17 - Renal Isotope Scan

17 - Renal Isotope Scan - ‫‪RENAL ISOTOPE SCAN‬‬...

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Unformatted text preview: ‫‪RENAL ISOTOPE SCAN‬‬ ‫‪RENAL‬‬ ‫الدكتور قصي المقبل‬ ‫أستاذ مشارك- قسم الشعة والطب‬ ‫النووي‬ ‫كلية الطب-جامعة العلوم والتكنولوجيا‬ ‫الردنية‬ RENAL SCAN RENAL Static renal scan Dynamic renal scan Static Renal Scan Static The Radiopharmaceutical is Tc99m- DMSA. DMSA. It is given intravenously. Image is obtained It in 2 hours. in It binds sufficiently to the renal tubules and It lasts for several hours. This will permit good renal cortical imaging. good The main clinical application of DMSA The scan is in acute pyelonephritis in children. scan Renal Morphology (functional anatomy) Pinhole images Posterior 2 mCi 99mTc-DMSA; imaged @ 3 hours post inj. DMSA; hours inj Acute Pyelonephritis in Children Acute The diagnosis of AP in children is difficult The based on clinical and laboratory findings. based Intravenous urography and renal Intravenous sonography have a low sensitivity and underestimate the degree of parenchymal involvement. involvement. DMSA scan is highly sensitive for the DMSA diagnosis of acute pyelonephritis in children. children. Pathophysiology of AP Pathophysiology In acute stage of AP, segmental renal infection In causes inflammatory process which results in edema. Edema causes focal vasculature pressure. This will result in ischemia. This stage manifests on the scan as focal This reduced uptake. reduced Later on, ischemia resolves completely in most Later cases or may progress and scar develops in few cases. Renal scarring and AP Renal On DMSA scan, the scar manifests as On focal cortical defect. focal The presence of renal scarring usually The mandates prolonged prophylactic antibiotics to prevent further attacks of AP antibiotics and further scarring. and Hypertension has been reported in 10%18% of patients with renal scarring Renal Scar Renal Renal Scar Renal Renal scarring and VUR Renal 30% of patients with renal scarring have 30% vesicoureteral reflux. vesicoureteral Renal scarring associated with vesicoureteral reflux accounts for 10% to 20% of patients with end-stage renal disease. Dynamic Renal Scan Dynamic Radiopharmaceuticals Technique Renogram and split function Clinical applications Radiopharmaceuticals Radiopharmaceuticals Filtered agents (DTPA) Tubular agents (MAG3) Technique Technique Perfusion phase Uptake phase Excretion phase Perfusion phase Perfusion 30-60 images are taken over 1 minute 30-60 immediately post injection. immediately This phase givens an idea about renal This vasculature. vasculature. Renal Perfusion (Qualitative) 8 mCi 99mTc-MAG3; imaged @ 2 sec/frame Uptake phase Uptake Image is taken every 15 seconds. This phase represents This radiopharmaceutical extraction from blood stream. stream. Peak uptake is expected in 4-6 minutes Peak post injection Renal Function (Qualitative and Quantitative) 8 mCi 99mTc-MAG3; MAG3; imaged @ 4min/frame imaged Excretion phase Excretion Image is taken every 15 seconds. Images will continue for total time of 30 Images minutes from the start point. minutes IV Lasix is given at 15 minutes from start IV point. point. Excretion is expected immediately after Excretion uptake peaking. Significant spontaneous excretion is expected before giving Lasix. excretion Renogram and Split Function Renogram It is a curve called time-activity curve. It is drawn by the computer. Split function is analyzed during 4-6 Split minutes post injection. minutes Split function means how much each Split kidney contributes to total renal function. kidney Normal limit of split function is 50% ± 6% Normal for each kidney with a total of 100%. for Renogram Renogram Data Acquisition and Processing Flow Function Renal Perfusion Renal Renal Uptake Phase Renal Renal Excretion Phase Renal Renogram Renogram Clinical Applications Clinical Dilated collecting system Dilated (hydronephrosis) (hydronephrosis) Residual function in atrophic kidney Dilated collecting system ((hydronephrosis (hydronephrosis This entity could be: 1-Obstructive hydronephrosis: Children: congenital (pelvi-uretric junction stenosis). stenosis). Adults: stone disease. Adults: 2-Non-obstructive hydronephrosis: vesicoureteral reflux. vesicoureteral Post-resolution of obstruction. Post-resolution Obstructive hydronephrosis Obstructive Lasix plays essential role in differentiating Lasix between obstructive from non-obstructive hydronephrosis. hydronephrosis. Initially there would be accumulation of radiopharmaceutical in dilated collecting system. system. If there is obstruction, there would be no If or poor response to Lasix and dilated collecting system will stay full. collecting Non-obstructive dilatation Non-obstructive IVU, ultrasound and pre-Lasix stage of dynamic IVU, renal scan will demonstrate dilated collecting system. By increasing urine flow using Lasix, intrapelvic By pressure will increase resulting in emptying of dilated collecting system. dilated Clinical Indications Clinical Dynamic renal scan is recommended as Dynamic the initial screening study in patients found on IVU or US to have hydronephrosis without obvious cause (equivocal obstruction). It is used to follow patients with managed It (treated) obstructive hydronephrosis. (treated) Obstructed Hydronephrosis Obstructed Obstructed Hydronephrosis Obstructed Obstructed Hydronephrosis Obstructed Non-obstructed Hydronephrosis Non-obstructed Non-obstructed Hydronephrosis Non-obstructed Non-obstructed Hydronephrosis Non-obstructed Non-obstructed Hydronephrosis Non-obstructed Residual Function in Atrophic Kidney Kidney Dynamic renal scan is very sensitive tool Dynamic to estimate the residual function in atrophic kidneys. atrophic Non-visualized kidneys on IVU and Non-visualized ultrasound can be visualized on dynamic renal scan. renal The kidney is considered non-functional if The its split function is 10 -15% and less. its Atrophic Kidney Atrophic ...
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