From May 11-14, 2007, the International Scientific Committee of Radionuclides in Nephrourology (ISCORN) group held its 12th consecutive meeting in Antalya, Turkey. This meeting marks the 40th anniversary of the concept of an international meeting devoted to the study of radionuclides in various aspects of kidney and urinary tract disease. This issue of the Seminars in Nuclear Medicine includes 6 manuscripts from lectures that were invited by the committee for presentation at the meeting and a review of the origin of this meeting, its organization, and its accomplishments. There were also free communications that are not included here. A special feature article reporting the consensus on renal transit time has been included in this issue with grant support from ISCORN. Few topics in renal nuclear medicine have met with the controversy that the measurement of transit time has generated. It has taken more than 2 years of intensive discussion among a group of experts in this area to resolve conflicting ideas in an effort to arrive at a consensus. Although the consensus does not represent unanimity among all of the members of the committee, it does present an acceptable overview of the use of renal transit time and its interpretation. To conserve space, the appendix for the transit time consensus is published on the ISCORN website (www.ISCORN.org). Individuals who wish to have a detailed understanding of the mathematical basis of transit time studies should consult that website.
The 6 articles that represent the highlights of the meeting reflect the fact that renal nuclear medicine has been relatively stable for the last several years, but there is a major opportunity for significant advancement in this area. The article by Massoud and colleagues reviews the potentials for genomic imaging. This is an area that will be of great importance not only in renal, but in all of nuclear medicine, with the evolution of genetic therapy and the identification of genetic-based disease. The need to image these aspects of the genome will increase and will undoubtedly become a major application of nuclear medicine over the next decade.
The competition of diagnostic radiology modalities with nuclear medicine has increased during the last several years and has become significant. It is probable that several aspects of renal nuclear medicine will be replaced by diagnostic radiology techniques. The article by Grenier and colleagues on magnetic resonance imaging assessment of renal function demonstrates the potential of this modality which, although not yet practical, is at hand. Dr. Szabo and colleagues present a review of renal radiopharmaceuticals. Like the rest of nuclear medicine, the advances in renal nuclear medicine are highly dependent on the development on new radiopharmaceuticals. Radiopharmaceuticals for renal positron emission tomography are complex. Most institutions do not have facilities available at this time to permit them to delve into this area. However, it is likely that as clinical utility is proven, they will achieve commercial production and be available routinely. Another area of competition for radionuclide studies is with routine renal function tests. Chemical monitoring of renal function has been widely accepted by the nephrologic community but there are a great many issues with these tests. Dr. Prigent has reviewed for us the potential errors and limitations of measuring renal function with substances such as creatinine. This makes a strong case for the use of radionuclides in this area.
An understanding of how one should interpret renal scans is another important subject. It is almost impossible in any diagnostic area to achieve unanimity of opinion. Utility is based largely on clinical experience and is affected by many factors. Dr. Taylor and colleagues review the influence of these factors and decision support systems on interpretation of the renogram. Finally, Drs. Biassoni and Chippington have provided us with a perspective of the role of imaging in urinary tract infection in children. This technique, while not utilized extensively in the United States, is employed in many pediatric centers in Europe. Clearly nuclear medicine has an important role to play in the evaluation of urinary tract infection and in determining the prognosis of infection. This too is a controversial area but Dr. Biassoni puts it in perspective for us.
Renal nuclear medicine, like the rest of the field, is alive and well and we look forward to future progress.
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