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IMAGE INTERPRETATION · RENAL AND GENITOURINARY

Direct Radionuclide Cystogram Technique

Direct radionuclide cystogram — sequential bladder filling frames, post-flow total, post-voiding views, and anterior/posterior bladder prevoid images
Direct radionuclide cystogram — sequential bladder filling frames, post-flow total, post-voiding views, and anterior/posterior bladder prevoid images

Provided clinical image

Question

The images shown are from a direct radionuclide cystogram (DRC). As the nuclear medicine technologist performing this procedure, how is the radiotracer introduced into the patient?

  1. AThe tracer is injected intravenously — it is filtered by the kidneys and travels down the ureters to fill the bladder naturally over 30–60 minutes (indirect method)
  2. BThe patient drinks a dilute oral solution of the tracer, which is absorbed by the gastrointestinal tract and concentrated in the urine within 2–3 hours
  3. CThe tracer is injected subcutaneously in the lower abdomen, where it is absorbed by the lymphatic system and drains into the bladder via the pelvic lymphatics
  4. DThe tracer is instilled directly into the bladder through a urinary catheter, mixed with sterile saline, which fills the bladder while imaging is performed
Show the answer and explanation

D. The tracer is instilled directly into the bladder through a urinary catheter, mixed with sterile saline, which fills the bladder while imaging is performed

In direct radionuclide cystography (DRC), a urinary catheter is inserted and a small amount of Tc-99m pertechnetate (or Tc-99m sulfur colloid) diluted in sterile saline is instilled directly into the bladder. Images are acquired continuously during filling and voiding to detect vesicoureteral reflux (VUR). This differs from INDIRECT cystography, where tracer is given IV and imaged after it fills the bladder through the kidneys — no catheter is needed for indirect, but it cannot detect reflux during the filling phase.

More renal and genitourinary images

Direct radionuclide cystogram — sequential frames during bladder filling and voiding phasesVesicoureteral Reflux on Radionuclide Cystogram Direct radionuclide cystogram — post-flow total image and post-voiding views showing the bladder before and after urinationWhy Post-Void Images on a Radionuclide Cystogram Tc-99m MAG3 renal scan — composite image, flow curve, renogram curves, and quantitative results showing bilateral abnormal drainage with asymmetric differential functionDifferential Renal Function on MAG3 Tc-99m MAG3 renogram curves — both kidneys show a continuously rising pattern throughout the 45-minute study; Left T½ = 80.65 min, Right T½ = 51.73 minBilateral Impaired Drainage on MAG3 Renogram Tc-99m MAG3 renal scan acquired with motion correction (MoCo) applied — noted in the window title 'Cine FLOW FUNCTION MoCo MoCo'Motion Correction in MAG3 Renal Scans Tc-99m MAG3 diuretic renogram with Lasix at 21 min — right kidney shows prolonged T½ (85.53 min) with persistent tracer retention and rising renogram curve post-furosemide, indicating UPJ obstructionUPJ Obstruction on MAG3 Diuretic Renogram
← Furosemide Dose for Diuretic RenographyVesicoureteral Reflux on Radionuclide Cystogram →

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