RENAL

SCINTIGRAPHY
Warissara-Napatriya R1/ Teerapon MD
NUCLEAR MEDICINE IS FUNCTIONAL IMAGING

• To visualise an organ needs a contrast with the surrounding

tissue.
• Radiography/CT needs difference in density.
• MRI needs difference in protons.
• Ultrasound needs difference in reflectivity.
• Nuclear Medicine needs difference in function.
TRACER ; RADIOPHARMACEUTICALS
• Substance added to a physiological pathway, which is handled by
that pathway but does not disturb it.
•Requires small chemical amount of material, but high contrast with
tissue which does not contain pathway.
• Tc-99m
• FUNCTIONAL IMAGING NEEDS TRACERS
• Need to study whole organ over an appropriate time interval.-
DTPA is a tracer for glomerular filtration
GENERAL INDICATIONS

• 1. Renal perfusion and function, including differential (also

known as split or relative) renal function
• 2. Glomerular filtration rate (GFR)
• 3. Effective renal plasma flow (ERPF)
 1. Urinary tract obstruction

2. Renovascular hypertension

CASES AND 3. Renal allograft perfusion and

DISEASES function and complications

4. Pyelonephritis and renal cortical

scarring

5. Congenital and acquired renal

abnormalities, including mass lesions
WHICH FUNCTION? WHICH AGENT?

• Glomerular Filtration Tc-99m-DTPA

• Glomerular Filtration Tc-99m-MAG3

+ Tubular Function

• Tubular Function Tc-99m-DMSA

TECHNETIUM-99M
DIETHYLENE
• Goal #1
TRIAMINE PENTA- • Goal #2
ACETIC ACID • Goal #3

(DTPA)
TECHNETIUM-99M • Rapid extraction by tubular cells
MERCAPTOACETYL • Secretion into the renal
TRIGLYCINE collecting system
• Goal #2

(MAG3) • Goal #3
TECHNETIUM-99M
DIMERCAPTOSUCCI • Goal #1
NIC ACID • Goal #2
• Goal #3
(DMSA)
Favorite foods and snacks

Favorite Disney movie

A FEW OF
Favorite unit I will teach this year MY
FAVORITE
Favorite restaurant THINGS

Favorite picture book

IN MY SPARE TIME

• List a few of your hobbies

• Share your favorite kind of vacation
• Add another way you spend your time outside of school
 YOUR TURN T O
I N T E RV I E W M E

W H AT Q U E S T I O N S W O U L D
YOU LIKE TO ASK ME?
We are going to have a great year
learning together!
SCINTGRAPHY
HEMODYNAMIC OF RENAL ARTERY
STENOSIS
• Reduced renal perfusion pressure
• Activaing renin-angiotensin system
• Angiotensin II cause selective constriction of efferent arterioles and pressure gradient across
GCM.
• ACE inhibitors caused efferent arterioles leading significant reversing decrease in GFR
CAPTOPRIL(ACI INHIBITOR) RENOGRAPHY

• Renovascular hypertension causing by stenosis of renal artery

• Prevalence is severe hypertension and end-stage renal disease
• Imaging assessment is scintigraphy
• ACE inhibitors caused efferent arterioles leading significant
reversing decrease in GFR to detection.
• Fasting for 4 hour and well hydration
• Blood pressure before administration of ACE inhibitor then q 10-15 min.
• Giving furosemide IV promptly of radiopharmaceutical administration >> for reduced retention
radiopharmaceutical in collecting system.
• Stop previous administration ACE inhibitor for3-7 day.
• With using enalaprilat and technetium MAG3 post ACE inhibitor scan can be completed within 60-
90 min
 Baseline scan 20-30min
 Enalaprilat IV 40 mg/kg
 Technetium-99m MAG3 is administered10-12 min later
 Second scan perform 20-30 min
EVALUATION OF RENAL ALLOGRAFTS

• To assessment of renal allograft dysfunction

• Technetium-99m MAG3 or technetium-99m DTPA may be used
• Renal perfusion image to assess the renal perfusion, cortical infarcts, ATN, collecting system
obstruction, rine leads, nephrotoxic effecti of medication
 Cyclosporin A
• Rejection allograft
RENAL CORTICAL IMAGING

• The radiopharmaceutical is technetium-99mm DMSA

• Optimal parachymal imaging obtained 2-4 hr. after administration
• In hydrohephrosis, Delay imaging at 24 hours or administration with furosemide.
ESTIMATION OF GFR

• Radiopharmaceutical : Technetium GFR-99m DTPA