Renal Scintigraphy Research Articles

Abstract 4135289: Renal Blood Perfusion is Closely Related to Right Ventricular Volume Overload in Congestive Heart Failure

Background: Cardiorenal syndrome (CRS) involves a bidirectional relationship where dysfunction in one organ exacerbates the other. A key factor in this interaction is the impact of right ventricular (RV) volume overload on renal blood flow, which is vital for the progression and management of heart failure (HF). Objective: This study aims to explore and quantify the relationship between right ventricular volume overload, i.e, echocardiographic assessments of right ventricular diameter (RVD), and the time-to-peak (TTP) of renal blood flow in patients with HF measured by 99mTc-DTPA renal scintigraphy. Methods: This single-center study included 304 stable, ambulatory HF patients admitted between October 2017 and August 2022. HF was diagnosed based on the 2016 ESC guidelines. Echocardiographic parameters, including RVD, and TTP of renal blood flow measured by 99mTc-DTPA renal scintigraphy, were collected. Statistical analysis was conducted using SPSS and R software, with Spearman correlation analysis used to assess the relationship between echocardiographic parameters and TTP. Results: The study showed there was a significant correlation between RVD and TTP (rs=0.535, P <0.001), indicating that RV volume overload is closely related to impaired renal perfusion. The median TTP among the study population was 27.25 seconds (IQR: 21-39 seconds). Corrected for body surface area (BSA), RVD was found to be significantly higher in patients with heart failure with reduced ejection fraction (HFrEF) compared to heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF) (HFrEF: 20.62 mm/m 2 , HFmrEF: 18.72 mm/m 2 , HFpEF: 18.09 mm/m 2 ; p < 0.001). Furthermore, right atrial diameter (RAD) corrected for BSA (RAD/BSA) demonstrated the strongest correlation with TTP in the HFrEF subgroup (rs=0.602, p<0.001). Conclusions: Our findings highlight the significant impact of right ventricular volume overload on renal perfusion, providing valuable insights into the pathophysiology of CRS. These results suggest that therapeutic strategies aimed at reducing RV overload could enhance renal perfusion and improve overall outcomes in HF patients.

Cisplatin-Induced Renal Failure Measured by Glomerular Filtration Rate (GFR) with 99mTc-DTPA Scans in Cancer Patients: A Systematic Review and Meta-Analysis

Background: Cisplatin is a potent agent commonly used to treat cancer, but its effects pose a significant risk to renal function. Therefore, the present study aimed to evaluate the impact of cisplatin on renal function as measured by glomerular filtration rate (GFR) using diethyltriamine-penta-acetic acid (DTPA) renal scintigraphy. Methods: Extensive literature searches were performed using PRISMA guidelines that investigated cisplatin-induced renal failure by measuring GFR with DTPA. Eligible studies were included based on predefined criteria. Data on GFR, serum creatinine levels, and acute kidney injury (AKI) before and after cisplatin therapy were extracted and analyzed. A meta-analysis was performed utilizing RevMan 5.4 to determine the overall effect of cisplatin on GFR before and after treatment. For non-randomized controlled trials (RCTs), quality assessment was performed using the Newcastle–Ottawa Scale, while for RCT, the Cochrane risk of bias tool was utilized. Results: Initially, 1003 studies were searched from different databases, including ScienceDirect, PubMed, Scopus, Google Scholar, and The Cochrane Library, and after screening, 8 studies (PubMed, Scopus, and GoogleS cholar) with 489 patients were found eligible for inclusion in the present study. Cisplatin was administrated with varying doses ranging from 20 mg/m2 to 114.02 mg/m2. The findings underscore the nephrotoxic effects of cisplatin, a widely used chemotherapeutic agent, as demonstrated by the significant decline in GFR observed across multiple treatment cycles, and these findings were also supported by the findings of a meta-analysis that showed a significant (p < 0.01) difference between peri- and post-treatment GFR level with 37.06 (95% CI, 10.90–63.23) effect size and 96% heterogeneity. In addition, the included studies were found to be of high quality. Conclusions: Cisplatin significantly affects renal function, as evidenced by a decrease in GFR measured with DTPA. The findings underscore the importance of the routine monitoring of GFR to detect early renal injury and guide treatment modification. Future research should focus on strategies to reduce cisplatin-induced toxicity and explore alternative therapies with reduced renal risk.

Assessment of post-pyeloplasty renal drainage in antenatally detected hydronephrosis by 99mTc-L, L-Ethylenedicysteine renal scintigraphy: the importance of delayed imaging.

Diuretic renal scintigraphy is important in diagnosing pelvi-ureteric junction obstruction (PUJO) in antenatally detected hydronephrotic (ANH) kidneys. Early-phase dynamic renal scintigraphy has several pitfalls contributing to the false interpretation of obstructed drainage, especially after pyeloplasty. This study explores the utility of delayed imaging in 99mTc-L,L-Ethylenedicysteine (EC) diuretic renal scintigraphy to assess post-pyeloplasty renal drainage in ANH. Data from May 2019 to January 2024 was retrospectively studied to identify infants with ANH who underwent surgery for PUJO and pre-and post-surgical assessment of renal drainage using 99mTc-L,L-EC diuretic renal scintigraphy. Dynamic and post-void static images were analyzed to calculate percentage drainage till 3h. Pre- and post-operative quantitative parameters were compared. Receiver operator curve analysis was done to calculate the threshold drainage to detect renal obstruction on postvoid images. In a cohort of 104 patients with a mean age of 10.1 ± 6.5months (range 2-36months) at surgery, 106 renal units (bilateral involvement in two patients) were analyzed. There was no significant difference in the sum of obstructive and equivocal curve patterns (105 vs 79, p = 0.06) and T1/2 values (105 vs 82, p = 0.093) before and after surgery. However, there was a significant difference between the pre-and post-surgery median 3-h percentage drainage (26 vs 80%, p < 0.001). A drainage threshold of less than 59% at 3h had 93.4% sensitivity and 92.5% specificity to detect obstructive drainage. Delayed images in diuretic renal scintigraphy are crucial in accurately interpreting post-pyeloplasty drainage patterns and help overcome pitfalls of the dynamic study.

Assessment of Kidney Function Discrepancies in Pediatric CAKUT Patients Using Bedside Schwartz Equation and Renal Scintigraphy

Background and Objectives: This research explores the correlation between estimated glomerular filtration rates (eGFR) obtained using the bedside Schwartz equation, and renal scintigraphy in children with congenital kidney and urinary tract abnormalities (CAKUT). The objective is to enhance understanding and management of renal health in this demographic by analyzing kidney size-function relationships. Methods: A retrospective observational analysis was performed on 94 pediatric CAKUT patients at the “Louis Turcanu” Emergency Hospital for Children, Timisoara. Kidney function data, extracted from medical records, were evaluated using the Schwartz equation, renal scintigraphy, and the gold standard iohexol clearance. Ethical approval was secured for the study, which employed descriptive and inferential statistical methods, including t-tests and correlation coefficients, to compare eGFR values. Results: Significant variances were found in eGFRs across different body surface area (BSA) percentiles. For instance, the eGFR for the right kidney in the 25th–50th BSA percentile (102.02 ± 41.52 mL/min/BSA) was notably higher than that of the left (35.60 ± 26.05 mL/min/BSA; p = 0.01). The overall sample reflected a higher eGFR in the right kidney (76.03 ± 40.91 mL/min/BSA) compared to the left (57.46 ± 35.91 mL/min/BSA; p = 0.02). Additionally, a strong positive Pearson correlation (r = 0.80, p = 0.02) was found between scintigraphy and ultrasound measures in the 50th–75th percentiles for left renal percentiles, demonstrating consistent patterns across different evaluations of kidney function. Conclusions: This comparison indicates a complex relationship between eGFR values and kidney size, suggesting potential inaccuracies in standard bedside eGFR measurements for pediatric CAKUT patients. The findings underscore the necessity for accurate diagnostic tools specifically designed for pediatric applications and advocate for the integration of multiple diagnostic techniques to improve clinical management.

Clinical guideline for static renal cortical scintigraphy in paediatrics.

Clinical guideline for static renal cortical scintigraphy in paediatrics.

The role of nuclear medicine techniques; Tc-99m-labeled dimercaptosuccinic acid, diethylenetriaminepentaacetic acid, and mercaptoacetyltriglycine scintigraphies in pediatric surgery

The purpose of this review is to highlight the pivotal role of nuclear medicine in pediatric surgery, specifically in the diagnosis and management of nephro-urological conditions. This review focuses on the applications and advantages of three key nuclear medicine techniques: Tc-99m dimercaptosuccinic acid (DMSA), Tc-99m diethylenetriaminepentaacetic acid (DTPA), and Tc-99m mercaptoacetyltriglycine (MAG3) scintigraphies. These imaging modalities are crucial for providing detailed anatomical and functional information with minimal invasiveness, essential for evaluating congenital anomalies, urinary tract infections, and obstructive uropathies in children. DMSA Scintigraphy is established as the gold standard for detecting renal cortical scarring and assessing functional renal parenchymal damage. It offers superior sensitivity and specificity compared to other imaging techniques, making it indispensable for identifying renal scars from recurrent urinary tract infections or pyelonephritis. DTPA Scintigraphy is critical for measuring glomerular filtration rate (GFR) and analyzing renogram curves, providing quantitative assessments of renal function. It effectively evaluates renal perfusion and identifies perfusion defects and renal ischemia, essential for managing conditions like renal artery stenosis and unilateral kidney disease. MAG3 Scintigraphy excels in dynamic renal scintigraphy, particularly in patients with impaired renal function. It provides high-quality images and superior diagnostic capability, making it invaluable for assessing ureteropelvic junction obstruction and other obstructive uropathies in pediatric patients. The review concludes by emphasizing the integration of these scintigraphy techniques with SPECT/CT, enhancing diagnostic accuracy and providing comprehensive anatomical and functional insights. Despite concerns regarding radiation exposure, measures such as dose optimization and advanced imaging techniques ensure safety and efficacy in pediatric applications.

3D dynamic diuretic renal scintigraphy using a hybrid whole body CZT SPECT/CT camera protocol in the evaluation of acute ureteric obstruction caused by ureteric stone

PurposeTo investigate the performance of dynamic 3D diuretic renal scintigraphy using a hybrid whole body CZT SPECT/CT for the evaluation of acute ureteric obstruction in patients with urinary stone disease.Methods20 patients who presented to the Emergency Department with acute renal colic due to urinary stone disease confirmed by means of CT were prospectively included. Three observers evaluated and graded hydronephrosis, hydroureter, perirenal stranding, and thickening of the renal fascia from the CT as well as the renal scintigraphy curves from the dynamic SPECT study. The normalized residual activity from dynamic SPECT was analysed at 16 min in all patients and at 20 min in suspected obstruction.ResultsRenal scintigraphy curves showed a sensitivity of 100%, specificity of 93%, PPV 83% and a NPV 100% for obstruction, while normalized residual activity showed a sensitivity of 100%, specificity of 73%, PPV 56% and a NPV 100%. All patients presented at least 2 secondary signs of obstruction on the CT, showing a PPV of only 25% for obstruction.ConclusionDynamic 3D diuretic renal scintigraphy CZT SPECT/CT provides valuable functional and anatomical information from one single examination. The combination of pathological renogram curves and high normalized residual activity values provide the most valuable imaging information to determine the presence of acute ureteric obstruction. The secondary signs of obstruction observed on CT are not specific and should not be used to confirm or discard obstruction in patients with urinary stone disease.Trial registration: ISRCTN15338358. Registration date 03/01/2024. Retrospectively registered. https://www.isrctn.com/ISRCTN15338358?q=miguel%20ochoa%20figueroa&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10

Supernumerary kidney fused to the isthmus of a horseshoe kidney, with subsequent nephroblastoma, identified with dynamic renal scintigraphy

Supernumerary kidney fused to the isthmus of a horseshoe kidney, with subsequent nephroblastoma, identified with dynamic renal scintigraphy

The Mayo Adhesive Probability Score as a Predictor of Postoperative Renal Function in Robot-assisted Partial Nephrectomy.

The aim of this study was to evaluate the Mayo Adhesive Probability (MAP) score as a predictor of split renal function deterioration after robot-assisted partial nephrectomy (RAPN). A total of 30 patients who underwent RAPN were identified retrospectively. The parameters evaluated included patient characteristics, tumor diameter, MAP score, warm ischemic time (WIT), and renal function. Split renal function was evaluated using Tc-99m DTPA renal scintigraphy before and six months after surgery. Univariate and multivariate logistic regression analyses were performed. Nine patients (30.0%) showed more than 90% preservation of split renal function on the operated side. The MAP score (p=0.015), cT1b tumor (p=0.0002), and WIT (p=0.044) were associated with preservation of split renal function six months after surgery on univariate analysis. The MAP score was the strongest predictor of preservation of split renal function six months after surgery on multivariable analysis (p=0.007). On receiver-operating characteristic (ROC) curve analysis, the MAP score (cutoff value 3.0; p=0.01) was a significant predictor of split renal function six months after surgery. The MAP score was significantly associated with postoperative split renal function six months after RAPN on the operated kidney side. The MAP score is useful for predicting split renal function after RAPN.

Hydronephrosis in children. Clinical and therapeutic considerations

The present study analyses the experience of the Pediatric Urology Clinic of the National Scientific-Practical Center of Pediatric Surgery "Acad. Natalia Gheorghiu" during the years 2013-2022. During this period, 35 children aged 0-18 years with congenital hydronephrosis were evaluated. Indications for surgery were acuity, changes recorded on urinary system ultrasonography, intravenous urography, renal scintigraphy, computed tomography with vasography, nuclear magnetic resonance with angiography. The used surgical intervention was resection of the pyelo-ureteral junction and plasty of the pyelo-ureteral junction Andersen-Hynes procedure. No immediate postoperative local (nephrosclerosis) or general complications were recorded. Chronic kidney disease developed in 4 patients. No deaths were recorded.

Assessment of ureteric jets as a supportive diagnostic modality for unilateral pelvi-ureteric junction obstruction and its utility in follow-up: A pilot study

Pelvi-Ureteric Junction Obstruction (PUJO) is a common cause of hydronephrosis (HDN) in children. While ultrasonography (USG) is useful for initial assessment and grading of hydronephrosis, it cannot differentiate obstructive from non-obstructive cases. Renal Dynamic Scintigraphy (RDS) confirms the diagnosis but involves ionizing radiation exposure. Ureteric jets using colour Doppler USG have been proposed for diagnosing obstructive HDN. Our study aimed to evaluate Ureteric Jet Frequency (UJF) and Relative Jet Frequency (RJF) in unilateral PUJO before and after furosemide (Lasix) administration, assessing their diagnostic and post-operative utility. Children (<14 years) with unilateral HDN underwent USG and RDS for PUJO diagnosis. Pyeloplasty was performed based on standard criteria. UJF and RJF were assessed before and after furosemide administration (0.5mg/kg) by colour Doppler USG. The non-obstructed side was taken as the control. Follow-up included repeat RDS and ureteric jet assessment. Fifty-two cases were included. UJF (pre- and post-Lasix) was significantly lower in the obstructed side compared to the non-obstructed side at baseline and post-pyeloplasty (p<0.0001). However, the baseline UJF difference between cases and controls was not significant (p>0.05). UJF and RJF (pre- and post-Lasix) increased postoperatively. The UJF difference decreased postoperatively (p<0.05). (attached Table) CONCLUSION: UJF and RJF are useful for diagnosing and monitoring unilateral PUJO. The effect of furosemide on UJF needs to be assessed using additional studies with larger sample sizes to understand if it can affect UJF in a way similar to that noted in diuretic scintigraphy.

Relationship between 1,5-anhydroglucitol and renal function assessed by dynamic renal scintigraphy in type 2 diabetes.

The reliability of serum 1,5-anhydroglucitol (1,5-AG) in type 2 diabetic patients with renal insufficiency remains controversial. To evaluate the relationship between renal function and serum 1,5-AG, and to assess the extent to which renal function influences 1,5-AG. A total of 5337 participants with type 2 diabetes were enrolled. The measured glomerular filtration rate (mGFR) was assayed using 99mTc-DTPA dynamic renal scintigraphy. All subjects were stratified into five groups based on mGFR (≥ 120 [n = 507], 90-120 [n = 2015], 60-90 [n = 2178], 30-60 [n = 604], and < 30 mL/min/1.73 m2 [n = 33]). Overall, the serum 1,5-AG and mGFR levels were 3.3 (1.7-7.0) μg/mL and 88.6 ± 24.1 mL/min/1.73 m2, respectively. mGFR was found to be negatively correlated with 1,5-AG levels (r = -0.189, P < 0.001). Multiple linear regression revealed that mGFR was independently and negatively related to serum 1,5-AG after adjusting for covariates including HbA1c (P < 0.001). In subgroups with mGFR ≥ 30 mL/min/1.73 m2, the correlation coefficients between 1,5-AG and HbA1c, fasting plasma glucose, postprandial plasma glucose, and the differences between postprandial and fasting plasma glucose remained significant (range from -0.126 to -0.743, all P < 0.01). However, the link between 1,5-AG and traditional glycemic markers was attenuated in individuals with mGFR < 30 mL/min/1.73 m2. Sensitivity analysis after excluding anemic patients showed similar results regarding the relationship between serum 1,5-AG and HbA1c across the mGFR subgroups. Although we observed a weak inverse correlation (r = -0.189) between mGFR and serum 1,5-AG in type 2 diabetes, 1,5-AG remains a valid marker for assessing glucose control in subjects with mild or moderate renal dysfunction.

Role of Ultrasonography and Dynamic Renal Scintigraphy Parameters in Decision Making Regarding Performance of Pyeloplasty in Children with Ureteropelvic Junction Obstruction

Role of Ultrasonography and Dynamic Renal Scintigraphy Parameters in Decision Making Regarding Performance of Pyeloplasty in Children with Ureteropelvic Junction Obstruction

Renal Function Preservation in Purely Off-Clamp Sutureless Robotic Partial Nephrectomy: Initial Experience and Technique.

The aim of our study is to evaluate the effectiveness and safety of a sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN), particularly its impact on renal function. A multicenter study was conducted from April 2021 to June 2022. Patients diagnosed with a renal mass of >2 cm and a PADUA score of ≤6 consecutively underwent an sl-oc RAPN procedure. Tumor features, patients characteristics, and intraoperative outcomes were assessed. An evaluation of renal function was performed preoperatively, and again at 1 and 3 months after surgery by measuring the creatinine and blood urea nitrogen levels. The renal function of the two separate kidneys was assessed by a sequential renal scintigraphy performed before and at least 30 days after surgery. A total of 21 patients underwent an sl-oc RAPN. The median age was 64 years (IQR 52/70), the median tumor diameter was 40 mm (IQR 29/45), and the median PADUA score was 4 (3.5/5). The intraoperative outcomes included operative time (OT), 90 (IQR 74/100) min; estimated blood loss (EBL), 150 (IQR 50/300) mL; and perioperative complications, CD > 3 1(5%); only two patients presented positive surgical margins in their final histology (2/21, 10%). Compared to the preoperative value, a decrease in renal function was highlighted with a statistically significant median decrease of 10 mL/min (p < 0.01). The renal scintigraphy showed an overall decrease in renal function compared to the preoperative value, with a range in the operated kidney that varied from 0 to 15 mL/s and from 0% to 40%, with a median value of 4 mL/s and 12%. sl-oc RAPN is a safe procedure, with a minimal impact on kidney function alteration. This technique has proven effective in preserving renal function and maintaining optimal oncological outcomes with limited complications.

Can CT or MRI volumetry substitute scintigraphy in living kidney donor evaluation? A systematic review

BackgroundCurrent potential living kidney donor’s assessment includes functional and anatomical evaluation. Scintigraphy is recommended in some cases and some centers include this test in the donor’s protocol. Recent studies advocate for the avoidance of this test as CT or MRI volumetry showed to accurately assess donor’s renal function.ObjectiveTo summarize scientific evidence on image tests for pre-donation and/or post-nephrectomy renal function evaluation.Evidence acquisitionThis review followed the guidelines set by the European Association of Urology and adhered to PRISMA 2020 recommendations. The protocol was registered in PROSPERO on 10th December 2022 (ID: CRD42022379273).Evidence synthesisTwenty-one studies met the inclusion criteria after thorough screening and eligibility assessment. According to QUADAS-2, patient selection and flow/timing domains showed a predominant low risk of bias.The correlation between split renal function (SRF) using CT and scintigraphy varied from weak (r = 0.21) to remarkably strong (r = 0.949). Bland–Altman agreement demonstrated moderate to excellent results, with mean differences ranging from -0.06% to 1.76%. The correlation between split renal volume (CT) and estimated glomerular filtration rate (eGFR) at 6 months or 1 year after nephrectomy showed a moderate correlation, with coefficients ranging from 0.708 to 0.83.The correlation between SRF (MRI) and renal scintigraphy reported a moderate correlation, with correlation coefficients of 0.58 and 0.84. MRI and scintigraphy displayed a good agreement, with a 66% agreement observed and mean differences of ± 0.3%.ConclusionsDespite study heterogeneity, MRI or CT-based renal volumetry appears promising compared to scintigraphy, with favorable correlations and agreement.

Comparison of proximal and distal laparoscopic ureteroureterostomy for complete duplex kidneys in children

ObjectiveTo compare efficacy of proximal and distal laparoscopic ureteroureterostomy (UU) for complete duplex kidneys in children.MethodsPatients who underwent laparoscopic UU for complete duplex kidneys between December 2016 and July 2022 were reviewed retrospectively. 71 patients who had normal lower pole moiety without vesicoureteral reflux (VUR) were recruited. All of them underwent ultrasound, voiding cystourethrography (VCUG), renal scintigraphy, and magnetic resonance urography preoperatively. Proximal laparoscopic UU was performed in 35 patients and distal laparoscopic UU in 36 patients. Double J stents were placed in normal lower pole moieties. Clinical data, including general information, diagnosis, surgical management, imaging characteristics, clinical symptoms and postoperative complications (classified according to the modified Clavien–Dindo classification), and length of stay were recorded. Measurement date comparisons between groups were performed by t test, counting date were analyzed by chi-square test.ResultsThe study consisted of 71 patients (56 females and 15 males) with complete duplex kidneys (41 in left kidney and 30 in right kidney). The patients’ mean age was 34 m (range 3–161 m) and follow-up ranged from 25 to 81 m. No significant difference was found in age and follow-up time between the two groups. Laparoscopic UU was performed in all patients successfully. The operation time of the two groups was 108.42 ± 26.95 min for distal UU vs 121.46 ± 35.15 min for proximal UU(p = 0.14). No significant difference in postoperative complications was seen between the two groups (22.2% vs 31.4%, p = 0.345). However, in terms of the grading of postoperative complications, the proximal UU group had a higher grade (3 of them had a grade of IV) and more serious complications.ConclusionsThere was no significant difference in the overall incidence of complications between distal and proximal UU. Compared with proximal laparoscopic UU, distal laparoscopic UU is easier to perform with less injury to the peripheral tissues. Postoperative complications of proximal UU are more serious and more difficult to manage. We recommend complete duplex kidney ureteral reconstruction with distal UU.

Dorsal Lumbotomy Pyeloplasty Via Transverse Incision, A Ten Years’ Experience

The Pelviureteric- junction obstruction (PUJO) is the commonest cause of hydronephrosis in children. Dismembered pyeloplasty is the gold standard procedure for PUJO. Dorsal transverse lumbotomy approach is our preferred approach to get access to Pelviureteric junction. This is a retrospective study of last 10 years of one Hundred and twenty three cases. All the patients were operated via dorsal lumbotomy approach. Pre-operative Investigations hemogram, Ultra sonography and a preoperative diuretic renal scintigraphy with diethyl tri-amino penta acetic acid (DTPA) / Ethylene dicysteine (EC.) and Dimercaptosuccinic acid (DMSA) was performed in every patient to assess the differential function and changes in renogram curve. Indication for pyeloplasty was PUJO with obstructed renogram with non-achievement or delayed excretion of Tracer (T ½). Patient were operated under General anaesthesia in prone position and standard Anderson-Hynes Dismembered pyeloplasty via transverse lumbotomy incision. A Total of 123 patients were operated with the median age of patients was 30 months; the average antero- posterior diameter of the renal pelvis was 24 mm. The Average time for surgery was 99 minutes, The Average days of admission were 4. Six patients had postoperative leak which were managed conservatively. Nine patients required redo surgery.

Unexpected Extrarenal Accumulation of Tc-99m Ethylene Dicysteine in a Case of Liposarcoma.

The technetium-99m ethylene dicysteine (Tc-99m EC) is a radiopharmaceutical used for renal scintigraphy, a noninvasive imaging technique that assesses kidney function as well as urinary tract obstruction. We describe the extrarenal Tc-99m EC uptake in a 70-year-old man with recurrent well-differentiated abdominal liposarcoma. In the present case, both liposarcoma lesions which were diagnosed by abdominal CT scan showed heterogeneous accumulation of the Tc-99m EC.

Kidney computed tomography perfusion in patients with ureteral obstruction.

Kidney perfusion on CT is an encouraging surrogate for renal scintigraphy in assessing renal function. However, data on dynamic volumetric CT in patients with kidney obstruction is lacking. Thus, the aim of this study is to determine the feasibility of CT-based renal perfusion using a dynamic volume to assess renal hemodynamics at different degrees and durations of obstruction. We included patients with unilateral kidney obstruction in our single-center, prospective study. The patients were divided into three groups. Patients without dilatation of the pelvicalyceal system (PCS) and normal parenchyma thickness were included into Group 1; patients with PCS dilatation and parenchyma thickness 1.8-2.4 cm-into Group 2; and patients with ureteropyelocalicoectasia and parenchyma thickness less than 1.8 cm-into Group 3. Total of 56 patients were enrolled. In Group 1 mean values of cortical and medullar arterial blood flow, blood volume, and extraction fraction were within the normal range. Changes in contralateral kidney were not determined. Patients from Group 2 showed significant differences in blood flow parameters in the cortical and medulla of the obstructed kidney. No changes in perfusion values in the contralateral kidney was observed. In patients from Group 3 there was a marked decrease in perfusion on the side of obstruction compared to Group 2, indicating that the degree of expansion of the PCS directly correlates with the change in blood flow. However, in the contralateral kidney, these indicators exceeded the normal values of perfusion. CT perfusion allows to objectively assess changes in blood flow in the setting of renal obstruction. The degree of obstruction directly affects the measured rate of blood flow.

Simultaneous assessment of renal function with hybrid SPECT/CT during whole-body bonescintigraphy (WbBS) in patients with prostate carcinoma (PC) and concomitant urological diseases with impaired renal drainage

Introduction: Whole-body bone scintigraphy (WbBS) is the „gold standard“ worldwide for early detection and evaluation of treatment of bone metastatic tumors, incl.PC.Due to the known renal excretion of the osteotropic RPh – 99mTc-methylene diphosphonate (99mTc-MDP), it is possible to perform an „early“ assessment of renal function, followed by a „late“ standard WbBS with SPECT/CT. Aim: The aim of the present study was to evaluate and indicate the diagnostic utility of a single administration of 99mTc-MDP with a dual protocol implemented in the CNM for sequential scintigraphic assessment of renal function and early detection, staging and evaluation of the treatment effect of bone metastases in patients with PCand concomitant urological diseases. Materials and methods: We present three patients with PC, referred for restaging of the oncological disease and performing WbBS in the CNM in USHATO, Sofia, Bulgaria. According to the indications and assessment of a nuclear medicine physician, a one-day protocol was carried out and introduced in the CNM, starting with dynamic renal scintigraphy (DRS) at the time of bo-lus i.v.injection of 99mTc-MDP and subsequent after the 2nd hour planar WbBS with hybrid target or wholebody SPECT/CT scan. Results: The first patient is with metastatic PC after complex treatment.Due to elevated levels of creatinine, „early“ DRS and „late“ restaging WbBS were performed, with reported full therapeutic effect of bone-metastatic disease and isosthenuric changes in right kidney, but with altered secretory-excretory phases and reduced total GFR.The second case is a patient with high-risk CP, who underwent hormonal and definitive radiation therapy, with episodes of renal colic. DRS revealed a hydronephrotic type nephrogram on the right, and a subsequent CT scan showed osteoporotic compression fractures of two vertebrae, without bon metastasis. An additional SPECT/CT finding is a calcium-dense calculus as a probable cause of the hydronephrotic changes. The third patient, is with high-risk CP and undergonetreatment. Initial DRSshowed secretory-excretory dysfunction of the right kidney with retention in the pyelocaliceal system. SubsequentWbBSand SPECT/CT revealed a complete therapeutic effect of a solitary bony lesion in the 6th right rib and malrotation of the right kidney with a staghorn calculus in the pyelon. All patients are referred for urological control. Conclusion: DRS performed with hybrid SPECT/ CT, in the course of routine WbBS, for re-staging of patients with CP, gives along with bone metastatic follow-up, valuable functional information about the separated renal function, drainage and morphological guidance for pathological changes from concomitant urological diseases.