Paediatric nephro-urology imaging: updates in renal scintigraphy and pitfalls

Paediatric nephro-urology imaging plays a central role in the evaluation of congenital renal abnormalities, with renal scintigraphy remaining the reference standard for functional assessment of drainage, differential renal function, and cortical integrity. Despite advances in ultrasound and cross-sectional imaging, nuclear medicine techniques continue to provide unique quantitative and physiological information that directly influences clinical decision-making. Recent developments include improved standardisation of paediatric renography protocols, optimised use of 99m Tc-labeled radiopharmaceuticals such as [ 99m Tc]Tc-MAG3, [ 99m Tc]Tc-EC and [ 99m Tc]Tc-DMSA, and increasing incorporation of hybrid SPECT/CT imaging for problem-solving in equivocal cases. Interpretation of diuretic renography has also evolved, with greater emphasis on integrated analysis rather than reliance on single quantitative indices. Paediatric renal scintigraphy, however, remains prone to interpretative pitfalls due to developmental renal physiology, technical variability, and overlapping imaging appearances between obstructive and non-obstructive systems. False-positive obstruction, misinterpretation of drainage patterns, and challenges in cortical defect characterisation remain significant issues. This review summarises current advances in paediatric renal scintigraphy, highlights optimised imaging protocols, and discusses common interpretative pitfalls with strategies to improve diagnostic accuracy in clinical practice.