肾积水中有 36 个 DR 加 F+10（坐位）方法显示为梗阻性发现。6 例患者显示为非梗阻性发现。32 例患者显示为梗阻性发现（其中 20 例在手术后 12 个月内发生 UAS）。15 例患者接受了 UAS 的手术治疗。在 1 例结果不确定的患者中，我们观察到回肠输尿管反流。
与 US 或 CTU 的放射学发现相比，在接受尿流改道术的膀胱癌患者的管理中，F+10（坐位）DR 方法的不确定诊断率较低。在有利重力条件下评估利尿半时间和 20 分钟/峰比等半定量指标可减少不确定反应，提高观察者间的一致性。
