The accuracy of 99mTc-DTPA scintigraphy in the evaluation of acute renal graft complications (original) (raw)
Related papers
MTC-Dtpa Scintigraphy in the Evaluation of Acute Renal Graft Complications
Purpose: Renal scintigraphy has been used for many years in the evaluation of renal transplants and can help in the diagnosis of graft complications, leading to prompt clinical management and preventing further deterioration of renal function. The purpose of this study was to evaluate the overall accuracy of renal scintigraphy with Tc-DTPA in the diagnosis of acute renal graft complications. Materials and Methods: Seventy-six scintigraphic studies performed in 55 patients (ages ranging from 6 to 65 years), were reviewed. Scintigraphy results were compared to biopsies performed within 5 days of imaging. Tc-DTPA study was performed within a mean time of 19 days after kidney transplants. Dynamic images were performed in the anterior position of the abdomen and pelvis every 2 seconds for 80 seconds (flow phase) and every 15 seconds for 30 minutes (functional phase), after an intravenous injection of 370 MBq (10 mCi) of Tc-DTPA. Results: The scintigraphic results were concordant with the...
Scintigraphic evaluation of the kidney
Romanian Journal of Military Medicine, 2015
There are more than one technique used to evaluate the kidney, besides the standard ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), there is also renal scintigraphy. The renal nuclear medicine procedures are grouped as in vitro (urine counting wells, basic probe detectors for clearance studies) and in vivo procedures (static and/or dynamic examinations done with planar gamma cameras, and single-photon emission computed tomography (SPECT) to determine kidney parameters or for cortical imaging). Renal scintigraphy has been a useful tool, since the early 1950s, in the diagnosis and management of many pathological changes in the kidney, especially in measuring renal function (e.g. obstructive/nonobstructive uropathies, renal inflammatory diseases, tumours, renal hypertension, and renal transplant viability). [1]
Transplantation Proceedings, 2003
K IDNEY TRANSPLANTATION has become the therapy of choice for children with end-stage renal failure. Compared with children who receive other forms of renal replacement therapy, pediatric transplant recipients show markedly better growth and development, and a better quality of life. 1,2 However, graft survival for children remains lower than for adults despite improvements in surgical techniques, immunosuppressive drugs, and medical care. The most common cause of renal graft loss is immunologic complications. Moreover, clinical recognition of these complications in the early period is usually difficult. 3 Allograft biopsy is considered the only definitive method to detect transplant problems but this is an invasive procedure that carries significant morbidity. 1 Quantitative noninvasive methods are needed to diagnose graft dysfunction in its early stages. Renal scintigraphy may meet these requirements. The aim of this study was to evaluate the value of serial quantitative Tc-99m diethylenetriamine pentaacetic acid (DTPA) scintigraphy for monitoring graft function and discovering complications in pediatric renal transplant recipients. For this purpose, scintigraphy findings were compared with the results of core-needle biopsy.
Diagnostic Accuracy of Color Doppler Sonography in Evaluation of Renal Transplant Rejection
PJR, 2016
BACKGROUND: De s pite th e introduction of ne w im m unos uppre s s ive age nts , th e incide nce of al l ograft re je ction afte r re nal trans pl antation is s til l h igh. Col or Doppl e r Sonograph y (CDS) is th e im aging te ch niq ue w h ich is s afe for th e e val uation of a re nal al l ograft. It provide s rapid re cove ry room e xam ination. If w arrante d, th e patie nt can im m e diate l y re turn to s urge ry, be re fe rre d for te s ting, or unde rgo oth e r inte rve ntional proce dure s. OBJECTIVE: It is aim of pre s e nt s tudy to de te rm ine diagnos tic accuracy of col or doppl e r s onograph y in acute re nal trans pl ant re je ction w ith s upport of h is topath ol ogical findings as gol d s tandard. METHODS: Total 88 patie nts of e ith e r ge nde r w ith age 20 ye ars or m ore and s us pe cte d of re nal trans pl ant re je ction w ith in one w e e k to one m onth afte r trans pl antation w e re incl ude d in th is s tudy. Col or doppl e r s onograph y w as pe rform e d and abdom inal , s e rial l ongitudinal and trans ve rs e im age s w e re as s e s s e d. Re s is tive inde x >0.8 w as cons ide re d graft re je ction. Se ns itivity, s pe cificity, PPV , NPP, and diagnos tic accuracy w e re cal cul ate d tak ing h is topath ol ogy as gol d s tandard. Th e data w e re anal yz e d us ing SPSS and p val ue s of >0.05 w e re cons ide re d as s ignificant. RESUL TS: M al e patie nts w e re 51.1% and fe m al e w e re 48.9 %. M e an age w as 36.5 ± 10 ye ars. Acute re nal trans pl ant re je ction w as diagnos e d in 46.5% patie nts us ing col or doppl e r s onograph y and on h is topath ol ogy it w as obs e rve d in 55.6% patie nts. Th e s e ns itivity of CDS w as 79 .2% , w h il e w e obs e rve d 9 5% s pe cificity and diagnos tic accuracy w as found 86.3%. CONCLUSION: W e propos e th at col or doppl e r s onograph y (CDS) is an accurate te s t for diagnos is of acute re nal trans pl ant re je ction. It is non-invas ive and h e l ps to avoid unne ce s s ary s urge rie s in s uch patie nts .
Limited clinical value of two consecutive post-transplant renal scintigraphy procedures
European Radiology, 2019
Objectives Duration of delayed graft function (DGF) and length of hospital stay (LOS) are outcomes of interest in an era that warrants increased efficacy of transplant care whereas renal allografts originate increasingly from marginal donors. While earlier studies investigate the predictive capability of a single renal scintigraphy, this study focuses on the value for both DGF duration and LOS of consecutively performed scintigraphies. Methods From 2011 to 2014, renal transplant recipients referred for a Tc-99m MAG3 renal scintigraphy were included in a single-center retrospective study. Primary endpoints were DGF duration and LOS. Both the first (≤ 3 days) and second scintigraphies (3-7 days after transplantation) were analyzed using a 4-grade qualitative scale and quantitative indices (TFS, cTER, MUC10, average upslope). Results We evaluated 200 first and 108 (54%) consecutively performed scintigraphies. The Kaplan-Meier curves for DGF duration and qualitative grading of the first and second scintigraphy showed significant differences between the grades (p < 0.01). The Kaplan-Meier curve for the delta grades between these procedures (lower, equal, or higher grade) did not show significant differences (p = 0.18). Multivariate analysis showed a significant association between the qualitative grades, from the first and second scintigraphy, and DGF duration, HR 1.8 (1.4-2.2, p < 0.01) and 2.8 (1.8-4.3, p < 0.01), respectively. Conclusions Qualitative grades of single renal scintigraphies, performed within 7 days after transplantation, can be used to make a reliable image-guided decision on the need for dialysis and to predict LOS. A consecutive renal scintigraphy, however, did not show an additional value in the assessment of DGF. Key Points • Post-transplant renal scintigraphy procedures provide information to predict delayed graft function duration and length of hospital stay. • Performing two consecutive renal scintigraphy procedures within 1 week after transplantation does not strengthen the prediction of delayed graft function duration and length of hospital stay. • Single renal scintigraphy procedures can be used to provide clinicians and patients with a reliable indication of the need for dialysis after transplantation and the expected duration of hospitalization.
Open Medicine, 2019
Purpose The aims of this study were to determine whether post transplant renal scan performed at around 1 week can predict graft failure, and to identify the best predictive factors among easy-to-measure variables. Materials and methods We retrospectively evaluated patients who underwent Tc-99m DTPA renal scan at approximately 1 week after renal transplantation. They were separated into two categories at 3 months after the operation; graft failure and non-failure. Graft failure was confirmed by biopsy (rejection). Non-failure was confirmed either by biopsy or clinical follow-up with serum creatine (Cr). Scan parameters including glomerular filtration rate (GFR), Hilson perfusion index, peaks of the iliac and graft perfusion curves were analyzed. Clinical variables including age, sex, height, weight, systolic blood pressure, serum Cr, type of donated kidney, side of transplant, and immunosuppressant were also analyzed. Results Among total 45 patients, graft failure was present in 11 ...
Grand Journal of Urology, 2022
Objective: This study aimed to evaluate whether computed tomography (CT) can replace scintigraphy for the preoperative evaluation of split renal function (SRF) and to determine the agreement between different CT volumetric measurement methods used so as to demonstrate this function. Materials and Methods: The split renal function (SRF) percentage of living kidney donor candidates was determined by diethylenetriamine pentaacetic acid (DTPA) perfusion scintigraphy. The modified ellipsoid volume (MELV), semi-automatic total kidney volume (STKV) and semi-automatic renal cortex volume (SRCV) of the candidates who underwent contrast-enhanced CT were measured and the percentages of both kidney volumes were calculated. The inter-method agreement was evaluated using Pearson's correlation test and the Bland-Altman plot test. Results: There was no correlation between the right and left kidney SRF and MELV (r=-0.033 and r=-0.092), MELV% (r=0.076 and r=0.076), STKV (r=-0.005 and r=-0.120), STKV% (r=0.175 and r=0.172), SRCV (r=-0.001 and r=0.130) and SRCV% (r=0.205 and r=0.183). There were significant correlations between the right MELV and STKV (r=0.855) and SRCV (r=0.813), and between the left MELV and STKV (r=0.787) and SRCV (r=0.770). Conclusion: Although CT provided detailed preoperative anatomical information, volumetric measurements did not show agreement with SRF. The agreement of each 3 volumetric examinations within themselves made us think that disagreement with SRF was independent of the volumetric method chosen.
Renal Scintigraphy in the Acute Care Setting
Seminars in Nuclear Medicine, 2013
Renal scintigraphy is a powerful imaging method that provides both functional and anatomic information, which is particularly useful in the acute care setting. In our institution, for the past 2 decades, we have used a 25-minute renal diuretic protocol, technetium-99m (99m Tc) mercaptoacetyltriglycine with simultaneous intravenous injection of furosemide, for all ages and indications, including both native and transplant kidneys. As such, this protocol has been widely used in the workup of acutely ill patients. In this setting, there are common clinical entities which affect patients with native and transplant kidneys. In adult patients with native kidneys one of the most frequent reasons for emergency room visits is renal colic due to urolithiasis. Although unenhanced computed tomography is useful to assess the anatomy in cases of renal colic, it does not provide functional information. Time zero furosemide renal scintigraphy can do both and we have shown that it can effectively stratify patients with renal colic. To this end, 4 characteristic patterns of scintirenography have been identified, standardized, and consistently applied: no obstruction, partial obstruction (mild vs high grade), complete obstruction, and stunned (postdecompressed) kidney. With the extensive use of this protocol over the past 2 decades, a pattern of ''regional parenchymal dysfunction'' indicative of acute pyelonephritis has also been delineated. This information has proved to be useful for patients presenting with urinary tract infection and suspected pyelonephritis, as well as for patients who were referred for workup of renal colic but were found to have acute pyelonephritis instead. In instances of abdominal trauma, renal scintigraphy is uniquely suited to identify urine leaks. This is also true in cases of suspected leak following renal transplant or from other iatrogenic/postsurgical causes. Patients presenting with acute renal failure can be evaluated with renal scintigraphy. A scintigraphic pattern of ''relative preservation of flow as compared to function'' has been identified as indicative of acute tubular necrosis, which is distinct from other potential causes of acute renal failure, such as nephrotoxicity and in the case of renal transplants, rejection.
Pediatric Transplantation, 2007
A retrospective analysis of the value of Tc-99m DTPA DRS in children requiring renal biopsy following transplantation. Thirty-one children following renal transplantation with possible rejection underwent thirty-nine DRS and biopsy within a 72-h period and clinical followed up for 12 months. The biopsy was classified according to the Banff 97. The DRS assessed semi-quantitatively images of renal perfusion and filtration, and the balance between these two images. The clinical notes were reviewed. Based on the biopsy results 15 children had acute rejection, three children chronic rejection, nine children a mixed appearance of both acute and chronic rejection while 12 children had no rejection. Based on the long-term clinical outcome, the DRS had an overall sensitivity of 76% and specificity of 86%. While renal biopsy remains the gold standard for the diagnosis of rejection, if the perfusion and filtration phases of the DRS are analysed separately and the results integrated, there is a possibility of suggesting that acute rejection is not the cause of the increase in creatinine. The DRS provides useful information to the nephrologist when taken in conjunction with the biopsy result and other investigations.