PET/TC en endocrinología nuclear. Resultados de la encuesta difundida por las distintas redes sociales de la SEMNIM en España / PET/CT in nuclear endocrinology: Results of the survey diffused through different social networks of the SEMNIM in Spain

Objetivo Desde el Grupo de Trabajo de Endocrinología de la SEMNIM, se planteó la necesidad de conocer el uso actual de la tecnología PET/TC aplicada en el campo de la endocrinología. El objetivo de la encuesta era obtener una fotografía instantánea del uso de la PET/TC en endocrinología nuclear, con el fin de conocer si está siendo adecuadamente utilizada y detectar posibles necesidades. Material y métodos Durante el primer trimestre del 2022, se analizaron los datos obtenidos de una encuesta que se difundió a través de distintas redes sociales a lo largo de la segunda mitad del 2021. Se recogieron datos sobre el uso de las distintas técnicas PET/TC en el carcinoma diferenciado de tiroides, el carcinoma medular de tiroides, los tumores neuroendocrinos y el hiperparatiroidismo. Resultados Un total de 15 centros respondieron la encuesta. El 79% de los hospitales utilizan la 18F-FDG PET/TC en el diagnóstico y/o seguimiento del carcinoma diferenciado de tiroides (media de exploraciones anuales: 36,9; rango 10-100). El 85% utilizan la 18F-DOPA PET/TC para el estudio de recidiva bioquímica de carcinoma medular de tiroides (media estudios anuales: 7,8; rango 2-20). El 77% utilizan la 18F-DOPA PET/TC para el estudio de los tumores neuroendocrinos: el 77% utilizan la 18F-DOPA PET/TC (media de 10 exploraciones anuales; rango 2-30) y el 69% utilizan el 68Ga-DOTA-SA (media de 24,7 exploraciones anuales; rango 2-127). El 79% utilizan la 18F-colina PET/TC para el estudio del hiperparatiroidismo (media de 30,1 exploraciones anuales; rango 10-120). Conclusiones El uso de la técnica PET/TC en endocrinología aún no está generalizado, sin embargo, vimos que las indicaciones en las cuales se utiliza son, en general, las reportadas en los distintos consensos (AU)

Aim To know the current use of the PET/CT technology applied in the field of endocrinology, the Endocrinology Working Group of SEMNIM proposed conducting a survey. The objective was to obtain a snapshot of the use of PET/CT in nuclear endocrinology, to know if it is being used properly and detect possible needs. Material and methods During the first quarter of 2022, we analyzed the data obtained from a survey that was distributed through different social networks throughout the second half of 2021. The survey asked for the use of the different PET/CT techniques available in Spain in different endocrinological pathologies like differentiated thyroid carcinoma, medullary thyroid carcinoma, neuroendocrine tumors and hyperparathyroidism. Results A total of 15 centers responded to the survey. A percentage of 79 of hospitals used 18F-FDG PET/CT in the diagnosis and/or follow-up of differentiated thyroid carcinoma (mean annual studies: 36.9; range 10–100); 85% used 18F-DOPA PET/CT for the study of biochemical recurrence of medullary thyroid carcinoma (mean annual studies: 7.8; range 2–20); 77% used 18F-DOPA PET/CT for the study of neuroendocrine tumors: 77% used 18F-DOPA PET/CT (mean of 10 scans per year; range 2–30) and 69% used 68Ga-DOTA-SA (mean of 24.7 studies per year; range 2–127); 79% used 18F-choline PET/CT for the study of hyperparathyroidism (mean of 30.1 annual studies; range 10–120). Conclusions We detected that the use of the PET/CT technique in endocrinology is not yet widespread, however, we saw that the indications in which it is used are, in general, those reported in the different consensus (AU)

PET/CT in nuclear endocrinology: Results of the survey diffused through different social networks of the SEMNIM in Spain.

AIM: To know the current use of the PET/CT technology applied in the field of endocrinology, the Endocrinology Working Group of SEMNIM proposed conducting a survey. The objective was to obtain a snapshot of the use of PET/CT in nuclear endocrinology, to know if it is being used properly and detect possible needs. MATERIAL AND METHODS: During the first quarter of 2022, we analyzed the data obtained from a survey that was distributed through different social networks throughout the second half of 2021. The survey asked for the use of the different PET/CT techniques available in Spain in different endocrinological pathologies like differentiated thyroid carcinoma, medullary thyroid carcinoma, neuroendocrine tumors and hyperparathyroidism. RESULTS: A total of 15 centers responded to the survey. A percentage of 79 of hospitals used 18F-FDG PET/CT in the diagnosis and/or follow-up of differentiated thyroid carcinoma (mean annual studies: 36.9; range 10-100); 85% used 18F-DOPA PET/CT for the study of biochemical recurrence of medullary thyroid carcinoma (mean annual studies: 7.8; range 2-20); 77% used 18F-DOPA PET/CT for the study of neuroendocrine tumors: 77% used 18F-DOPA PET/CT (mean of 10 scans per year; range 2-30) and 69% used 68Ga-DOTA-SA (mean of 24.7 studies per year; range 2-127); 79% used 18F-choline PET/CT for the study of hyperparathyroidism (mean of 30.1 annual studies; range 10-120). CONCLUSIONS: We detected that the use of the PET/CT technique in endocrinology is not yet widespread, however, we saw that the indications in which it is used are, in general, those reported in the different consensus.

Utilidad de la 18F-FDG PET/TC en el cáncer de tiroides / Usefulness of 18F-FDG PET/CT in thyroid carcinoma

No disponible

[(123)I-MIBG myocardial scintigraphy in the diagnosis of Lewy body dementia]. / Gammagrafía miocárdica con I-MIBG en el diagnóstico de la demencia con cuerpos de Lewy.

INTRODUCTION: Lewy body dementia (LBD) is the second most common cause of neurodegenerative dementia after Alzheimer's disease (AD). A cardiac post-ganglionic sympathetic denervation has been described in this condition which can be quantified by MIBG (metaiodobenzylguanidine) myocardial scintigraphy. The aim of our work was to retrospectively evaluate cardiac MIBG uptake (expressed as the heart-to-mediastinum ratio at 4h (HMR) in patients with suspected LBD, and to examine its relationship with clinical and para-clinical data. MATERIAL AND METHODS: A total of 77 patients with clinical suspicion of LBD evaluated at our centre between September 2005 and June 2008 to whom a MIBG myocardial scintigraphy has been performed were retrospectively reviewed. International Consensus Criteria of LBD were applied to divide the sample into probable LBD, possible LBD and non-LBD. HMR values and their relationships with clinical and neuropsychological data were analysed. A subgroup of patients had FP-CIT (fluoropropyl-carbomethoxy-3ß-4-iodophenyltropane) SPECT as a part of the evaluation. RESULTS: Mean HMR values were significantly lower in probable LBD group than in possible LBD and non-LBD groups. Low HMR values were associated only with reduced FP-CIT uptake in the striatum, but not with any clinical or neuropsychological item. CONCLUSIONS: Low MIBG myocardial scintigraphy uptake is a robust measure in LBD, and it is not largely affected by medical conditions, or by the stage of the disease. In LBD reduced MIBG myocardial uptake is associated with nigrostriatal degeneration.

[SPECT-CT 67Ga studies in lymphoma disease. Contribution to staging and follow-up]. / Estudios SPECT-TAC con Ga de la enfermedad linfomatosa. Su aportación en la estadificación y seguimiento de la enfermedad.

INTRODUCTION: 67Ga scintigraphy is an established method for the staging and follow-up of patients diagnosed of lymphomas. The aim of this study is to evaluate advantages of 67Ga SPECT-CT study over planar, SPECT and high resolution CT studies in lymphoma disease. MATERIAL AND METHODS: One hundred and one 67Ga studies corresponding to 74 patients (46 men) were obtained, mean age 44 years. Thirty-eight patients (51 %) were diagnosed of Hodgkin's lymphoma and 36 were non-Hodgkin's lymphoma. All patients were evaluated with 67Ga and high-resolution CT studies. 67Ga studies were performed in a hybrid system, obtaining planar, SPECT and fused SPECT-CT imaging. Findings obtained from 67Ga studies were correlated with findings obtained from CT studies, both much in number of tumoral lesions and in their localization. RESULTS: Planar, SPECT, SPECT-CT and CT studies detected 123, 146, 155 and 132 lesions respectively. SPECT-CT and CT were concordant in 52 studies, while there was no concordance between SPECT-CT and CT in the remaining 49 studies, SPECT-CT detecting more lesions than CT in 28 of them. These findings changed the disease stage 18 times (18 % of whole studies). CONCLUSION: These results show better efficiency of 67Ga SPECT-CT compared to the other acquisition methods of 67Ga study and to CT for detection of tumoral lymphomatous lesions. 67Ga SPECT-CT study improves the diagnostic yield of the study with 67Ga in patients with lymphoma, providing better anatomical localization of tumoral lesions and detection of extraganglionar disease.

Estudios SPECT-TAC con 67Ga de la enfermedad linfomatosa. Su aportación en la estadificación y seguimiento de la enfermedad / SPECT-CT 67Ga studies in lymphoma disease. Contribution to staging and follow-up

Introducción. La gammagrafía con 67Ga es un método establecido en la estadificación y seguimiento de los pacientes diagnosticados de linfoma. El objetivo de este estudio es valorar las ventajas de la gammagrafía con 67Ga y SPECT-TAC sobre los estudios planares y SPECT y sobre la TAC de alta resolución en la enfermedad linfomatosa. Material y métodos. Se analizaron 101 estudios con 67Ga pertenecientes a 74 pacientes (46 hombres), edad media 44 años. Treinta y ocho pacientes (51 %) estaban diagnosticados de linfoma de Hodgkin y 36 no hodgkinianos. Todos los pacientes fueron evaluados mediante estudio con 67Ga y TAC de alta resolución. La exploración con 67Ga se realizó en un sistema híbrido, obteniendo imágenes planares, SPECT y fusión SPECT-TAC. Los resultados obtenidos de los estudios con 67Ga se compararon con los de la TAC, tanto en número de lesiones como en su localización. Resultados. Los estudios planares, SPECT, SPECT-TAC y TAC detectaron 123, 146, 155 y 132 lesiones, respectivamente. La SPECT-TAC y la TAC fueron coincidentes en 52 estudios, mientras que en los otros 49 estudios no hubo concordancia en número de lesiones, detectando la SPECT-TAC más lesiones que la TAC en 28 de ellos, modificando la estadificación de la enfermedad en 18 ocasiones (18 % de los estudios). Conclusiones. Estos resultados muestran una mayor efectividad del estudio de 67Ga y fusión SPECT-TAC en comparación con los otros métodos de adquisición gammagráficos y con la TAC de alta resolución en la detección de lesiones linfomatosas. Este método mejora el rendimiento diagnóstico de los estudios con 67Ga, aportando una mejor localización anatómica de las lesiones y permitiendo detectar lesiones extraganglionares

Introduction. 67Ga scintigraphy is an established method for the staging and follow-up of patients diagnosed of lymphomas. The aim of this study is to evaluate advantages of 67Ga SPECT-CT study over planar, SPECT and high resolution CT studies in lymphoma disease. Material and methods. One hundred and one 67Ga studies corresponding to 74 patients (46 men) were obtained, mean age 44 years. Thirty-eight patients (51 %) were diagnosed of Hodgkin's lymphoma and 36 were non-Hodgkin's lymphoma. All patients were evaluated with 67Ga and high-resolution CT studies. 67Ga studies were performed in a hybrid system, obtaining planar, SPECT and fused SPECT-CT imaging. Findings obtained from 67Ga studies were correlated with findings obtained from CT studies, both much in number of tumoral lesions and in their localization. Results. Planar, SPECT, SPECT-CT and CT studies detected 123, 146, 155 and 132 lesions respectively. SPECT-CT and CT were concordant in 52 studies, while there was no concordance between SPECT-CT and CT in the remaining 49 studies, SPECT-CT detecting more lesions than CT in 28 of them. These findings changed the disease stage 18 times (18 % of whole studies). Conclusion. These results show better efficiency of 67Ga SPECT-CT compared to the other acquisition methods of 67Ga study and to CT for detection of tumoral lymphomatous lesions. 67Ga SPECT-CT study improves the diagnostic yield of the study with 67Ga in patients with lymphoma, providing better anatomical localization of tumoral lesions and detection of extraganglionar disease

[123I-MIBG SPECT-CT combined with gamma probe for radioguided localization of pheochromocytoma]. / SPECT-TC con 123I-MIBG y sonda gamma portátil en la localización radioguiada de un feocromocitoma.

We report a case of a 56-year-old male with high suspicion of an intraabdominal catecholamine-producer tumor. The patient underwent different diagnostic procedures including 123I-meta-iodobenzylguanidine (123I-MIBG) scintigraphy, with subsequent SPECT and low resolution CT for attenuation correction and anatomic and functional image fusion. After practicing a new 123I-MIBG scintigraphy the patient was taken to the operating room, where a hand-held gamma probe detector helped to localize the lesion.

SPECT-TC con 123I-MIBG y sonda gamma portátil en la localización radioguiada de un feocromocitoma / 123I-MIBG SPECT-CT combined with gamma probe for radioguided localization of pheochromocytoma

Presentamos el caso de un hombre de 56 años con elevada sospecha de tumoración intraabdominal productora de catecolaminas. El paciente fue sometido a diversas pruebas diagnósticas, entre las que se incluyó un rastreo gammagráfico con 123I-metayodobencilguanidina (123I-MIBG), complementado con SPECT y TC de baja resolución para corrección de atenuación y posterior fusión de las imágenes anatómicas y funcionales. Después de un nuevo rastreo con 123I-MIBG el paciente fue intervenido quirúrgicamente con el apoyo intraoperatorio de una sonda gamma portátil, que facilitó la localización de la tumoración

We report a case of a 56-year-old male with high suspicion of an intraabdominal catecholamine-producer tumor. The patient underwent different diagnostic procedures including 123I-meta-iodobenzylguanidine (123I-MIBG) scintigraphy, with subsequent SPECT and low resolution CT for attenuation correction and anatomic and functional image fusion. After practicing a new 123I-MIBG scintigraphy the patient was taken to the operating room, where a hand-held gamma probe detector helped to localize the lesion

[Tumor redifferentiation in papillary thyroid carcinoma alter retinoic acid administration]. / Rediferenciación tumoral en carcinoma papilar de tiroides tras la administración de ácido retinoico.

Male patient, 73 year old, with papillary thyroid carcinoma treated by surgery, 131I and L-Tyroxine, with bone metastasis, detected by bone scintigraphy and CT scan, which negative radioiodine uptake. In order to induce tumoral redifferentiation, retinoic acid (70 mg/day) was administered for three months before 131I treatment. A radioiodine scan performed after treatment showed uptake in some of the bone metastasis. Nine months later, and due to disease progression, a second induction with retinoic acid was performed before 131I treatment. The radioiodine scan performed after treatment showed greater uptake and higher number of bone lesions than the previous scan.

Rediferenciación tumoral en carcinoma papilar de tiroides tras la administración de ácido retinoico / Tumor redifferentiation in papillary thyroid carcinoma after retinoic acid administration

Paciente varón de 73 años con carcinoma papilar de tiroides tratado con cirugía, 131I y L-Tiroxina, que presentó metástasis óseas, objetivadas por gammagrafía ósea y TAC, que no captaban 131I. Con el fin de inducir rediferenciación tumoral, se administró ácido retinoico (70 mg/día) durante tres meses previos a tratamiento con 131I. El rastreo postratamiento evidenció captación de 131I en algunas metástasis óseas. Por este motivo, y debido a progresión de la enfermedad, nueve meses más tarde se realizó una segunda inducción con ácido retinoico previa a tratamiento con 131I. En esta ocasión el rastreo postratamiento mostró captación de 131I de mayor grado de intensidad y en más lesiones óseas que las detectadas por el rastreo anterior (AU)

Male patient, 73 year old, with papillary thyroid carcinoma treated by surgery, 131I and L-Tyroxine, with bone metastasis, detected by bone scintigraphy and CT scan, which negative radioiodine uptake. In order to induce tumoral redifferentiation, retinoic acid (70 mg/day) was administered for three months after treatment showed uptake in some of the bone metastasis. Nine months later, and due to disease progression, a second induction with retinoic acid was performed before 131I treatment. The radioiodine scan performed after treatment showed greater uptake and higher number of bone lesions than the previous scan (AU)

[Congenital renal abnormalities in neonates with fetal vesicoureteral reflux. Detection by 99m-technetium(m)-dimercaptosuccinic acid renal scintigraphy]. / Anomalías renales congénitas en neonatos con reflujo vesicoureteral fetal. Detección con gammagrafía renal-99mTc-DMSA.

BACKGROUND: "Fetal" vesicoureteral reflux (VUR) is characterized by predominance among males, high grade reflux and renal parenchymal abnormalities, indicating an association between sterile VUR and kidney lesions. OBJECTIVES: To determine, using technetium99m-dimercaptosuccinic acid (99mTc-DMSA) renal scan, the incidence of congenital renal abnormalities in infants with sterile VUR detected during the postnatal evaluation of prenatal hydronephrosis or sibling reflux screening and to speculate on the mechanisms of these lesions. METHODS: We retrospectively reviewed the DMSA renal scans of infants with VUR without a history of urinary tract infection (UTI). DMSA differential uptake less than or equal to 40% or cortical defects were considered as renal abnormalities. The findings were correlated with those of postnatal renal ultrasonography. RESULTS: Eighteen patients (15 boys and 3 girls) were included with VUR grade V, IV, III and II in 5, 10, 6 and 6, respectively, of the 36 renal units. DMSA revealed parenchymal abnormalities in 50% (9/18) of the patients and in 33% (9/27) of the renal units with VUR; most of the patients were boys (7 boys, 2 girls) with VUR grade V or IV (6/9; 66%). Postnatal ultrasonography showed low sensitivity (22%) to renal injury. CONCLUSIONS: In infants with sterile VUR, especially boys with high grade VUR, kidney abnormalities can already be present at birth suggesting a pathophysiology of renal injury independent of UTI. Moreover, renal parenchymal defects detected by DMSA renal scan are frequently not identified by postnatal renal ultrasound. Therefore, we recommend DMSA scanning in the initial evaluation of infants with VUR.

Anomalías renales congénitas en neonatos con reflujo vesicoureteral fetal. Detección con gammagrafía renal-99mTc-DMSA / Congenital renal abnormalities in neonates with fetal vesicoureteral reflux. Detection by 99M-technetiumM-Dimercaptosuccinic acid renal scintigraphy

Antecedentes: El reflujo vesicoureteral (RVU) "fetal" se caracteriza por una preponderancia masculina, reflujo de alto grado y anomalías parenquimatosas renales, estableciéndose una asociación entre RVU estéril y lesión renal. Objetivos Determinar, mediante gammagrafía renal con 99m tecnecio ácido dimercapto-succínico (99mTc-DMSA), la incidencia de anomalías renales congénitas en lactantes con RVU detectado posnatalmente por hidronefrosis prenatal o por cribado familiar, y especular sobre los mecanismos de acción de estas lesiones. Métodos: Se han revisado retrospectivamente las gammagrafías renales de lactantes con RVU y sin antecedentes de infección del tracto urinario (ITU), considerando anomalías renales: captación diferencial menor o igual al 40 por ciento o presencia de defectos corticales. Los hallazgos gammagráficos se han correlacionado con los de la ecografía posnatal. Resultados: Dieciocho pacientes cumplieron los criterios de inclusión; 15 niños y 3 niñas con RVU grado V, IV, III y II en 5, 10, 6 y 6 de las 36 unidades renales. La gammagrafía mostró alteraciones parenquimatosas en el 50 por ciento (9/18) de los pacientes y el 33 por ciento (9/27) de las unidades renales refluyentes; la mayoría fueron niños (7 niños, 2 niñas) con RVU de GV o GIV (6/9; 66 por ciento). La sensibilidad de la ecografía posnatal para detectar signos de lesión renal fue baja (22 por ciento). Conclusiones: Lactantes con RVU estéril, especialmente varones con RVU de alto grado, pueden presentar ya al nacimiento anomalías parenquimatosas renales, lo cual sugiere una etiopatogenia congénita de lesión renal independiente de la ITU. Estos defectos identificados por gammagrafía con frecuencia no son detectados en la ecografía posnatal. Por ambos motivos recomendamos la gammagrafía renal DMSA en la evaluación inicial de lactantes con RVU fetal (AU)

[Role of direct radionuclide cystography and renal study by dimercaptosuccinic acid (DMSA) in the diagnosis and follow-up of vesicoureteral reflux]. / La cistografía isotópica directa y la gammagrafía renal con ácido dimercaptosuccínico (DMSA) en el diagnóstico y seguimiento del reflujo vesicoureteral.

AIM: To evaluate the role of isotopic studies in the diagnosis and follow-up of vesicoureteral reflux (VUR) and to present the results of our current protocol. MATERIAL AND METHODS: Forty three patients with VUR were retrospectively studied with a mean follow-up of 43 years (1-11 years). VUR was diagnosed by voiding cystourethrography and followed-up by direct radionuclide cystography. During the follow-up all patients were studied by means of renal DMSA scintigraphy (21 were also studied during the acute phase of febrile urinary tract infection). RESULTS: Eighty three renal units were examined. Voiding cystourethrography was positive for VUR in 49 renal units (59%; 8 grade I, 18 grade II, 15 grade III, and 8 grade IV). During the follow-up, direct radionuclide cystography showed decrease or disappearance of VUR in 29 renal units (35%; 4 grade I, 16 grade II, 7 grade III, and 2 grade IV). DMSA studies performed during the follow-up showed cortical lesions in 17 renal units (5 with VUR grade II, 7 with grade III, and 5 grade IV). Nine of 21 patients examined by DMSA during the acute phase of febrile urinary tract infection showed cortical damage (43%), and 6 of them (67%) progressed to cortical lesion in the follow-up DMSA. CONCLUSIONS: The present protocol allows for the correct diagnosis and control of VUR, the early detection of acute renal damage, and the control of its evolution.

La cistografía isotópica directa y la gammagrafía renal con ácido dimercaptosuccínico (DMSA) en el diagnóstico y seguimiento del reflujo vesicoureteral / Role of direct radionuclide cystography and renal study by dimercaptosuccinic acid (DMSA) in the diagnosis and follow-up of vesicoureteral reflux

Objetivo: Valorar la utilidad de la cistografía isotópica directa (CID) y de la gammagrafía renal con ácido dimercaptosuccínico (DMSA) en el diagnóstico y seguimiento del RVU, según los resultados obtenidos a partir del protocolo actual de nuestro centro. Material y Métodos: Se han estudiado retrospectivamente 43 pacientes diagnosticados de RVU con un período de seguimiento medio de 4 ñ 3 años (1-11 años). El diagnóstico de RVU se realizó mediante cistografía radiológica (CUMS) y el seguimiento mediante CUMS y/o CID. Durante el seguimiento se realizó gammagrafía renal con DMSA a todos los pacientes. Veintiún pacientes también fueron estudiados con DMSA durante la fase aguda de la infección urinaria febril. Resultados: Se exploraron 83 unidades renales. En el momento del diagnóstico la CUMS fue positiva para RVU en 49 unidades renales (59 per cent; 8 grado I, 18 grado II, 15 grado III y 8 grado IV). Durante el seguimiento por CID se observó disminución o desaparición del RVU en 29 unidades renales (35 per cent; 4 grado I, 16 grado II, 7 grado III y 2 grado IV). Durante el seguimiento el DMSA mostró lesiones corticales en 17 unidades renales (5 con RVU grado II, 7 grado III y 5 grado IV). Nueve de los 21 pacientes estudiados con DMSA durante la fase aguda de la infección urinaria febril presentaron afectación cortical (43 per cent), de los cuales 6 evolucionaron a lesión cortical en el DMSA de control (67 per cent). Conclusiones: El protocolo descrito permite diagnosticar y controlar el RVU, identificar precozmente la afectación renal y controlar su evolución (AU)

[Nephrourology and nuclear medicine today]. / Nefrourología y medicina nuclear en la actualidad.

OBJECTIVE: To review the radioisotope studies in Nephrourology that are frequently performed in the Nuclear Medicine Department, their clinical applications and diagnostic yield. METHODS/RESULTS: Radionuclide studies in Nephrourology allow evaluation of different aspects of renal function after intravenous injection of radioisotopes by blood volume/time (ml/min) measurements (glomerular filtration rate, effective renal plasma flow) or visualization in the form of images or graphic display (renal scintigraphy, sequential study, renography) that permit determination of the differential renal function. A sequential study, diuresis renography or angiotensin converting enzyme (ACE) inhibitor renography can be performed to evaluate the changes in renal function induced by the diuretics or ACE inhibitors. Radionuclide cystography permits detecting vesicoureteric reflux. These radioisotope studies are commonly utilized in detecting reflux nephropathy and renal scarring (renal scintigraphy and radionuclide cystography), obstructive nephropathy (diuresis renography), renovascular hypertension (ACE inhibitor renography) and in evaluating renal transplantation (sequential study, renography, diuresis renography and ACE inhibitor renography). CONCLUSION: Radionuclide studies have different applications in Nephrourology, some of which are considered to be diagnostic gold standards, such as renal scintigraphy with DMSA to detect cortical anomalies, ACE inhibitor renography to identify hypertensive patients that will not benefit from revascularization surgery and to determine the glomerular filtration rate. Other studies, such as diuretic renography, are not considered to be gold standards due to the lack of standardized protocols.