Volume 44, Number 2

March 2014



his issue of the Seminars in Nuclear Medicine is devoted to a subject that was one of the earliest applications of radionuclide methodology in clinical medicine. It represents a selection of articles from a meeting that has been held triennially continuously since 1971. Drs Jean Louis FunkBrentano and M. Donald Blaufox decided to form a group that would pursue the subject of radionuclides in diseases of the kidneys and urinary tract after attending a meeting on the subject in Liege Belgium in 1967.1 The first of these meetings was held in 1971 in New York City and they have been held regularly at approximately 3-year intervals ever since. A full history of the group is available in an earlier publication.2 Initially, the proceedings of the meetings were published as freestanding volumes, but as the demand for meeting proceedings began to decline, this type of publication became impractical. In 2008, the editors of the Seminars in Nuclear Medicine decided that it would be appropriate and useful to publish selected articles from the meeting to provide an overview of the areas of progress and importance in clinical renal nuclear medicine.3,4 The articles in this current issue of the seminars are derived from presentations at the 15th triennial meeting that was held in Varese, Italy, in October 2013. A summary and overview of that meeting is presented in the accompanying editorial comment from Dr Diego DePalma who was the chairman and organizer of those sessions. More information about the group, its functions, and their accomplishments can be found online at www.ISCORN.org. The articles included here encompass a broad range of applications of radionuclides in nephrourology. The first article by Dr Emmanuel Durand4 is devoted to a comparison of magnetic resonance imaging with radionuclide methods used to evaluate the kidney. Dr Durand, who is currently designated to chair the next meeting, points out the remarkable progress that has been made in functional evaluation with MRI, but it is interesting to note that the “gold standard” used in all of these studies is invariably radionuclide methodology. Drs Cho and Szabo5 then present us with a broad overview of molecular imaging of urogenital diseases. There is a great promise for using this methodology to explore areas of renal physiology and function that could not easily be measured in any other manner. Hopefully their article will stimulate further work in this area by other centers. An area that has been at the forefront

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of renal nuclear medicine since it was first introduced into clinical medicine is its application in renal vascular disease. Remarkable progress in the medical treatment of hypertension during the past decade and the realization that there is very little benefit to relieving renal artery stenosis has led to a major change in this application. The number of studies on renal vascular hypertension has declined precipitously over the past few years. Dr Alain Prigent6 and Philippe Chaumet-Riffaud review for us how the problems in renal vascular disease are currently approached and the role of nuclear medicine. An area that has seen relatively little application in the United States, although it is used much more extensively in Europe, and especially in pediatrics, is that of nuclear medicine techniques in febrile urinary tract infections. Drs Edefonti7, Tel, Testa, and DePalma review for us this very important application that continues to be underutilized but can be critically important in patient management. Another area that has decreased considerably in utilization is that of evaluation of the transplanted kidney. Dr Ayşe Aktaş8 reviews for us all the potential applications of radionuclides in transplanted kidneys and helps to show how even though it is being used less frequently at this time, there still remain a considerable number of problems in renal transplants that can be evaluated very efficiently and accurately with radionuclides. Many centers have very little experience with renal nuclear medicine, and many trainees do not have adequate exposure to deal with the evaluation of the studies competently. Drs Taylor9 and Garcia have developed and are continuing to develop a computer-assisted diagnostic process that helps the neophyte and even the more expert person in evaluating renal nuclear procedures and arriving at a correct diagnosis. In this issue, the article from the proceedings deals with diuretic renography. After the initial introduction of the renogram, there was a considerable amount of overutilization of the technique followed by overinterpretation and then some skepticism of its value and a decline in use. As newer methods have become available, the potential value of renal nuclear medicine has increased in all aspects, including urology and oncology. However, there is a general lack of understanding of many of these techniques, which require a very sophisticated knowledge of physiology and renal function. Hopefully, a review of the articles here will put in perspective some of the highlights



78 from the radionuclides in nephrourology meeting that was held in Varese and also help to educate the nuclear medicine physician and the radiologist about their uses. Leonard M. Freeman, MD M. Donald Blaufox, MD, PhD

References 1. Timmermans L, Merchie G, (eds): Radioisotopes in the diagnosis of diseases of the kidneys and urinary tract. Proceedings of the 1st International Symposium, June 22-25, 1967, Liege, Belgium (International Congress Series 178). Amsterdam, Excepta Medica Foundation, 1969

2. Blaufox MD: A brief history of the radionuclides in Nephrourology Group (ISCORN). Semin Nucl Med 2008;38:2-8 3. De Palma D: Editorial. Semin Nucl Med 2014;44(2):79-81 4. Duranad E: Comparison of magnetic resonance imaging with radionuclide methods of evaluating the kidney. Semin Nucl Med 2014;44(2):82-92 5. Cho SY, Szabo Z: Molecular imaging of urogenital diseases. Semin Nucl Med 2014;44(2):93-109 6. Prigent A, Chaumet-Riffaud P: Clinical problems in renovascular disease and the role of nuclear medicine. Semin Nucl Med 2014;44(2):110-122 7. Edefonti A, Tel F, Testa S, De Palma D: Febrile urinary tract infections: Clinical and laboratory diagnosis, imaging, and prognosis. Semin Nucl Med 2014;44(2):123-128 8. Aktas A: Transplanted kidney function evaluation. Semin Nucl Med 2014;44(2):129-145 9. Taylor AT, Garcia EV: Computer-assisted diagnosis in renal nuclear medicine: rationale, methodology, and interpretative criteria for diuretic renography. Semin Nucl Med 2014;44(2):146-158

Seminars in nuclear medicine.

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