1. Renal Scintigraphy (part 1)
By:
Prof. Dr. Hosna Moustafa
Cairo University, Egypt

2. Physiology Nephron is basic functional unit of kidney.
Each kidney has over million nephrons.
Urine formation begins with filtration of blood.
Average renal plasma flow is 600ml/m.
Twenty percent of this is filtered through the glomeruli as glomerular filtration rate (GFR 120ml/m).

3. Renal cortical imaging (DMSA)
A dose of 2 – 5 mCi of 99mTc-DMSA which is a tubular agent bind to proximal tubular cells in cortex (50%).
Imaging at 2 – 4 hours following injection with the patient supine in anterior, posterior, RPO & LPO for 500 K count using proper zoom.
Pin hole or SPECT may be added to planar.
Differential tubular function calculation through anterior and posterior images and calculate geometric mean.

4. Main indications
Pyelonephritis result from vesicoureteric reflux of infected urine. Follow up scanning at 6 months in infection:
Resolution of infection.
Scar formation.
Assessment of function (divided, regional).
Assessment of mass lesions (cyst, tumours, pseudotumors).
Congenital abnormalities (fusion, ectopia)

5. Normal DMSA
Homogenous intense uptake in both kidneys without scars or focal lesions

6. 1- Follow up of infection
Focal diminished uptake in the upper pole of the right kidney
(? Infection)
Multiple areas of diminished uptake involving right kidney
(multiple scars)

7. 2- Assessment of function
Pelvic kidney (Tc-DMSA)
Differential function: RT = 62% LT= 38%

8. 3- Assessment of mass lesions ( Pseudotumors Fetal lobulations)

9. 4- Congenital Anomalies
Agenesis.
Ectopia.
Fusion (horseshoe, crossed fused ectopia).
Polycystic kidney.
Multicystic dysplastic kidney.
Pseudo-masses (hypertrophic column of Bertin).

10. Horse-shoe kidney with impaired function of the left one.
Congenital anomalies
Horse-shoe kidney with impaired function of the left one.
Crossed ectopia

12. Dynamic Renal Imaging Radiopharmaceuticals
Glomerular agents:
99mTc-DTPA: A dose of 5 – 10 mCi of is most widely used in vivo GFR measurement.
Tubular agent:
I-131 OIH: A dose 300 μCi
Tc-MAG3: A dose of 8 mCi

13. Dynamic Renal Imaging Procedure
Supine with image posteriorly except in transplant anteriorly with the kidney in the center of the filed.
Flow phase: 1 sec/frame for 60 frames.
Dynamic phase: every 30 sec for30 min.
Post void static image: For the kidneys for 500 k count.
Processing: Region of interest around kidney, and background. Calculate differential uptake, draw renogram curves.

14. Dynamic Renal Scanning Clinical applications
Renal perfusion and function .
Impaired renal function
Diagnosis of reno-vascular hypertension .
Diagnosis of obstructive uropathy .
Renal transplant .

15. 1- Normal perfusion and clearance
Function

16. Relative (split) function ROI’s

17. Normal renogram curves
Vascular phase.
Parenchymal phase.
Washout (excretory) phase.

18. 2- Impaired renal function
GFR = 29 ml/min
Creat = 2.8 mg%
Markedly diminished perfusion, renal uptake and execration more marked in the left side.

19. Captopril Renal Scan: : Reno vascular Disease
Negative study

20. 3- Captopril Renal Scan: Reno vascular Disease
Positive study

21. Renal Angioghrapy ( Rt. RAS )
Before correction
After correction

22. Thank you