Taner ERSELCAN, Semra ÖZDEMİR, Zekiye HASBEK, Levent CANKORKMAZ, Bülent TURGUT, Demet ALAYGUT

Comparison of two different periods of renal cortical activity ratios in the evaluation of ureteropelvic junction obstruction by dynamic renal scintigraphy

Amaç. Retrospektif olan bu çalışmada amacımız, üreteropelvik bileşkede darlığı olan çocuk hastagrubunda, renal sintigrafilerde, 1inci ve 20nci dakikalardan elde edilen kortikal aktivite oranının,obstrüksiyonun varlığının belirlenmesinde takip parametresi olarak kullanılabilirliğiniaraştırmaktır. Yöntem. Çalışmaya toplam 322 renogram dahil edildi. Standart renogram eğrileridiüretiğe verdiği cevaba göre vizüel olarak nonobstrüktif, obstrüktif ve şüpheli olaraksınıflandırıldı. Ayrıca her bir böbrek için 1inci ve 20nci dakikalarda kortikal ROIler çizildi vekortikal sayımlar elde edildi. Bunun dışında renogram ile hesaplanan T 1/2 10 dakikanın altındaolan böbrekler normal, 10-20 dakika indetermine, >20 dakika kötü drenaj olarak kabul edildi.Obstrüksiyon paternleri ile 1inci ve 20nci dakikalardaki kortikal aktivite oranları karşılaştırıldı.Bulgular. Kortikal aktivite sayımlarının oranları ile vizüel olarak belirlenen obstrüktif patern(nonobstrüktif, obstrüktif ve şüpheli) karşılaştırıldığında, Tc-99m DTPA renogramında,1inci/20nci dak. kortikal aktivite oranı %82,8in üzerinde olan hastalar obstrüktif, %59,3 ile%82.8 olan hastalar obstrüksiyon açısından şüpheli olarak bulundu. Tc-99 m MAG-3 ile yapılansintigrafilerde ise, 1inci/20nci dak. kortikal aktivite oranı %74,2nin üzerinde olan hastalarobstrüktif, %44,6 ile %74,2 olan hastalar obstrüksiyon açısından şüpheli olarak bulundu. T½parametresinin böbreklerin obstrüksiyon paterni ile karşılaştırılması sonucunda; vizüeldeğerlendirmeye göre non-obstrüktif olan 299 böbreğin 124ünde (41,5%) T½ indetermine grupta,7sinde (2,3%) ise T½ obstrüktif gruptaydı. Vizüel değerlendirmede şüpheli grupta yer alan 17böbreğin 4ünde (23,5%) T½ normal grupta, 5inde (29,4%) T½ indetermine grupta ve 8inde(47,1%) T½ obstrüktif grupta yer almaktaydı. Sonuç. Biz çocuk hasta grubunda 1inci/20ncidakika kortikal aktivite oranlarının kullanılmasının da obstrüksiyon tanısının konulmasındayardımcı olduğunu düşünmekteyiz.

Üreterop elvik bileşke darlıklarının dinamik renal sintigraf i ile değerlendirilmesinde iki f arklı perioddaki kortikal aktivite oranlarının karşılaştırılması

Aim. The aim of this retrospective study is to investigate whether the renal cortical activity at 1stand 20th minutes in renal scintigraphy can be used as a following parameter to determine thepresence of obstruction in pediatric patients group with ureteropelvic junction obstruction.Method. The consecutive 322 kidney renograms were included in the study. Standardized diureticrenograms were visually classified into three groups as non-obstructive, obstructive andindetermined according to their responses to the diuretic. In addition, the cortical regions ofinterest (ROI) were drawn manually at 1st and 20th min for each kidney and the cortical countswere obtained. Apart from this, kidneys were divided into three major sub-groups based onclearance half-time (T1/2); T1/220 min asobstruction and T1/2 with a value between 10 and 20 minutes as an indeterminate result.Afterwards visual obstruction patterns and 1st/20th min. cortical activity ratios were compared.Results. When the cortical activity ratios are compared to visual obstructive pattern(non- obstructive, obstructive and indeterminate); on the Tc99m DTPA renograms the cortical activityratios which were greater than 82.8% were obstructive, ranging from 59.3% to 82.8% were foundindeterminate. On the Tc-99m MAG-3 renograms the cortical activity ratios which were greaterthan 74.2% were obstructive, ranging from 44.6% to74.2% were found indeterminate. As a resultof the comparison of T 1/2 parameter with the obstruction patterns of the kidneys, T 1/2 was inindeterminate group in 124 (41.5%) out of 299 kidneys visually evaluated as non-obstructive whilein 7 (2.3%) kidneys T1/2 was in obstructive group. In 4 (23.5%) out of 17 kidneys which werevisually evaluated as indeterminate, T 1/2 was in normal group, in 5 (29.4%) of them T 1/2 was inindeterminate group and in 8 (47.1%) of the 17 kidneys T 1/2 was in obstructive group.Conclusion. We think that the use of 1st/20th min. cortical activity ratios on the diuretic renogramare helpful in establishing a diagnosis of obstruction in pediatric patient group.

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