Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Renal scintigraphy

13,851 views

Published on

1.DMSA scintigraphy
2.Dynamic renal studies

Published in: Health & Medicine

Renal scintigraphy

  1. 1. Renal RadionuclideRenal Radionuclide imagingimaging Dr.Aftab QadirDr.Aftab Qadir
  2. 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. 3. GF TS TF Tc-99m DTPA >95% Tc-99m MAG3 <5% 95% I-131 OIH 20% 80% Tc-99m DMSA some 60%
  4. 4. Perfusion MAG3, DTPA Morphology DMSA Obstruction MAG3, DTPA, OIH Relative function All GFR quantitation EDTA, DTPA Clin. Question Agent
  5. 5. • 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
  6. 6. Normal DMSANormal DMSA pinholepinhole LPO RPOLPO RPO
  7. 7. Normal DMSA studyNormal DMSA study
  8. 8. Applications of DMSAApplications 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
  9. 9. • Agenesis • Renal ectopia • Fusion (horseshoe) • Multicystic dysplastic kidney
  10. 10. Horseshoe kidneyHorseshoe kidney
  11. 11. ectopic kidneyectopic kidney
  12. 12. Post infective scarringPost infective scarring
  13. 13. Bilateral Wilms' tumorsBilateral Wilms' tumors
  14. 14. • Acute or chronic pyelonephritis • Hydronephrosis • Cyst • Tumors • Trauma (contusion, laceration, rupture, hematoma) • Infarct • Abscesses
  15. 15. • Acute pyelonephritis • single or multiple “cold” defects • renal contour not distorted • diffuse decreased uptake • diffusely enlarged kidney or focal bulging
  16. 16. RightRight acute pyelonephritisacute pyelonephritis
  17. 17. • Tracer: MAG3, (DTPA) • Labeling with technetium- 99m gives a lower radiation dose • better imaging and measurement statistics
  18. 18. Normal Tc-MAG3 dynamic renalNormal Tc-MAG3 dynamic renal studystudy
  19. 19. DTPA normalDTPA normal
  20. 20. DTPA normalDTPA normal
  21. 21. Relative (split) functionRelative (split) function
  22. 22. Diuretic (Lasix) Renal Scan
  23. 23. • 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 (T1/2)
  24. 24. • 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
  25. 25. Dilated but unobstructed renal pelvis
  26. 26. Low-grade obstructionLow-grade obstruction
  27. 27. • Normal < 10 min • Obstructed > 20 min • Indeterminate 10 - 20 min
  28. 28. Captopril Renal ScanCaptopril Renal Scan (ACEI Renography)(ACEI Renography)
  29. 29. • Gold standard: angiography • Initial non-invasive tests: • Duplex sonography • ACEI renography • Other tests: • MRA
  30. 30. • 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
  31. 31. • 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.
  32. 32. Right renal artery stenosisRight renal artery stenosis
  33. 33. ACEI RenographyACEI Renography Grading renogram curvesGrading renogram curves
  34. 34. 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
  35. 35. • 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.
  36. 36. • 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
  37. 37. • 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
  38. 38. filling voiding post-voidfilling voiding post-void
  39. 39. Acute tubular necrosisAcute tubular necrosis
  40. 40. acute tubular necrosisacute tubular necrosis
  41. 41. Few casesFew cases
  42. 42. DMSADMSA Left AgenesisLeft Agenesis
  43. 43. DMSA -horseshoe kidneyDMSA -horseshoe kidney
  44. 44. Unilateral PUJ obstructionUnilateral PUJ obstruction

×