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Comparison of the EANM and SNM guidelines on diuretic renography in children

De Man, Kathia E.a; Troch, Monique E.b; Dobbeleir, André A.a; Duong, Hong Phuocc; Goethals, Ingeborg M.a

Nuclear Medicine Communications: May 2015 - Volume 36 - Issue 5 - p 486–488
doi: 10.1097/MNM.0000000000000278

Objective When taking into account the Society of Nuclear Medicine (SNM) and European Association of Nuclear Medicine (EANM) guidelines on diuretic renography in children, we see important divergences in the preparation, acquisition, processing, and interpretation of the results. In this study, we estimated the quality of renal drainage according to these two guidelines.

Patients and methods Ninety kidneys with hydronephrosis or severe vesicorenal reflux were processed and analyzed according to the SNM (estimation of the T1/2 of the washout curve and conclusions about the possible existence of obstruction) and EANM guidelines (estimation of normalized residual activity or NORA, and output efficiency or OE on the late postmicturition images, without any conclusion about the possible existence of obstruction). Among the 90 kidneys, 39, 20, and 31 were considered to have normal, equivocal, or poor drainage (obstruction), respectively, when the SNM guidelines were used.

Results All 39 kidneys with good drainage according to SNM were also considered as normal using the EANM guidelines. Among the 20 equivocal cases based on T1/2, concordance between the two guidelines was obtained in only 35 and 0% when using NORA and OE (OE was considered normal in all 20 cases), respectively. Among the 31 cases defined as obstructed by SNM, only five were classified as ‘poor drainage’ using NORA and no single case was classified thus using OE.

Conclusion This limited study demonstrates that the use of different guidelines can lead to different interpretations of the results. This is unacceptable, and an agreement between both pediatric task groups of the SNM and EANM is urgently required.

aDepartment of Nuclear Medicine, Ghent University Hospital

bDepartment of Nuclear Medicine, AZ Sint-Lucas, Ghent

cDepartment Pediatric Nephrology, Queen Fabiola Children’s Hospital, Brussels, Belgium

Correspondence to Kathia E. De Man, MD, Department of Nuclear Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Tel: +32 (0)9 332 3028; e-mail:

Received November 23, 2014

Received in revised form December 28, 2014

Accepted December 31, 2014

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