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IMAGE INTERPRETATION · RENAL AND GENITOURINARY

Vesicoureteral Reflux on Radionuclide Cystogram

Direct radionuclide cystogram — sequential frames during bladder filling and voiding phases
Direct radionuclide cystogram — sequential frames during bladder filling and voiding phases

Provided clinical image

Question

During a direct radionuclide cystogram like the one shown, what specific finding on the images indicates that VESICOURETERAL REFLUX (VUR) is present?

  1. AThe bladder fails to empty completely on post-voiding images, leaving significant residual tracer activity in the bladder after the patient voids
  2. BRadiotracer activity appears in the ureters or kidneys during bladder filling or voiding, indicating urine flowing backward from the bladder toward the kidneys
  3. CThe bladder appears enlarged and asymmetric on pre-void images, indicating increased bladder capacity due to detrusor muscle hypertrophy
  4. DActivity is seen only in the urethra during voiding, indicating normal antegrade urine flow without any evidence of retrograde reflux
Show the answer and explanation

B. Radiotracer activity appears in the ureters or kidneys during bladder filling or voiding, indicating urine flowing backward from the bladder toward the kidneys

Vesicoureteral reflux (VUR) is identified when radiotracer activity is seen moving from the bladder upward into one or both ureters and/or renal pelves during the filling or voiding phase. Normally, tracer should remain confined to the bladder during filling and exit only through the urethra during voiding. Any appearance of tracer in the upper urinary tract (ureters or kidneys) is abnormal and indicates retrograde flow — VUR. The direct method is very sensitive for VUR because imaging is continuous throughout the entire filling and voiding cycle, catching both low-pressure and high-pressure reflux.

More renal and genitourinary images

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← Direct Radionuclide Cystogram TechniqueWhy Post-Void Images on a Radionuclide Cystogram →

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