Radionuclide Diagnostics
of the Urinary System
1. Static renal scintigraphy
2. Dynamic renal scintigraphy (renoscintigraphy)
- with diuretic test
- with Captopril test
- voiding renal scintigraphy
3. Determination of renal clearances
4. Radionuclide cystography
RENOSCINTIGRAPHY
Radiopharmaceuticals (accumulation mechanisms):
99mTc-EC
99mTc-DTPA
glomelural filtration
and tubular secretion
99mTc-MAG
3
tubular secretion
99mTc-DTPA
glomelural filtration
123/131I-OIH
glomelural filtration
and tubular secretion
99mTc-EC
(123/131I-OIH)
99mTc-MAG
3
RENOSCINTIGRAPHY
Indications:
1.
Diagnosis of obstructive uro- and nephropathy
2.
Evaluation of renovasular hypertension
3.
Diagnosis of transplanted kidney
4.
Post-traumatic functional evaluation of kidney(s)
5.
Detection and localization of traces of functioning renal parenchyma
6.
Diagnosis of congenital kidney anomalies
7.
Detection and monitoring of vesicoureteral reflux (voiding
renoscintigraphy – indirect method)
8.
Detecting inflammations and cortical scars (parametric clearance
images).
RENOSCINTIGRAPHY
Physiological renoscintigraphy
2 min. sequential images
Renographic curves
L
R
Uptake phase
Vascular phase
Elimination phase
RENOSCINTIGRAPHY
Obstructive uropathy (complete)
L
R
RENOSCINTIGRAPHY
Obstructive uropathy (incomplete)
Renographic curves
L R
Furosemide
Left
Right
Diuretic test
Relative function:
LK: 57% RK: 43%
Renovascular hypertension (RT:
99mTc-EC)
Control study
Sensitivity and specificity ≥ 90%
Study after administering
Captopril (50mg p.o.)
Angio-CT:
Right renal
artery stenosis
RENOSCINTIGRAPHY
Congenital disorders
L
R
Horseshoe kidney
R
Agenesis
RENOSCINTIGRAPHY
L
P
Hypoplasia
Cirrhotic kidney
L
R
RENOSCINTIGRAPHY
Parametric clearance images
Physiological images – normal
clearance function of kidneys
Static sc.
(planar image)
Static sc.
(SPECT)
Parametric
image
Renal scarring (chronic pyelonephritis)
Static sc.
(SPECT)
Parametric
image
Renoscintigraphy
STATIC RENAL SCINTIGRAPHY
Radiopharmaceutical:
99mTc-DMSA
Mechanism of accumulation – taken up and cumulated in the cells of
proximal convulted tubes.
Planar image (PA)
Renal cortex
SPECT image (coronal plane)
LK: 52%, RK:48%
Imaging methods: planar scintigraphy
(posteroanterior and posterior-lateral oblique projections), SPECT
STATIC RENAL SCINTIGRAPHY
Indications:
1.
Detection of post-inflammatory renal scars (especially in children)
2.
Evaluation of kidneys during acute infection (confirmation of acute
pyelonephritis in children)
3.
Differentiation between pseudotumors and neoplastic tumors of kidneys
4.
Detection and localization of traces of functioning renal parenchyma
5.
Diagnosis of congenital kidney anomalies
STATIC RENAL SCINTIGRAPHY
Cortical scars
Reduced renal function
10%
L
90%
R
Ectopic kidney
STATIC RENAL SCINTIGRAPHY
Tumor (left kidney)
USG
”Pseudotumor” (right kidney)
DETERMINATION OF KIDNEY CLEARANCES (GFR, ERPF)
Radiopharmaceuticals: 99mTc–DTPA (GFR)
GFR – glommerular filtration rate
ERPF – effective renal plasma flow
131I–OIH
(ERPF)
99mTc–EC (ERPF)
Method:
Taking blood samples in constant time intervals (2-10
samples), after intravenous injection of known activity of
radiopharmaeutical.
Advantages:
- measuring kidney clearance after a single injection of the RF
- high accuracy
- no need for urine collection
Indications:
Evaluating and monitoring renal function in
chronic kidney diseases or in patients treated
with nephrotoxic drugs (e.g. antibiotics, cancer
chemotherapy), evaluation of kidney function in
potential kidney donors.
Steżenie kreatyniny [mg%]
25
20
15
10
5
1,2
0
0
20
40
60
80
GFR [ml/min]
100
120
140
RADIONUCLIDE CYSTOGRAPHY
Radiopharmaceuticals:
99mTc–DTPA
or
99mTc–colloid
applied intravesically.
Indications:
Radiological VUR grading system
L
Detection and monitoring of vesicoureteral reflux
(VUR) in children with recurring urinary tract
infections, evaluating treatment effectiveness.
R
mild VUR (I°)
moderate VUR (II-III°)
severe VUR (IV-V°)