Презентация на тему Radionuclide examination of urinary tract

anatomic details
As morphologic method (X-ray,US,CT,MRI)

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Glomerular filtration
⬜ 99mTc DTPA
⬜
Tubular secretion
⬜ 99mTc MAG3
⬜ 131I, 123I – OIH
Tubular fixation
⬜ 99mTc DMSA
⬜ 99mTc
glucoheptonate

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Nuclear medicine is a medical specialty involving

the application of radioactive substances in the diagnosis and treatment
of disease.

In nuclear medicine procedures, radionuclides are combined with other elements to form chemical compounds, or else combined with existing pharmaceutical compounds, to
form radiopharmaceuticals. These radiopharmaceuticals, once administered to the patient, can localize to specific organs or cellular receptors
There are several techniques of diagnostic nuclear medicine.
Scintigraphy
PET
SPECT

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Three basic classes of radionuclide are employed

in nuclear renography.

•Filtered agents

•Excreted agents

•Cortical imaging agents

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DTPA and MAG3 are filtered through the

glomerulus. This is useful in evaluating:

Perfusion
Vascular supply
Filtration
Measuring renal function (glomerular filtration rate)
Drainage
Detects obstruction

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MAG3 and Hipuran are excreted by the

renal tubules. These radionuclides are helpful in evaluating patients with:

Diminished renal function

Kidney transplants

MAG3 is both filtered and excreted so some radiologists prefer it to other radionuclides

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DMSA and Glucoheptonate are accumulated in the

cortex so they are helpful in evaluating:
•Renal scarring from chronic infection

•Infarction
•Renal mass
•Differential renal mass (proportion of total renal mass contributed by each kidney)

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There are two main radionuclide techniques for

studying the kidneys:

The Renogram which measures renal function. Scans of renal
morphology (DMSA scan). The advent of CT and ultrasound has reduced the need for such scans. They are now used mainly for evaluating renal scanning.

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Radiopharmaceticals
99mTc-DTPA – Diethylentriamine pentaacetic acid

belongs to the

group of chelate compounds
is excreted from kidneys through glomerular filtration with a half-life of 70 minutes
it is the most suitable substance
for measuring glomerular filtration (GFR) and good imaging of renal parenchyma

Vižďa J. a kol : Atlas of Renal Scintigraphy, 2002.

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Radiopharmaceticals
99mTc-MAG3 - Mercapto-acetyltriglycine
-is one of the newly

developed radiopharmaceuticals
-is rapidly excreted by the kidneys via active tubular secretion and minor part via glomerular filtration
-organic anions (which include MAG3) have a carboxyl group which specifically binds to the receptors of tubular cells mediating the active transport of MAG3 into the cells of the proximal tubulus
-with normaI renal function 70% of the administered activity of the radiopharmaceutical (RP) is excreted within 30 minutes after the application

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Dynamic renal study
Radiopharmaceutical
99mTc - MAG3

Patient Preparation
adequately hydration prior to

the examination
it is recommended to drink 100 ml of liquids per 10 kg of the body weight 30 min prior the examination empty bladder
p.are requested to void completely prior to the study

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Area of interest
This is a graphical representation

of the area from which radioactivity is measured in the analysis. There are two such areas for each kidney.
Kidney area
Background area
The radioactivity detected in the background area is subtracted from that detected from the kidney to eliminate background noise.

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Normally, the curves show rapid uptake (flow

curve on left) and rapid drainage (function curve on right). Each kidney is plotted separately (see labels) on each graph.

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A
II.
III.
Vascular phase
Secretory
Excretory




I.
čas

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A
čas
normal
obstructed pattern
impaired renal function parenchymal lesion pattern
renal

failure pattern
without measurable kidney uptake

renal failure patern

Patterns of renographic curves

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ANT
POST
RPO
LPO




Normal renal scan

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Evaluation
- number of kidneys

position
size
shape
the size, number and location

of areas cortical loss
split renal function
Note!
Cortical „cold“ defect may be due to different etiology :
tumor, abscess, cysts ….
alrealdy is necesarry to compare with US