Jennifer Wakefield BMedSc, Presenter: Nothing to Disclose

Lorenzo Biassoni MBBS, Abstract Co-Author: Nothing to Disclose

Marina Easty FRCR, Abstract Co-Author: Nothing to Disclose

Divyesh Desai, Abstract Co-Author: Nothing to Disclose

Indirect Radionuclide Cystography (IRC) is a non-invasive test, performed primarily to investigate vesico-ureteric reflux. The gold standard methods for the evaluation of vesico-ureteric reflux (Micturating Cystourethrogram) and urinary bladder function (Urodynamic study) are invasive. The aim of this analysis was to evaluate if IRC could be used as a screening tool for Urodynamic Studies (UDS).

49 toilet-trained children aged between 2 and 18 years were enrolled into a retrospective study at a tertiary paediatric referral centre (Jan- Dec 2009), and underwent a MAG3/ IRC to investigate for vesico-ureteric reflux. The IRC was performed after the MAG3 renogram when the child wanted to void, with no additional radiation burden. If the child failed to void completely after the first IRC or if activity remained within the collecting system, one or more IRCs were acquired. The following parameters were evaluated: completeness of bladder emptying, voided volume, duration of micturition, hesitancy period pre-micturition, and presence of vesico-ureteric reflux. In this preliminary analysis, only the completeness of bladder emptying was considered. The IRC was classified as showing normal bladder function if the child completely voided in at least one IRC, and abnormal if there was a significant bladder residual in all IRCs performed. The IRC results were compared to the patient’s recent UDS findings.

All 8 children with urinary bladder dysfunction determined by IRC also had abnormal UDS findings. There was a discrepancy in the IRC and UDS results in 15 children(65%), with IRC assessment of bladder function as normal and UDS demonstrating urinary bladder dysfunction. In the majority of these patients(80%), this discrepancy was due to UDS demonstrating a significant urinary bladder residual (> 30ml).

This preliminary analysis with rather strict IRC criteria for the definition of an abnormal bladder, shows that IRC is not a clinically effective preliminary method of assessing urinary bladder function in toilet- trained children. The addition of other parameters of bladder dysfunction to the IRC, e.g. a flow meter to record flow- rate readings, may increase the diagnostic yield.

Urodynamic study is the gold standard for urinary bladder evaluation, but it is invasive. Indirect Radionuclide Cystography is a non- invasive preliminary test to assess post- void bladder residual.

Wakefield, J, Biassoni, L, Easty, M, Desai, D, Indirect Radionuclide Cystography as a Low Cost Screening Tool for Bladder Dysfunction.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11007994.html