Renal scintigraphy

1.DMSA scintigraphy
2.Dynamic renal studies

1. Renal Radionuclide Renal Radionuclide
imagingimaging
Dr.Aftab QadirDr.Aftab Qadir

2. •Renal perfusion and function
•Obstruction (Lasix renal scan)
•Renovascular HTN (Captopril renal scan)
•Infection (renal morphology scan)
•Pre-surgical quantitation (nephrectomy)
•Renal transplant
•Congenital anomalies, masses
(renal morphology scan)

3. GF TS TF
Tc-99m DTPA >95%
Tc-99m MAG3 <5% 95%
I-131 OIH 20% 80%
Tc-99m DMSA some 60%

5. Perfusion MAG3, DTPA
Morphology DMSA
Obstruction MAG3, DTPA, OIH
Relative functionAll
GFR quantitation EDTA, DTPA
Clin. Question Agent

6. •Tracers
•Tc-99m DMSA
•Acquisition
•2-4 hrs post-injection
•pinhole posterior + post. oblique (or SPECT)
1.DMSA scintigraphy1.DMSA scintigraphy
Renal Morphology ScanRenal Morphology Scan

8. Normal DMSA Normal DMSA
pinholepinhole
LPO RPOLPO RPO

9. Normal DMSA studyNormal DMSA study

10. Applications of DMSA Applications of DMSA
scintigraphyscintigraphy
1.Renal ectopia and anomalies1.Renal ectopia and anomalies
2.Renal masses and pseudomasses2.Renal masses and pseudomasses
3.Infection and scarring3.Infection and scarring

11. •Agenesis
•Renal ectopia
•Fusion (horseshoe)
•Multicystic dysplastic kidney

12. Horseshoe kidneyHorseshoe kidney

13. ectopic kidney ectopic kidney

14. Post infective scarring Post infective scarring

15. Bilateral Wilms' tumorsBilateral Wilms' tumors

16. •Acute or chronic pyelonephritis
•Hydronephrosis
•Cyst
•Tumors
•Trauma (contusion, laceration, rupture, hematoma)
•Infarct
•Abscesses

17. •Acute pyelonephritis
•single or multiple “cold” defects
•renal contour not distorted
•diffuse decreased uptake
•diffusely enlarged kidney or focal bulging

18. Right Right acute pyelonephritis acute pyelonephritis

19. •Tracer: MAG3, (DTPA)
•Labeling with technetium- 99m gives a lower
radiation dose
•better imaging and measurement statistics

20. Normal Tc-MAG3 dynamic renal Normal Tc-MAG3 dynamic renal
studystudy

23. DTPA normalDTPA normal

24. DTPA normalDTPA normal

25. Relative (split) functionRelative (split) function

28. Diuretic (Lasix) Renal Scan

29. •Hydronephrosis - tracer pooling in dilated renal pelvis
•Lasix induces increased urine flow
•If obstructed >>> will not wash out
•If dilated, non-obstructed >>> will wash out
•Can quantitate rate of washout (T
1/2
)

30. •Tracers: Tc-99m MAG3 5-10 mCi
•Acquisition: supine until pelvis full
(can switch to sitting post- Lasix)
•Flow (angiogram) : 2-3 sec / frame x 1 min
•Dynamic: 15-30 sec / frame x 20-30 min

34. Dilated but unobstructed renal pelvis

35. Low-grade obstructionLow-grade obstruction

36. •Normal < 10 min
•Obstructed > 20 min
•Indeterminate 10 - 20 min

38. Captopril Renal ScanCaptopril Renal Scan
(ACEI Renography) (ACEI Renography)

39. •Gold standard: angiography
•Initial non-invasive tests:
•Duplex sonography
•ACEI renography
•Other tests:
•MRA

40. •Off ACEI & ATII receptor blockers x 3-7 days
•Off diuretics x 5-7days
•No solid food x 4 hours
•Patient well hydrated
•10 ml/kg water 30-60 min pre and during test
•ACEI
•Captopril 25-50 mg po (crushed), 1 hr pre-scan
Patient PreparationPatient Preparation

41. •Tracer: Tc-99m MAG3 (or DTPA)
•Protocol: 1 day vs. 2 day test
•1 day test: baseline scan (1-2 mCi) followed by
post-Capto scan (8-10 mCi)
•Acquisition: flow & dynamic x 20-30 min.

42. Right renal artery stenosisRight renal artery stenosis

43. ACEI RenographyACEI Renography
Grading renogram curvesGrading renogram curves

44. Grade I Mild delay in Tmax (6-11 min using 99m Tc-
DTPA) with a falling excretion phase
Grade 2 More prolonged delay in T max (greater than
11 min) but still with an excretion phase
Grade 3 with marked reduction in function of the
affected kidney

48. •Evaluation of children with recurrent UTI
•30-50% have VUR
•Follow up after initial VCUG
•Assess effect of therapy / surgery
•Screening of siblings of reflux patients.

49. •Tc-99m
•via Foley
•can do at any age
•VUR during filling
•catheterization
•Tc-99m DTPA or
Tc-99m MAG3
•i.v.
•no catheter
•info on kidneys
•need patient
cooperation
•need good renal
function
AdvantageAdvantage
Disadv.Disadv.
Direct Indirect

50. •Lower radiation dose
(5 vs 300 mrad to
ovary)
•Smaller amount of
reflux detectable
•Quantitation of post-
void residual volume
•Cannot detect distal
ureteral reflux
•No anatomic detail
•Grading difficult
Advantages Disadvantages

51. filling voiding post-voidfilling voiding post-void

53. Acute tubular necrosisAcute tubular necrosis

54. acute tubular necrosisacute tubular necrosis

55. Few casesFew cases

57. DMSA DMSA Left AgenesisLeft Agenesis

58. DMSA -horseshoe kidneyDMSA -horseshoe kidney

59. Unilateral PUJ obstructionUnilateral PUJ obstruction