Renal Radionuclide Imaging, an Evergreen Forty Years Old (original) (raw)
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Pediatric Radiology, 2008
Background In children who have undergone both 99m Tc-DMSA and 99m Tc-MAG3 studies for the assessment of differential renal function (DRF) and drainage, respectively, we have noticed good agreement between the calculated DRF values, and hypothesized that there is no significant difference in DRF values calculated from these tests. Therefore, both tests may not always be necessary. Objective To determine whether there is a statistically significant difference between DRF values calculated using 99m Tc-DMSA and those calculated using 99m Tc-MAG3. Materials and methods We retrospectively identified children imaged with 99m Tc-DMSA and 99m Tc-MAG3. We recorded DRF values, age, indication, and renal pelvis diameter. For the 99m Tc-DMSA studies we recorded the imaging time after injection. For the 99m Tc-MAG3 studies we recorded the delay between injection and data acquisition, diuretic use and evidence of delayed drainage or reflux. Results We identified 100 episodes in 92 children where both 99m Tc-DMSA and 99m Tc-MAG3 scans had been performed within a few days. The commonest indication was urinary tract infection or pelviureteric junction obstruction. The mean age of the children was 6.96 years. A significant but clinically acceptable trend was seen between abnormal DRF and difference between tests. A significant link was found with the difference between tests and the time of imaging after DMSA injection, and also with scarring. No significant effect was caused by renal pelvis dilatation, delayed drainage, frusemide administration, or delayed 99m Tc-MAG3 imaging. Conclusion If a 99m Tc-MAG3 study has been performed then a 99m Tc-DMSA study is unnecessary provided DRF is normal on the 99m Tc-MAG3 study and there is no scarring. A change in practice would lead to considerable savings in time, cost and radiation burden.
Utility of technetium-99m-MAG3 diuretic renography in the neonatal period
Journal of Nuclear …, 1995
levels commonly involved are at the pelvi-unetenic (PUJ) and vesico-uretenic junctions (VUJ). The management van ies from a conservative approach in nonobstructed kidneys to different operative procedures for PUJ and VUJ ob structions (1). Diuretic renography provides an important diagnostic tool in assessing for functional obstruction of urinary drain age that is safe and relatively noninvasive. Due to its de pendence on glomenulan filtration, 99mTc@diethyhenetni@ aminepentaacetic acid (@Tc-DTPA) has been reported to be unreliable in the neonatal period due to immature renal function, with reduced glomerular filtration rate (GFR) and reduced responsiveness to a diuretic stimulus (2â€"5). Technetium-99m mencaptoacetyltniglycine (@Tc-MAG3) is a radiophanmaceutical that has advantageous properties oven DTPA in diuretic nenognaphy, especially in the neo natal period, in that it is actively secreted predominantly by the anionic tubular transport system with only about 11% filtered at the glomenuhi. It therefore has a higher extraction ratio resulting in a higher kidney-to-background ratio giving improved images for qualitative and quantitative analysis (6). Previous studies have examined the use of MAG3 and/on DTPA in diuretic renography with broad age ranges (7â€" 10). More recently, Chung et al. (11) demonstrated diuretic renography to be reliable in evaluating hydnonephrósisdun ing the neonatal period using either 99mTc@DTPAon 99mTc.. MAG3.
Journal of Urology, 1997
Purpose: We compared the estimation of differential renal function by 99mtechnetium (Tc)dimercapto-succinic acid (DMSA) and 99mTc-pentetic acid scintigraphic methods for followup of prenatally diagnosed unilateral renal pelvic dilatation. Materials and Methods: We retrospectively analyzed differential renal function estimations calculated by static and dynamic methods in time matched test pairs that were included in the charts of 51 children monitored for prenatally diagnosed unilateral renal pelvic dilatation at our institution in a 5-year period. Results: There were 96 test pairs with available archived raw data. Using the analytic method of assessment of agreement between the 2 tests, a 95% limit of agreement of-t9% was calculated. Of the 96 pairs of tests the results of 94 revealed no significant difference. Subgroup analysis by patient age and operative intervention (13 postoperative pairs) also showed no difference in the results of the 2 tests. Conclusions: We established the 95% limits of agreement between ""Tc-DMSA a n d ""Tcpentetic acid tests of differential renal function to be 2 9 % discrepancy in 96 test pairs. During followup of prenatally diagnosed unilateral renal pelvic dilatation the assessment of differential renal function can be made by ""Tc-DMSA static or dynamic diuretic renography techniques. This interchangeability is consistent at all patient ages regardless of operative intervention. Since dynamic diuretic renography provides differential function and drainage data, using ""Tc-DMSA in this context is unnecessary and subjects patients to an unnecessary radiation burden.
Acta Informatica Medica
Introduction: Congenital hydronephrosis (CH) is a condition with dilated renal pelvis with or without dilation of renal calyces. Aim: To examine the role of magnetic resonance urography in the detection of congenital hydronephrosis in comparison to dynamic renal scintigraphy (DRS). Patients and methods: Resarch included 58 (n=58) patients with diagnosis of congenital unilateral or bilateral dilatation of kidney duct system. Each patient had a one-time or multiple hospitalization at the Nephrology Department of the Pediatric Clinic, with performed: ultrasound which confirmed CH, voiding cystourethrography / voiding urosonography was confirmed based on which the vesicoureteral reflux (VUR) was established / excluded, dynamic renal scintigraphy and magnetic urography (analysis was made by CHOP-fMRU software) on the basis of which the uterine anatomy and the relative renal function were evaluated. Results: Male patients were represented in 40 cases (69%). The average age was 4.4 ± 4.3 years with the youngest patient at the age of 2 months, and the oldest was 17 years old. According to diagnostic entities, the most common diagnosis was ureteropelvic junction (UPJ) obstruction in over half of cases (30 or 51.7%), followed by subjects with ureterovesical junction (UVJ) obstruction (11 or 19%), VUR was recorded in 9 (15.5%) cases, and pyelon fissus in 7 (12.1%), and one case (1.7%) was recorded with bilateral megaureter. Comparison of the value of the renal function obtained with DRS and CHOP-fMRU methods shows that there were no statistically significant differences between two methods. In the case of right kidney, the mean DRS value was 53.4 ± 18.4% (range 13-100%), while CHOP-fMRU was 51.8 ± 22.4 (range 0-96.7%). In the case of left kidney, the average value according to the DRS method was 46.9 ± 18.9% (range 0-87%) and according to CHOP-fMRU 47.6 ± 21.5% (range 8.3-100%). The correlation coefficients of both right and left kidneys show a highly statistically significant correlation between these two methods. Conclusion: Magnetic resonance urography in the pediatric population in CH based on results should be an integral part of the management of these patients, especially in congenital obstructive uropathy, in complex and associated congenital anomalies, as it provides morphological and functional data on the state of the kidneys and urinary tract.
Journal of Urology, 2006
We present our experience with dynamic contrast enhanced magnetic resonance urography for evaluation and treatment in infants born with prenatally recognized hydronephrosis. We determined the characteristics of renal dysgenesis in this population. Materials and Methods: We reviewed magnetic resonance urography images done within the first 6 months of life in 67 infants born with prenatally recognized hydronephrosis. High resolution imaging was used to establish a morphological diagnosis. Functional evaluation was used to assess obstruction and individual renal function. Voiding cystourethrography was performed in 62 patients. Results: Our study included 67 infants (87 renal units). There were 54 boys and 13 girls with a mean age of 2.8 months (range 0.9 to 4.6). Of these 87 renal units 30 (35%) had ureteropelvic junction obstruction, 18 (21%) had primary megaureters, 10 (11%) had nondilating vesicoureteral reflux, 10 (11%) had fetal folds, 8 (9%) had posterior urethral valves, 6 (7%) had ectopic ureters, 4 (5%) had multicystic dysplastic kidneys and 1 (1%) had a normal study. Magnetic resonance urography revealed renal dysgenesis in 24 renal units (28%), consisting of loss of corticomedullary differentiation, renal cystic changes distinct from multicystic dysplastic kidneys, solid renal dysplasia, hypoplasia and dysmorphic calyces. Conclusions: Magnetic resonance urography is an excellent addition to our armamentarium for evaluating neonatal hydronephrosis and renal dysgenesis. Due to its comprehensiveness magnetic resonance urography has the potential to become the study of choice for evaluating infants with significant prenatally recognized hydronephrosis. However, further prospective, comparative studies in larger patient populations are needed to justify the cost and the need for sedation in infants.
Urography versus DMSA scan in children with vesicoureteric reflux
Pediatric Nephrology, 1989
Following the diagnosis of primary vesicoureteric reflux, identified as part of the investigation of urinary tract infection, 299 refluxing kidneys in 202 children (aged 0-14 years) were prospectively evaluated using intravenous urography (IVU) and the DMSA renal scan at least 4 weeks after urine infection. There was 88% concordance between IVU and the DMSA scan, but in 12% there were discrepancies manifested in 37 kidneys from 31 children. Thirty-four kidneys were normal on IVU but showed scars of reflux nephropathy (RN) on the technetium 99m -dimercaptosuccinic acid (DMSA) renal scan; 4 of these (2 infants and 2 pre-school children) had severe generalized changes on scanning. Three kidneys were normal of DMSA scan and, although abnormal on initial IVU, were considered to be normal when this was repeated. During a followup period of 5 years an annual DMSA was undertaken in 194 patients and the renal scars remained unchanged in all except 1 child. The IVU was repeated 1-3 years after the initial study in 31 children in which the results of the first imaging did not agree. In 28 patients (34 kidneys) in which the initial IVU was normal but the DMSA abnormal, IVU evidence of scarring emerged in 30 of 34 kidneys, including the 4 patients with severe generalized damage on the DMSA. We conclude that abnormalities detected by the DMSA scan may precede the radiological findings, especially in young children. Even severe RN can be established in kidneys that appear normal on the IVU.
2012
Objective: Renal scintigraphy has privileges in imaging methods in terms of providing functional information. Technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) used in imaging of renal parenchyma is the most reliable radiopharmaceutical in the calculation of differential renal function (DRF). In this study, it was aimed to compare the agents of dynamic renal scintigraphy such as Technetium-99m diethylenetriamine pentaacetic acid (Tc-99m DTPA) and Technetium99m mercaptoacethyltriglycine (Tc-99m MAG3) based on Tc-99m DMSA in terms of DRF. Methodology: Tc-99m DTPA and Tc-99m DMSA scintigraphies were performed in Group A; Tc99m MAG3 and Tc-99m DMSA scintigraphies were performed in Group B. There were 57 patients [23 F, 34 M; mean age: 18.8 ± 17.1 years old (range: 3 months-60 years)] in Group A and 30 patients [15 F, 15 M; mean age: 15.7 ± 14.8 years old (range: 3 months-59 years)] in Group B. The DRF values calculated with Tc-99m DTPA and Tc-99m MAG3 were statistically compared with...
Clinical Radiology, 2000
AIM: To compare assessment by MR excretory urography (MREU), Doppler ultrasound and isotope renography of women with symptomatic hydronephrosis in pregnancy and to define its cause. MATERIALS AND METHODS: Eleven women at 19-34 weeks of gestation were studied prospectively with gadolinium-enhanced breath-hold gradient echo MREU and transabdominal Doppler ultrasound compared with a 'gold standard' of isotope renography employing frusemide challenge. All studies were performed within 24 h, were reported independently in a blinded fashion and employed clearly defined criteria. Obstetric and infant outcomes were obtained. RESULTS: There were no adverse reactions to gadolinium administration in pregnancy and no adverse obstetric or infant outcomes. Three of the 11 women were unable to tolerate the complete MREU protocol. Ultrasound indices could not be used to predict ureteric obstruction as shown by isotope renography. MREU agreed with renographic findings in five of the six cases with obstruction and in two without obstruction. MREU directly demonstrated hydronephrosis to result from extrinsic compression of the ureter between the gravid uterus and iliopsoas muscle. CONCLUSION: MR excretory urography is a promising technique which affords equivalent functional and additional anatomical information to isotope renography. It is more accurate than Doppler ultrasound in the assessment of ureteric obstruction in pregnancy. Spencer, J. A. et al. (2000). Clinical Radiology 55, 446-453.