99mTc-diethylenetriaminepentaacetic Acid Research Articles

Growth and function in childhood of a normal solitary kidney from birth or from early infancy

Children with a solitary kidney (SK) have an increased long-term risk of hypertension, albuminuria and glomerulosclerosis. In this study, we assessed the early signs of impaired glomerular filtration in children with a SK from birth or from early infancy. Renal growth and function at ages 4-15.5 years were studied in 38 children with SK and 40 matched control subjects in terms of accelerated growth. The systolic/diastolic blood pressure Z-scores (p = 0.01/<0.05) and the resistance index (RI) of the arcuate arteries (p = 0.05) were higher in the children with SK. Creatinine clearance and 24-h protein and albumin urinary excretion showed no difference. All but seven children with SK had 99mTc diethylene-triamine pentaacetic acid glomerular filtration rate values of >80 ml/min/1.73 m(2). An independent positive correlation was found between length of the follow-up time and 24-h albumin urinary excretion (β = 0.54, p < 0.01). Accelerated postnatal growth was positively related with kidney volume (β = 0.35, p < 0.05). Among our patient cohort, renal function was well preserved at ages 4-15.5 years in children who were born with a SK. However, both their higher blood pressure and RI and the correlation of 24-h albumin urinary excretion with length of follow-up time underline the need for monitoring to detect early signs of glomerular hyperfiltration and, if necessary, implement timely intervention. SK hypertrophy was found to be correlated with postnatal growth.

Clinical assessment of delayed gastric emptying and diabetic complications using gastric emptying scintigraphy: Involvement of vascular disorder

Delayed gastric emptying, including gastroparesis, is a common complication in diabetes mellitus. The association between delayed gastric emptying and overall diabetic complications remains to be studied in detail. We analysed this association. We performed gastric emptying scintigraphy of (99m) Tc-diethylenetriaminepentaacetic acid in 34 patients with diabetes to measure the gastric emptying half-times (T1/2) of the whole stomach (WS), proximal stomach (PS) and distal stomach (DS). We assessed T1/2, diabetic-related factors and complications. The prevalence of autonomic neuropathy was higher in the group with delayed T1/2 of the WS than in the normal group. Analysis of intima-media thickness (IMT) and ankle brachial pressure index (ABI), which are risk indicators for vascular disorder, showed that IMT of the carotid bulb was greater in the group with delayed T1/2 of the WS than in the normal group (2·41 mm [1·50-2·81] versus 1·40 mm [0·81-2·08], P = 0·015). T1/2 of the WS correlated positively with IMT of the carotid bulb (r = 0·391, P = 0·027) and negatively with ABI (r = -0·389, P = 0·028). These correlations were mainly attributed to PS and were the same in patients without autonomic neuropathy. In seven of nine patients who received scintigraphy again after diabetic treatment, glycosylated haemoglobin (HbA1c) levels decreased and T1/2 of the WS shortened compared with before treatment. Vascular disorder, among other cofactors such as autonomic neuropathy, could be involved in the pathophysiology of delayed gastric emptying. Medium- to long-term glycaemic control was associated with gastric emptying.

Clinical evaluation of SPECT/CT fusion imaging for the diagnosis and determination of localisation of cerebrospinal rhinorrhea

ObjectiveThe objective was to evaluate the clinical value of the single photon emission computerized tomography/computed tomography (SPECT/CT) fusion imaging for the diagnosis and determination of localisation of cerebrospinal rhinorrhea. MethodsA total of 33 patients with cerebrospinal rhinorrhea were preoperatively injected with 99mTc-diethylenetriamine pentaacetic acid (DTPA) through lumbar puncture and then subjected to planar imaging of the cistern 120 min and 180 min after operation. CT and ECT were then performed. Finally, the rhinorrhea ventage and leaking path were confirmed by fusion image analysis. ResultsThirty-one patients who underwent fusion imaging and 30 patients who underwent planar imaging showed abnormal nuclide activity in the cavity between the basis cranii and the nose. After operation, 30 patients who underwent fusion imaging and 18 patients who underwent planar imaging showed complete correction of the leakage. The diagnosis sensitivity and positional accuracy of fusion imaging were 93.9% (31/33) and 90.9% (30/33) at P>.05. The values of planar imaging were 93.5% (29/31) and 79.3% (23/29) at P<.05. Conclusion99mTc-DTPA SPECT/CT fusion imaging of the cistern is an efficient, simple, and accurate method that may be used for diagnosing and determining the localisation of cerebrospinal rhinorrhea ventage and leakage path.

Effects of nitric oxide synthase inhibition on glutamine action in a bacterial translocation model

Glutamine may be a precursor for NO synthesis, which may play a crucial role in bacterial translocation (BT). The goal of the present study was to investigate the potential effects of glutamine on BT and the immunological response in an experimental model of NO synthase inhibition by NG-nitro-L-arginine methyl ester (l-NAME). Mice were randomly assigned to four groups: sham; intestinal obstruction (IO); IO+500 mg/kg per d glutamine (GLN); IO+GLN plus 10 mg/kg per d l-NAME (GLN/LN). The groups were pretreated for 7 d. BT was induced by ileal ligation and was assessed 18 h later by measuring the radioactivity of 99mTc-Escherichia coli in the blood and organs. Mucosal damage was determined using a histological analysis. Intestinal permeability (IP) was assessed by measuring the levels of 99mTc-diethylenetriaminepentaacetic acid in the blood at 4, 8 and 18 h after surgery. IgA and cytokine concentrations were determined by ELISA in the intestinal fluid and plasma, respectively. BT was increased in the GLN/LN and IO groups than in the GLN and sham groups. IP and intestinal mucosa structure of the sham, GLN and GLN/LN groups were similar. The GLN group had the highest levels of interferon-γ, while IL-10 and secretory IgA levels were higher than those of the IO group but similar to those of the GLN/LN group. The present results suggest that effects of the glutamine pathway on BT were mediated by NO. The latter also interferes with the pro-inflammatory systemic immunological response. On the other hand, IP integrity preserved by the use of glutamine is independent of NO.

Excretory urography and renal scintigraphy for chronic obstructed kidney: does nonopacity mean nonsalvageability?

This study aimed to ascertain whether nonopacified kidney on excretory urography (also known as intravenous urography [IVU]) indicates nonsalvageability. We retrospectively reviewed 45 adult patients with chronic unilateral urinary tract obstruction, in whom IVU revealed nonopacified kidney on one side but normal excretion on the contralateral side. Affected kidneys with split glomerular filtration rate (GFR) < 10 mL/min/1.73 m2 on 99mTc-diethylenetriaminepentaacetic acid diuretic renal scintigraphy were considered nonsalvageable. Non-function was defined based on cutoff points (< 15% and < 20%) to determine the sensitivity and specificity of differential renal function. Differences in IVU and renal scintigraphy findings, with respect to the duration of delayed filming on IVU, were analysed for significance. The results of IVU and renal scintigraphy findings for 34 (75.6%) nonopacified kidneys matched, representing nonsalvageable kidneys. Sensitivity and specificity of differential renal function were 76% and 100%, respectively, when the cutoff point for non-function was set at < 15%. Sensitivity and specificity were 97% and 82%, respectively, when the cutoff point was < 20%. There was no significant difference between renal scintigraphy findings and IVU with 2-hour and > 2-hour delayed films (p = 0.96). Although most nonopacified kidneys on IVU were nonsalvageable, a quarter of them were found to be salvageable on renal scintigraphy. Besides split GFR, differential function at cutoff point < 15% could be used to determine non-function of a chronic obstructed kidney when the contralateral kidney is normal. Delayed filming beyond two hours appears unnecessary in ensuring non-excretion on IVU.

Improved reproducibility of simple quantitative indices from 99mTc-GSA liver functional imaging

ObjectiveWe evaluated intra- and interoperator reproducibilities in calculating the conventional indices HH15 and LHL15 from 99mTc-diethylenetriamine pentaacetic acid galactosyl human serum albumin (99mTc-GSA) scintigraphy, and proposed new, simple methods for the calculation of quantitative indices.MethodsThe results of 99mTc-GSA scintigraphy in 33 patients were retrospectively analyzed. Heart and liver ROIs were drawn manually to cover cardiac blood pool and entire liver, respectively, and HH15 and LHL15 were calculated. In addition, square regions of interest (ROIs) of fixed sizes were placed at the highest activity in blood pool and the liver. Using the square heart ROI, sHH15, an equivalent of HH15, was computed. Fractional liver uptake at 15 min (FLU15) was calculated using the square heart and liver ROIs. Intra- and interoperator reproducibilities, as well as correlation with Indocyanine green retention rate at 15 min (ICG R15), were assessed for these four indices by linear regression analysis.ResultsSubstantial intra- and interoperator variabilities were found for HH15 and LHL15. The correlation coefficients for intra- and interoperator comparisons were 0.884 and 0.869 for HH15, respectively, and 0.919 and 0.917 for LHL15, respectively. The use of square ROIs instead of hand-drawn ROIs improved reproducibility. The correlation coefficients for intra- and interoperator comparisons were 0.988 and 0.973 for sHH15, respectively, and 0.989 and 0.975 for FLU15, respectively. Correlation with ICG R15 was better for sHH15 (r = 0.619) and FLU15 (r = −0.656) than for HH15 (r = 0.439) and LHL15 (r = −0.490).ConclusionsHH15 and LHL15 showed substantial intra- and interoperator variabilities, and the use of square ROIs are indicated to provide better reproducibility.

Effect of the NSAID Diclofenac on 99mTc-MAG3 and 99mTc-DTPA Renography

Renal function and disease are commonly evaluated by radionuclide studies. The choice of radiopharmaceutical agent for various studies is crucial for proper interpretation. (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG3) is excreted almost exclusively by the renal tubules, whereas (99m)Tc-diethylenetriamine pentaacetic acid ((99m)Tc-DTPA) is predominantly excreted by glomerular filtration. The present study compared the effect of the nonsteroidal antiinflammatory drug (NSAID) diclofenac, which is the most commonly used drug to relieve kidney pain, on the kinetic behavior of administered (99m)Tc-MAG3 and (99m)Tc-DTPA in experimental animals. Two groups of 12 New Zealand White rabbits ((99m)Tc-MAG3 and (99m)Tc-DTPA) were used for the renography. Each rabbit served as its own control. The animals were given 60 mL of saline intravenously 30 min before each renographic study. A baseline study (control) was done by injecting 48 MBq (1.3 mCi) of (99m)Tc-MAG3, and renography was performed. Two days later, a single intravenous dose of diclofenac (2 mg/kg) (treated animals) was given, and after 20 min, (99m)Tc-MAG3 renography was performed. This procedure was repeated for the (99m)Tc-DTPA group after administration of 96 MBq (2.6 mCi) of the tracer. Dynamic images (as 2-s frames for the first minute and 30-s frames for the next 30 min on a 64 × 64 matrix) were acquired using a γ-camera equipped with a low-energy high-resolution collimator interfaced with a computer. Regions of interest were drawn over the whole kidneys. Time-activity curves were generated from the region of interest. Time to peak activity (T(max)), time from peak to 50% activity (T(1/2)), and the uptake slope of each kidney were calculated from the renograms for control and treated rabbits. Administration of diclofenac shifted the experimental renogram curves to the right, compared with the control curves, indicating that there was a delayed renal uptake of the 2 tracers and clearance of the radioactivity. The calculated average values of T(max) for control and treated rabbits using (99m)Tc-MAG3 were 1.8 ± 0.5 and 6.35 ± 0.4 min, respectively, whereas those of (99m)Tc-DTPA were 3.4 ± 0.4 and 18.2 ± 2 min, respectively. The T1/2 for control and treated rabbits for (99m)Tc-MAG3 were 3.2 ± 0.07 and 6.6 ± 0.07 min, respectively, whereas those for (99m)Tc-DTPA were 10.1 ± 1 and 35 ± 4 min, respectively. The differences were statistically significant (P < 0.05). This study showed that diclofenac delayed both T(max) and T1/2. The NSAID-induced kinetic changes were considerably greater for (99m)Tc-DTPA than for (99m)Tc-MAG3. On the basis of these findings, it is suggested that (99m)Tc-MAG3 be used to perform renography for studies involving the use of NSAID administration to decrease any change that may occur due to the type of tracer and not to the condition of the kidney.

Quantitative Tc-99m DTPA renal transplant scintigraphy predicts graft survival in the very early postoperative period

Early evaluation of renal allograft prognosis is important for identification and targeted management of 'at-risk' grafts but is difficult in the absence of established tests. Tc-99m diethylene triamine pentaacetic acid renal transplant scintigraphy is a useful noninvasive method for assessing graft function. We aimed to assess the relative role of quantitative scintigraphic parameters in the immediate postoperative period for the assessment of short-term and long-term prognoses. Data from 290 dynamic renal transplant scintigraphy procedures, performed on 161 recipients on day 1 (D1) or day 4 (D4) after transplantation, were analysed to derive various perfusion parameters [Kirchner's Index, Hilson's Index (HI), kidney-to-aorta ratio and ΔP] as well as nonperfusion parameters (graft washout t (1/2), P : PI ratio, P : U ratio, R20/3, T10 and T20) using regions of interest within the whole renal graft and iliac artery. Information on graft survival up to 1 year (as a measure of short-term prognosis) and serum creatinine at 1 year (regarded as a predictor for longer-term prognosis) was collected. Mann-Whitney tests, receiver-operating characteristic curve analyses and odds ratios were used to assess the utility of each parameter in stratifying the risk for graft failure within 1 year. Correlations between each parameter and 1-year serum creatinine were tested using Spearman's rank correlation. Eleven grafts failed within 1 year. All perfusion parameters on both D1 and D4 showed significant differences between the failure and survival groups (P=0.026-0.0005). No significant between-group differences were observed for nonperfusion parameters except for R20/3 on D1 (P=0.0298). Receiver-operating characteristic analysis showed moderate accuracy for HI and ΔP on both D1 and D4 (area under the curve: 0.73-0.84); ΔP of longer than 6.0 s on D4 was associated with 24.9 times higher relative risk for graft failure within 1 year (sensitivity 88% and specificity 83%). For the assessment of long-term prognosis, a moderate correlation was found between most perfusion parameters (Kirchner's Index, HI and kidney-to-aorta ratio on both D1 and D4) and 1-year serum creatinine (ρ=0.40-0.50; P ≤ 0.0001). The nonperfusion parameters showed only weak correlation. Perfusion assessment using HI and ΔP is useful in the assessment of graft prognosis. This can be achieved as early as D1 and D4 after transplantation.

Tc-99m diethylenetriamine pentaacetic acid (DTPA): Is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients?

Methotrexate[MTX] is commonly employed as the initial DMARD used for treatment of Rheumatoid arthritis[RA]. We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. Fifty two RA adult females with normal base-line serum creatinine and GFR at the initial diagnosis of the disease were included. Group-1[G1] included 30 patients[mean age 40.4±4.4years] on MTX and NSAIDS, while 22 RA patients[mean age 38.5±8.2years] who received NSAIDs only served as the control group[G2]. Renal function was assessed by GFR-measurement using Technetium diethylenetriamine-pentaacetic acid[Tc-99m-DTPA] at the point of the study time corresponding to disease duration. 21/30[70%] in G1 showed reduced GFR compared to 6/22[27.3%] in G2[P0.007] with 3.3±0.5% annual reduction of GFR. Reduced GFR in G1 showed significant negative correlation with age[r=−0.396, P=0.005], MTX-cumulative dose[r=−0.263, P=0.049], MTX-intake duration[r=−0.293, P=0.031] and NSAID-intake duration[r=−0.344, P=0.014]. Low dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction over time that could be monitored by Tc-99m DTPA.

Superiority of non-capsulated 14C-urea breath test over capsule based method for detection of Helicobacter pylori infection – a preliminary report

14C-urea breath test (14C-UBT) is employed as a 'gold standard' technique for the detection of active gastric Helicobacter pylori infection and is recommended as the best option for "test-and-treat" strategy in primary health care centers. To compare the performance of capsulated and non-capsulated 14C-UBT protocols for the detection of H. pylori infection in patients. Fifty eight H. pylori infected patients underwent routine upper GI endoscopy and biopsies were processed for rapid urease test (RUT) and histopathology examination. Capsulated 14C-UBT was done in a novel way by using 74 kBq of 14C-urea along with 6.0 MBq of 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) to simultaneously monitor the movement and the fate of ingested capsule after delineating the stomach contour by using 20.0 MBq of 99mTechnetium pertechnetate (99mTcO4-) under dual head gamma camera. Non-capsulated 14C-UBT was performed within 2 days of the previous test and the results of these protocols were compared. In 3 out of 58 H. pylori positive cases (5.17%), 14C-UBT results were found to be negative by using the capsulated method. Interestingly, on monitoring the real time images of the capsule in these cases it was found that misdiagnosis of H. pylori infection occurred mainly due to either rapid transit of the 14C-urea containing capsule from the upper gastric tract or its incomplete resolution in the stomach during the phase of breath collection. Use of non-capsulated '4C-UBT protocol appears to be a superior option than the conventional capsule based technique for the detection of H. pylori infection.

Pulmonary and nasal deposition of ketorolac tromethamine solution (SPRIX) following intranasal administration

Ketorolac tromethamine is a racemic, non-steroidal, anti-inflammatory drug (NSAID). An intra-nasal (IN) formulation, SPRIX®, is approved for the treatment of short term (up to 5 days) acute moderate to moderately severe pain. The primary objective of this study was to determine whether 99mTc-diethylenetriaminepenta acetic acid (DTPA) radiolabelled ketorolac tromethamine formulation (31.5mg) was deposited in the lungs of healthy subjects (4 men and 9 women) following nasal inhalation of different intensities (gentle or vigorous sniff) and under different postural conditions (upright or semi-supine). The secondary objectives were to determine the deposition pattern of radiolabelled ketorolac solution in the nasal cavity and the clearance of the radiolabel over a 6h period post-administration. The nasal spray pump delivery device used showed a droplet size distribution with a volume mean diameter (VMD) of 50μm and approximately 85% of the aerosol mass contained in droplets >10μm diameter. The fraction of the dose recorded from the lung regions averaged <0.5%, and was considered to represent scattered radiation rather than true pulmonary deposition. This fraction was not affected by posture or by inhalation manoeuvre. The majority of the radiolabelled intranasal dose was deposited in the nasal cavity. The visual spread patterns within the nasal cavity were most uniform following administration in the upright position regardless of inhalation manoeuvre. Clearance from the nasal cavity was initially very rapid, with only 16–30% of the dose remaining after 10min and 6–14% after 6h. Retention was greatest following gentle inhalation.

Effect of Mosapride Citrate on Gastric Emptying in Interferon-Induced Gastroparesis

Gastroparesis, a gastrointestinal autonomic neuropathy, is a common adverse reaction in chronic hepatitis C (CHC) patients receiving interferon therapy. Current therapeutic options are limited. We evaluated the efficacy of mosapride for IFN-induced gastroparesis. Twenty-four consecutive CHC patients were randomly assigned to either the control group, which received pegylated interferon α-2b at 1.5 μg/kg/week and ribavirin at 600-1,000 mg/day, depending on body weight (PegIFN/RBV), or the mosapride group, which received PegIFN/RBV plus mosapride at 15 mg/person/day. The solid-phase gastric emptying half-times (T1/2) of the total, proximal, and distal stomach (scintigraphy) and digestive symptoms (questionnaire) were measured within one week before and four weeks after initiation of the assigned therapy. The test meal comprised a 200-g pancake containing Tc-99m diethylenetriamine pentaacetic acid. In the control group, after PegIFN/RBV initiation, a significant increase was observed in the total T1/2 (before: 84.0 ± 22.1 min versus after: 100.8 ± 28.9 min, P = 0.03), the distal T1/2 (before: 95.3 ± 32.2 min versus after: 115.3 ± 41.4 min, P = 0.03), and digestive symptom score (before: 3.2 ± 1.4 versus after: 8.1 ± 4.8, P = 0.02); proximal T1/2 change was not significant. In the mosapride group, no significant delays were observed in the total, proximal, and distal T1/2 values; the change in symptom scores was not significant. Mosapride improved total and distal gastric motility in IFN-induced gastroparesis, and consequently relieved symptoms.

A Case of Enterocutaneous Fistula Diagnosed with Tc-99m DTPA Fistulography Using Hybrid SPECT/CT.

Enterocutaneous fistula (ECF) is a communication between the bowel lumen and the skin, which especially occurs post-operatively and is associated with significant morbidity and mortality. Correct diagnosis and anatomical information of ECF are crucial for a patient's management. Here, we present a case of ECF clearly diagnosed by hybrid single-photon emission computed tomography/computed tomography (SPECT/CT). A 61-year-old man was admitted to our hospital with persistent pus discharge from a surgical wound of previous cystectomy and ileal conduit formation. Initially, he was assessed with fistulography, and ECF was suspected by intraluminal contrast media. As clinical symptom and signs were not definitely matched with ECF, Tc-99m diethylene triamine pentaacetic acid (DTPA) SPECT/CT was performed for the evaluation of fistular tract as an alternative method. On the SPECT/CT after injection of Tc-99m DTPA to the putative fistular opening, fistular as well as intraluminal radioactivity was clearly visualized. SPECT/CT is a sensitive and safe diagnostic imaging tool for ECF.

Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal function reserve estimation: is it a reliable predictive tool for assessment of preclinical renal involvement in scleroderma patients?

Prognosis of systemic sclerosis (SSc) depends on internal organ involvement. We assessed the value of renal function reserve (RFR) for the detection of preclinical nephropathy in scleroderma. Thirty SSc patients with normal serum creatinine and 30 healthy controls were included. Medsger disease severity score, glomerular filtration rate (GFR), and microalbuminuria were measured. Tc-99m DTPA was utilized for GFR measurement at baseline and after oral protein overload (stimulated GFR). RFR was calculated as the percentile increase of stimulated GFR. SSc patients had lower means of baseline GFR (P=0.001), stimulated GFR (P=0.004), RFR (P=0.046), and higher microalbuminuria (P=0.009) than controls. According to baseline GFR, SSc patients showed three categories-normal baseline GFR (n=12), hyperfiltration GFR (n=3), and reduced baseline GFR (n=15). In the former category, RFR was normal in 6/12 patients and abnormal in the remainders (50%). Hyperfiltration patients and those with reduced baseline GFR showed abnormal RFR. A statistically significant negative association was found between microalbuminuria versus stimulated GFR and RFR (r= -0.5, P=0.007 and r= -0.45, P=0.013, respectively). The majority of SSc patients with abnormal RFR had disease duration of ≥48 months (60% vs. 20%, P=0.008). All SSc patients with pulmonary hypertension had abnormal RFR, while reduced baseline GFR was noted in only 60%. A significant negative correlation was found between reduced baseline GFR and cumulative dose of corticosteroids in SSc patients (r= -0.4, P=0.022). RFR estimation could be a useful predictive marker for preclinical renal involvement in SSc patients so that early prophylactic measures and therapy modifications could be considered.

Scrotal Lymphedema Mimicking Urine Leakage

Tc-99m diethylene triamine pentaacetic acid (DTPA) dynamic renal scan is widely used to evaluate urological complications after renal transplantation, especially for urine leakage. Although the most common site of urine leakage is based on urethrovesical anastomoses, it can also be seen anywhere in the abdomen, even in the scrotum. In our case, we showed scrotal lymphedema caused false-positive result for scrotal urine leakage detected by Tc-99m DTPA dynamic renal scan.

Creatinine-based glomerular filtration rate estimation in patients with liver disease

Limitations of serum creatinine in patients with an impaired liver function are well known. The commonly used modification of diet in renal disease (MDRD) equation has a low diagnostic performance to approximate kidney function in patients after liver transplantation (LT) and patients with liver cirrhosis (LC). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula has been shown to provide a more accurate estimation of kidney function in patients with chronic kidney disease, but studies in patients with liver disease are lacking. We evaluated the diagnostic performance of CKD-EPI in comparison with the re-expressed MDRD formula in patients after LT (group 1; n=59) and in patients suffering from LC (group 2; n=44). GFR was measured by 99mTc-diethylenetriamine penta-acetic acid (group 1) and inulin clearance (group 2). Bias, precision, and accuracy as compared with the measured GFR were determined. The measured mean GFR (95% confidence interval) was 52.3 ml/min/1.73 m2 (47.7; 56.9; group 1) and 35.3 ml/min/1.73 m2 (29.12; 41.3; group 2), respectively. In transplanted patients GFR estimation by CKD-EPI and MDRD did not significantly differ with respect to bias (9.7 vs. 4.3 ml/min/1.73 m2), precision (16.9 vs. 15.5 ml/min/1.73 m2) and accuracy (64.4 vs. 69.5% within 30% of 'true GFR'). In patients with LC, both formulae showed a very high bias (42.5 vs. 40.1 ml/min/1.73 m2), a very low precision (20.7 vs. 25.7 ml/min/1.73 m2) and accuracy (6.8 within 30% of the measured GFR in both groups). The CKD-EPI equation does not improve the creatinine-based GFR estimation in patients after LT. In patients with LC, both equations should not be applied as they extremely overestimate GFR.

Dissociation of Tc-99m DTPA in a nebulizer

An unexpected biodistribution of nebulized Tc-99m diethylene triamine pentaacetic acid was detected after the ventilation of a patient referred for diagnosis of pulmonary embolism. Radiochemical purity testing of the stock vial showed more than 95% labelling. Further investigation indicated that the problem was possibly associated with a cleaning agent used for the nebulizer, leading to the dissociation of the Tc-99m diethylene triamine pentaacetic acid. Manufacturer's instructions for cleaning of the nebulizer specify the use of 70% denatured ethanol solution, but a chlorine-based agent had been used inadvertently.

Clinical study of the new intelligent determination and analysis system for glomerular filtration rate

To discuss the clinical application value of determining glomerular filtration rate(GFR) with the new intelligent determination and analysis system for GFR (B&G System). GFR of 216 hospitalized patients suffering from the different diseases was determined accurately by clearance rate of (99m)Tc-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) (Tc-GFR), and the serum creatinine (SCr) and blood urea nitrogen (BUN) were also determined. At the same time GFR was determined by B&G system and Robert formula (B&G-GFR, Robert-GFR), and creatinine clearance rate (CCr) and GFR were calculated by Cockcroft/Gault formula(CG-CCr-GFR). All the results were compared, and correlation analysis was done for the three groups of data. Among 216 patients, B&G-GFR and Tc-GFR in 106 patients with renal insufficiency and 110 patients with normal renal function showed no significant difference (ml · min(-1)· 1.73 m(-2): 29.13 ± 18.96 vs. 32.28 ± 25.03, 121.13 ± 49.79 vs. 118.48 ± 43.25, both P >0.05), while Robert-GFR (ml · min(-1) · 1.73 m(-2): 21.45 ± 15.67, 93.54 ± 30.01) and CG-CCr-GFR (ml · min(-1) · 1.73 m(-2): 11.87 ± 8.69, 86.27 ± 21.44)were significantly lower than Tc-GFR (P<0.05 or P <0.01 ). The values of B&G-GFR, Robert-GFR, CG-CCr-GFR and Tc-GFR in renal insufficiency group (ml · min(-1) · 1.73 m(-2) :6.15 ± 14.07, 13.83 ± 11.36, 23.41 ± 24.34) were respectively significantly lower than that of normal renal function group (ml · min(-1) · 1.73 m(-2):7.65 ± 6.54, 24.94 ± 13.24, 32.21 ± 21.81, all P <0.05). B&G-GFR, Robert-GFR, and CG-CCr-GFR of both groups were positively correlated with Tc-GFR (P<0.05 or P <0.01), but negatively correlated with SCr (P<0.05 or P <0.01). B&G-GFR, Robert-GFR and CG-CCr-GFR , to a certain extent, do accurately reflect GFR. However, B&G-GFR is more accurate than others, and it can take the place of Tc-GFR clinically. B&G system has the advantage of accuracy, simplicity, speed, safety and low-price compared with other methods for the determination of GFR, and it warrants popularization.

Assessment of renal impairment by non-contrast-enhanced conventional magnetic resonance imaging: comparison with 99mTc-DTPA renography

The aim of this study was to determine whether non-contrast-enhanced magnetic resonance imaging (MRI) can detect three levels of renal impairment by evaluating the differences and agreement with (99m)Tc-diethylenetriamine pentaacetic acid (DTPA) renography. A total of 28 patients with kidney disease were enrolled in the study. MRI findings, including visual corticomedullary differentiation (CMD) on T1- and T2-weighted imaging (T1WI, T2WI), cortical irregularity, the number of renal cysts, and the volume of the kidney, were evaluated for individual kidneys and pairs of kidneys. The differences and agreement between MRI findings and the three levels of renal impairment based on the glomerular filtration rate (GFR) measured using (99m)Tc-DTPA renography were analyzed. All MRI findings except the number of renal cysts in pairs of kidneys were consistent with the patient's classification. The agreement between the patient's classifications based on GFR and that based on the visual CMD on T1WI and T2WI was almost perfect or substantial in both individual kidneys and pairs of kidneys. Non-contrast-enhanced MRI was capable of distinguishing three levels of renal function, including serious renal impairment.

Abdominal ultrasound with scintigraphic and clinical correlates in infants with sickle cell anemia: baseline data from the BABY HUG trial.

The purpose of this study is to perform and evaluate baseline abdominal ultrasound in infants with sickle cell anemia who participated in the BABY HUG multiinstitutional randomized placebo-controlled trial of hydroxyurea therapy and to examine the potential relationships among ultrasound results and clinical, nuclear medicine, and laboratory data. After local institutional review board approval and with informed guardian consent, 116 girls and 87 boys (age range, 7.5-18 months) with sickle cell anemia underwent standardized abdominal sonography at 14 institutions. Imaging was centrally reviewed by one radiologist who assessed and measured the spleen, kidneys, gallbladder, and common bile duct. Baseline physical assessment of spleen size, serum alanine aminotransferase and bilirubin levels, (99m)Tc sulfur colloid liver-spleen scans, and (99m)Tc diethylenetriaminepentaacetic acid clearance glomerular filtration rates (GFRs) were obtained. Analysis of variance and the Student test were performed to compare sonographic findings to published results in healthy children and to clinical and laboratory findings. The mean (± SD) spleen volume (108 ± 47 mL) was significantly greater than published normal control values (30 ± 14 mL; p < 0.0001). There was no correlation between spleen volume and function assessed by liver-spleen scan. The mean GFR (125 ± 34 mL/min/1.73 m(2)) was elevated compared with control GFRs (92 ± 18 mL/min/1.73 m(2)). Renal volumes (right kidney, 29 ± 8 mL; left kidney, 31 ± 9 mL) were significantly greater than control volumes (right kidney, 27 ± 3 mL; left kidney, 27 ± 3 mL; p < 0.0001) and were positively correlated with GFR (p = 0.0009). Five percent of patients had sonographic biliary abnormalities (sludge, n = 6; dilated common bile duct, n = 2; and cholelithiasis and thickened gallbladder wall, n = 1 each). There was no correlation between biliary sonographic findings and laboratory results. In infants with sickle cell anemia, sonographic spleen volume does not reflect function, but increased renal volume correlates with GFR and is consistent with hyperfiltration. Sonographic biliary abnormalities can occur early in life, while remaining clinically silent.