Tc-99m MAG3 Research Articles

Determining Split Renal Function in Children With Ureteropelvic Junction Stenosis: Technetium-99m Mercaptoacetyltriglycine (Tc-99m MAG-3) or Technetium-99m Dimercaptosuccinic Acid (Tc-99m DMSA)?

Background Ureteropelvic junction stenosis (UPJS) is the most common cause of clinically significant antenatal hydronephrosis. We compared separate renal function results obtained using technetium-99m-mercaptoacetyltriglycine (Tc-99m MAG-3) and technetium-99m-dimercaptosuccinic acid (Tc-99m DMSA) in pediatric patients with UPJS to evaluate the adequacy of Tc-99m MAG-3 scintigraphy and the necessity of additional Tc-99m DMSA scintigraphy during follow-up. Methodology Patients diagnosed with hydronephrosis in the Pediatric Nephrology Department of Pamukkale University Faculty of Medicine over a period of 10 years (2012-2022) were evaluated retrospectively. Patients who had been diagnosed with UPJS and underwent both Tc-99m MAG-3 and Tc-99m DMSA scintigraphy during follow-up were included in the study. Technetium-99m-labeled MAG-3 and DMSA scans were re-evaluated for all patients by the Department of Nuclear Medicine. Results The study included 52 children with unilateral UPJS (12 girls and 40 boys) with a mean age of 6.34 ± 4.81 years (range: 2.97-9.79 years). Thirty-six patients (69.2%) were diagnosed antenatally. Differential renal function in Tc-99m DMSA was 46.94 ± 10.64 and in Tc-99m MAG-3 was 43.08 ± 11.18; the functions were lower in Tc-99m MAG-3, but the values were within normal limits for both groups (p=0.0001, z=-3.893). When differential renal functions were compared between Tc-99m DMSA and Tc-99m MAG-3 results, a statistically significant positive and strong correlation was found in the kidney with ureteropelvic junction obstruction (UPJO) (p=0.0001, r=0.752). When classifying the Tc-99m MAG-3 and Tc-99m DMSA results in the kidney with UPJO (supranormal, normal, low function) for the determination of differential renal functions, there was a consistency of 76%, and it was correlated (p=0.0001, k=0.456). While two patients had supranormal function and 13 patients had low function in Tc-99m MAG-3, five patients had supranormal function, and eight patients had low function in Tc-99m DMSA. Conclusions Some studies in the literature have reported that Tc-99m MAG-3 causes supranormal function measurements in patients with UPJS; our results showed that Tc-99m DMSA resulted in a higher rate of supranormal values for affected kidneys. We believe that Tc-99m DMSA should not be performed in addition to Tc-99m MAG-3 scintigraphy in the follow-up of every patient with UPJS but can be utilized in select cases, such as patients with surgical indications and those suspected before surgery.

Comparison of absolute renal uptake by using Tc-99m MAG-3 and Tc-99m DMSA.

The purpose of this study is to compare the value of absolute renal uptake (ARU %) in patients by using Tc-99m MAG-3 and Tc-99m DMSA scan. Absolute renal uptake is calculated using Tc-99m MAG-3 and Tc-99m DMSA in renal scintigraphy, Itoh and Tauex kidney depth methods used, respectively. n = 40 adult patients of both genders were included. All patients underwent Tc-99m MAG-3 and Tc-99m DMSA, respectively. The values of ARU (%) were calculated separately in selected patients n = 40, (left = 17, right = 23 normal functioning kidneys) by MAG-3 and DMSA. Absolute renal uptake (%) of Tc-99m MAG-3 in left kidneys was found to be 15.2 ± 3.4, with spilt renal function 79.2 ± 14.7 and ARU (%) in right kidneys 16.2 ± 3.4 with spilt renal function 77.5 ± 19. Absolute renal uptake of Tc-99m DMSA in left kidneys was 17.5 ± 3.2 and in right kidneys 17.9 ± 4.5 with spilt renal function 81.8 ± 10.7 and 79.3 ± 13.8 for left and right kidney, respectively. Statistical analysis showed strong Pearson correlation. Absolute renal uptake % was found to be more reliable in cases of bilateral compromised kidneys. ARU (%) calculated by Tc-99m MAG-3 solely can be used as predictor of renal function. The use of Tc-99m MAG-3 has more advantages than Tc-99m DMSA alone in renal scintigraphy as dynamic scintigraphy gives less radiation burden to patient, more information regarding renal function, and shorter stay time at hospital in comparison to static renal imaging. SRF % is less reliable than ARU (%).

Voiding Sistoüretrogram ile Tanı Konulan Vezikoüreteral Reflü'nün Saptanmasında Dinamik Böbrek Sintigrafisinin Rolü

Aims: This study aims to evaluate the role of standardized dynamic renal scintigraphy (DRS) in recognizing vesicoureteral reflux (VUR) in patients detected with VUR by voiding cystourethrography (VCUG). Methods: The data of all pediatric patients who underwent both VCUG and DRS [technetium-99m diethylenetriamine pentaacetic acid (Tc-99m DTPA) or technetium-99m mercaptoacetyltriglycine dynamic renal scintigraphy (Tc-99m MAG-3)] in our hospital between 2013 and 2022 were retrospectively reviewed. Tc-99m MAG-3 was used in infants and Tc-99m DTPA radiopharmaceutical in children over one year old. According to VCUG findings, VUR grades were grouped as grade I-II-III low-grade VUR and IV-V high-grade VUR. The role of DRS in detecting VUR in both low and high-VUR-grade groups was evaluated. Results: A total of 56 patients (and 69 renal units), 23 girls (%41.1), and 33 boys (%68.9) were included in this study. The median value of the time elapsed between the DRS and VCUG examinations was nine days. According to VCUG, VUR was grade I in five renal units, grade II in 19 renal units, grade III in six renal units, grade IV in six renal units, and grade V in 33 renal units. DRS detected VUR in two of 30 renal units (%6.7) in the low VUR grade group. On the other hand, VUR was observed with DRS in 27 of 39 renal units (%69.2) in the high VUR grade group. Conclusions: Standardized DRS shows very low sensitivity in recognizing low-grade VUR, and its performance in detecting high-grade VUR is comparatively better. Raising awareness among clinicians that VUR can be observed with standardized DRS will benefit the patient in terms of early detection of accompanying VUR pathologies.

MP69-12 THE PREDICTION OF RENAL FUNCTION CHANGE AFTER UNILATERAL NEPHROURETERECTOMY IN UPPER TRACT UROTHELIAL CARCINOMA PATIENTS BY USING TC-99M MAG3 RENAL SCAN

You have accessJournal of UrologyCME1 Apr 2023MP69-12 THE PREDICTION OF RENAL FUNCTION CHANGE AFTER UNILATERAL NEPHROURETERECTOMY IN UPPER TRACT UROTHELIAL CARCINOMA PATIENTS BY USING TC-99M MAG3 RENAL SCAN Kai-Sen Su, Yi-Hsiu Huang, Ming-Hsuan Ku, Wei-Ren Chen, Tzu-Hao Huang, Tzu-Chun Wei, I-Shen Huang, Yu-Hua Fan, Chih-Chieh Lin, Tzu-Ping Lin, Hsiao-Jen Chung, Junne-Yih Kuo, Yen-Hwa Chang, Teng-Lung Lin, Jhih-Sian Huang, and Jen-Chieh Chen Kai-Sen SuKai-Sen Su More articles by this author , Yi-Hsiu HuangYi-Hsiu Huang More articles by this author , Ming-Hsuan KuMing-Hsuan Ku More articles by this author , Wei-Ren ChenWei-Ren Chen More articles by this author , Tzu-Hao HuangTzu-Hao Huang More articles by this author , Tzu-Chun WeiTzu-Chun Wei More articles by this author , I-Shen HuangI-Shen Huang More articles by this author , Yu-Hua FanYu-Hua Fan More articles by this author , Chih-Chieh LinChih-Chieh Lin More articles by this author , Tzu-Ping LinTzu-Ping Lin More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung More articles by this author , Junne-Yih KuoJunne-Yih Kuo More articles by this author , Yen-Hwa ChangYen-Hwa Chang More articles by this author , Teng-Lung LinTeng-Lung Lin More articles by this author , Jhih-Sian HuangJhih-Sian Huang More articles by this author , and Jen-Chieh ChenJen-Chieh Chen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical nephroureterectomy with bladder cuff excision (RNU BCE) is the standard of treatment for high-risk upper tract urothelial carcinoma (UTUC). We aim to develop a predictive equation for post-unilateral RNU BCE renal function by using pre-operative renal scintigraphy. METHODS: From January 2010 to December 2020, patients diagnosed with UTUC and underwent unilateral RNU BCE in our institute were reviewed. Comprehensive renal function evaluation by technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) renal scintigraphy was done pre-operatively. Serum creatinine level was recorded pre-operatively, 3 months (3M) and 6 months (6M) post-operatively (OP). Pearson’s linear correlation analysis was used for developing predictive equation. Internal validation with patients of the same criteria recruited after the study period (2021’s database) was done to test the equation’s accuracy. Cisplatin ineligibility by renal function was defined as eGFR <60 ml/min/1.73m2. RESULTS: In total, 487 patients who underwent unilateral RNU BCE for UTUC were included. The median pre-operative total effective renal plasma flow (ERPF) was 241.30 ml/min, and the lesion side accounted for 35.6% of total ERPF. Pre-operative lesion side ERPF ratio was significantly associated to post-operative decrease of eGFR ratio at 3 months (R=0.613, p<0.001), and the predictive equation was established as: Post-OP 3M Decrease of eGFR (%)=0.675 x Lesion Side/Total ERPF Ratio (%)+0.919. Internal validation with 2021’s database showed high accuracy of prediction in post-OP 3M eGFR decrease (R=0.896). For the 12 patients that experienced RNU-related cisplatin ineligibility, our predictive equation successfully foresaw such renal function loss in all patients, with a prediction accuracy of 12/12 (100%). CONCLUSIONS: We established a predictive equation using pre-operative lesion side ERPF ratio to predict post-operative eGFR loss. Such an equation could accurately predict residual renal function and foresee RNU-related cisplatin ineligibility before unilateral RNU. Source of Funding: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e968 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kai-Sen Su More articles by this author Yi-Hsiu Huang More articles by this author Ming-Hsuan Ku More articles by this author Wei-Ren Chen More articles by this author Tzu-Hao Huang More articles by this author Tzu-Chun Wei More articles by this author I-Shen Huang More articles by this author Yu-Hua Fan More articles by this author Chih-Chieh Lin More articles by this author Tzu-Ping Lin More articles by this author Hsiao-Jen Chung More articles by this author Junne-Yih Kuo More articles by this author Yen-Hwa Chang More articles by this author Teng-Lung Lin More articles by this author Jhih-Sian Huang More articles by this author Jen-Chieh Chen More articles by this author Expand All Advertisement PDF downloadLoading ...

The prediction of renal function change after unilateral nephroureterectomy in upper tract urothelial carcinoma patients by using tc-99m mag3 renal scan

The prediction of renal function change after unilateral nephroureterectomy in upper tract urothelial carcinoma patients by using tc-99m mag3 renal scan

The Usefulness of 99m Tc Diethylenetriamine Pentaacetate (DTPA) or Mercaptoacetyltriglycine (MAG3) Renal Perfusion Scan in Assessing Chronic Renal Complications of COVID-19

Background: Imaging departments worldwide are exploring different ways to help manage chronic complications of COVID-19 after two years. Objectives: Renal complications following acute kidney injury in the acute phase of COVID-19 or exacerbation of chronic kidney disease (CKD) are crucial. Methods: This article presented the role of 99m Tc diethylenetriamine pentaacetate (DTPA) or mercaptoacetyltriglycine (MAG3) renal perfusion scan in managing chronic renal complications following COVID-19 by submitting the relevant techniques and available radiopharmaceuticals. Results: Renal perfusion scan with 99m Tc DTPA and MAG3 could evaluate profusion and function in acute and chronic settings and manage these renal complications. Conclusions: Based on the results, 99m Tc DTPA or MAG3 renal perfusion scan could detect, monitor, and evaluate response to treatment in COVID-19-related renal chronic damages and complications.

Outcomes of Robot-Assisted Laparoscopic Pyeloplasty Based on Degree of Obstruction on Preoperative Tc-99 MAG-3 Renal Scintigraphy.

Objective: Management of symptomatic ureteropelvic junction (UPJ) obstruction with hydronephrosis and discordant Tc-99 mercaptoacetyltriglycine (MAG-3) renal scintigraphy is challenging. In this study we describe long-term outcomes of patients who underwent robot-assisted laparoscopic pyeloplasty for the correction of symptomatic UPJ obstruction with discordant preoperative Tc-99m MAG-3 renal scintigraphy. Methods: Patients undergoing robot-assisted laparoscopic pyeloplasty for symptomatic UPJ obstruction at a single academic center from 2009 to 2021 were retrospectively reviewed. Patients were categorized into three groups with varying degrees of obstruction based on preoperative MAG-3 imaging: Group 1: no obstruction (Lasix T1/2 clearance <10 minutes), Group 2: equivocal obstruction (Lasix T1/2 clearance 10-20 minutes), and Group 3: obstruction (Lasix T1/2 clearance >20 minutes. Pyeloplasty success was defined as resolution of symptoms and improvement/stable computed tomography (CT) imaging or MAG-3 scintigraphy. Failure was defined as persistence of symptoms with either obstruction on functional imaging, worsening hydronephrosis, or subsequent intervention. Results: A total of 125 cases were identified, with a median patient age of 35 years. Dismembered pyeloplasty technique was performed in 98.4% of cases. Median preoperative split renal function on MAG-3 scintigraphy was the only statistically significant (p = 0.003) difference in preoperative characteristics between the three groups. There were 15 postoperative complications, with a rate of Clavien-Dindo grade 3 or higher complications of 4.8%. Overall pyeloplasty success was 92.8%, with success rates of 100% (15/15) and 97% (32/33) in the no obstruction and equivocal obstruction groups, respectively. Median time to pyeloplasty failure was 20.4 months. Conclusion: Robot-assisted laparoscopic pyeloplasty is a safe and effective surgical intervention for correcting UPJ obstruction. Patients with symptoms of UPJ obstruction and discordant functional imaging studies demonstrate similar or improved success rates after pyeloplasty compared with patients with documented high-grade obstruction. Based on these findings preoperative renal scan may not be reliable in appropriate selection of candidacy for pyeloplasty.

Inguinal ureteral herniation detected by Tc‐99m MAG3 renogram

Pediatrics InternationalVolume 64, Issue 1 e15076 Clinical Notes Inguinal ureteral herniation detected by Tc-99m MAG3 renogram Takahiro Hosokawa, Corresponding Author Takahiro Hosokawa snowglobe@infoseek.jp orcid.org/0000-0001-9523-4077 Department of Radiology, Saitama Children’s Medical Center, Saitama, Japan Correspondence: Takahiro Hosokawa, MD, Department of Radiology, Saitama Children’s Medical Center, 1-2 Shintoshin Chuo-ku Saitama, Saitama, 330-8777 Japan. Email: snowglobe@infoseek.jpSearch for more papers by this authorMayuki Uchiyama, Mayuki Uchiyama Department of Radiology, The Jikei University School of Medicine, Minato-ku, JapanSearch for more papers by this authorKentaro Hayashi, Kentaro Hayashi Department of Surgery, Saitama Children’s Medical Center, Saitama, JapanSearch for more papers by this authorTetsuya Ishimaru, Tetsuya Ishimaru Department of Surgery, Saitama Children’s Medical Center, Saitama, JapanSearch for more papers by this authorHiroshi Kawashima, Hiroshi Kawashima Department of Surgery, Saitama Children’s Medical Center, Saitama, JapanSearch for more papers by this author Takahiro Hosokawa, Corresponding Author Takahiro Hosokawa snowglobe@infoseek.jp orcid.org/0000-0001-9523-4077 Department of Radiology, Saitama Children’s Medical Center, Saitama, Japan Correspondence: Takahiro Hosokawa, MD, Department of Radiology, Saitama Children’s Medical Center, 1-2 Shintoshin Chuo-ku Saitama, Saitama, 330-8777 Japan. Email: snowglobe@infoseek.jpSearch for more papers by this authorMayuki Uchiyama, Mayuki Uchiyama Department of Radiology, The Jikei University School of Medicine, Minato-ku, JapanSearch for more papers by this authorKentaro Hayashi, Kentaro Hayashi Department of Surgery, Saitama Children’s Medical Center, Saitama, JapanSearch for more papers by this authorTetsuya Ishimaru, Tetsuya Ishimaru Department of Surgery, Saitama Children’s Medical Center, Saitama, JapanSearch for more papers by this authorHiroshi Kawashima, Hiroshi Kawashima Department of Surgery, Saitama Children’s Medical Center, Saitama, JapanSearch for more papers by this author First published: 12 March 2022 https://doi.org/10.1111/ped.15076Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume64, Issue1January/December 2022e15076 RelatedInformation

Comparison between Tc-99m DTPA and Tc-99m MAG3 Renal Scintigraphy for Prediction of Early Adverse Outcome After Kidney Transplantation.

Renal scintigraphy (RS) with either technetium-99m diethylene-triamine-pentaacetate (Tc-99m DTPA) or technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) has both been used to evaluate early allograft function after kidney transplantation (KT). This study was done to compare the predictive performance of RS using these two radiopharmaceuticals for prediction of outcomes during first 3months of KT. This retrospective study included patients who received KT then underwent both Tc-99m DTPA and Tc-99m MAG3 RS, successively. Receiver operating characteristic (ROC) curve analysis was used to determine the predictiveness of RS parameters on early clinical adverse outcomes of either (1) graft-related death, (2) need for graft resection, (3) delayed graft function requiring temporary dialysis, or (4) a serum creatinine level of ≥ 2.0mg/dL at three months post-KT, as well as to predict biopsy-confirmed acute tubular necrosis and acute rejection. Of 187 patients included, 77 (41.2%) had at least one early adverse clinical outcome. Tc-99m MAG3 RS was more predictive than Tc-99m DTPA RS, in terms of AUCROC, in three parameters including time to peak (0.754 vs. 0.516, p-value 0.0001), 20-min to peak ratio (0.762 vs. 0.651, p-value 0.006), and 20-min to 3-min ratio (0.823 vs. 0.699, p-value 0.0005). Acute tubular necrosis was better predicted by Tc-99m MAG3 RS while both were at best only modest in predicting acute rejection. Three parameters which, when obtained from Tc-99m MAG3 RS, had superior predictiveness compared with Tc-99m DTPA RS, including time to peak, 20-min to peak ratio, and 20-min to 3-min ratio.

Effect of Ursodeoxycholic Acid on the Biodistribution and Excretion of Technetium-99m Radiopharmaceuticals in Rat: A Potential Image Quality Enhancer.

PurposeThis study aimed to investigate the effect of ursodeoxycholic acid (UDCA) on the biodistribution and excretion of technetium-99m (Tc-99m)-labeled radiopharmaceuticals.Materials and MethodsTc-99m hydroxy-methylene-diphosphonate (HDP), Tc-99m pertechnetate, and Tc-99m dimercaptosuccinic acid (DMSA) were injected via the tail vein of rats. After 30 min, the control group was administered saline, and the UDCA group was given UDCA orally. Scintigraphy images were acquired after 30 min and 1, 2, 3, and 4 h. Radioactivity and rate of change were compared. Tc-99m mercaptoacetyltriglycine (MAG3) imaging was also performed.ResultsIn image analysis of Tc-99m HDP, radioactivity of the buttock was lower in the UDCA group at 4 h. Rates of change in the buttock were significantly different at 3 h–30 min and 4 h–30 min, and buttock radioactivity in the UDCA group had decreased more. In analysis of Tc-99m pertechnetate, radioactivity of the buttock was higher in the control group. Rates of change in the thyroid gland and buttock were different at 1 h–30 min, 3 h–30 min, and 4 h–30 min, with radioactivity in the UDCA group decreasing more. In the analysis of Tc-99m DMSA, while the radioactivity of the kidneys in the control group showed little decrease at 1 h–30 min, that in the UDCA group increased. In the analysis of Tc-99m MAG3 images, radioactivity and radioactivity/total body radioactivity (TBA) values for the kidneys were higher in the UDCA group at 2 min. At 5 and 10 min, radioactivity/TBA values for soft tissue in the UDCA group were lower than those in the control group.ConclusionThis study demonstrated that administration of UDCA increases renal excretion and soft tissue clearance of radiopharmaceuticals. This investigation could contribute to the broadening of applications of UDCA.

Body morphometry appropriate computational phantoms for dose and risk optimization in pediatric renal imaging with Tc-99m DMSA and Tc-99m MAG3

Current guidelines for administered activity (AA) in pediatric nuclear medicine imaging studies are based on a 2016 harmonization of the 2010 North American Consensus guidelines and the 2007 European Association of Nuclear Medicine pediatric dosage card. These guidelines assign AA scaled to patient body mass, with further constraints on maximum and minimum values of radiopharmaceutical activity. These guidelines, however, are not formulated based upon a rigor-ous evaluation of diagnostic image quality. In a recent study of the renal cortex imaging agent 99mTc-DMSA (Li Y et al 2019), body mass-based dosing guidelines were shown to not give the same level of image quality for patients of differing body mass. Their data suggest that patient girth at the level of the kidneys may be a better morphometric parameter to consider when selecting AA for renal nuclear medicine imaging. The objective of the present work was thus to develop a dedicated series of computational phantoms to support image quality and organ dose studies in pediatric renal imaging using 99mTc-DMSA or 99mTc-MAG3. The final library consists of 50 male and female phantoms of ages 0 to 15 years, with percentile variations (5th to 95th) in waist circumference (WC) at each age. For each phantom, nominal values of kidney volume, length, and depth were incorporated into the phantom design. Organ absorbed doses, detriment-weighted doses, and stochastic risks were assessed using ICRP reference biokinetic models for both agents. In Monte Carlo radiation transport simulations, organ doses for these agents yielded detriment-weighted dose coefficients (mSv/MBq) that were in general larger than current ICRP values of the effective dose coefficients (age and WC-averaged ratios of eDW/e were 1.40 for the male phantoms and 1.49 for the female phantoms). Values of risk index (ratio of radiation-induced to natural background cancer incidence risk x 100) varied between 0.062 (newborns) to 0.108 (15-year-olds) for 99mTc-DMSA and between 0.026 (newborns) to 0.122 (15-year-olds) for 99mTc-MAG3. Using tallies of photon exit fluence as a rough surrogate for uniform image quality, our study demonstrated that through body region-of-interest optimization of AA, there is the potential for further dose and risk reductions of between factors of 1.5 to 3.0 beyond simple weight-based dosing guidance.

Pictorial review of urinary tract obstruction on Tc-99m MAG3 renograms with diuretic

Category: Pictorial review.

Limited clinical value of two consecutive post-transplant renal scintigraphy procedures

ObjectivesDuration of delayed graft function (DGF) and length of hospital stay (LOS) are outcomes of interest in an era that warrants increased efficacy of transplant care whereas renal allografts originate increasingly from marginal donors. While earlier studies investigate the predictive capability of a single renal scintigraphy, this study focuses on the value for both DGF duration and LOS of consecutively performed scintigraphies.MethodsFrom 2011 to 2014, renal transplant recipients referred for a Tc-99m MAG3 renal scintigraphy were included in a single-center retrospective study. Primary endpoints were DGF duration and LOS. Both the first (≤ 3 days) and second scintigraphies (3–7 days after transplantation) were analyzed using a 4-grade qualitative scale and quantitative indices (TFS, cTER, MUC10, average upslope).ResultsWe evaluated 200 first and 108 (54%) consecutively performed scintigraphies. The Kaplan-Meier curves for DGF duration and qualitative grading of the first and second scintigraphy showed significant differences between the grades (p < 0.01). The Kaplan-Meier curve for the delta grades between these procedures (lower, equal, or higher grade) did not show significant differences (p = 0.18). Multivariate analysis showed a significant association between the qualitative grades, from the first and second scintigraphy, and DGF duration, HR 1.8 (1.4–2.2, p < 0.01) and 2.8 (1.8–4.3, p < 0.01), respectively.ConclusionsQualitative grades of single renal scintigraphies, performed within 7 days after transplantation, can be used to make a reliable image-guided decision on the need for dialysis and to predict LOS. A consecutive renal scintigraphy, however, did not show an additional value in the assessment of DGF.Key Points• Post-transplant renal scintigraphy procedures provide information to predict delayed graft function duration and length of hospital stay.• Performing two consecutive renal scintigraphy procedures within 1 week after transplantation does not strengthen the prediction of delayed graft function duration and length of hospital stay.• Single renal scintigraphy procedures can be used to provide clinicians and patients with a reliable indication of the need for dialysis after transplantation and the expected duration of hospitalization.

Prognostic Value of Effective Renal Plasma Flow for First-year Renal Outcome in Kidney Allograft Recipients

IntroductionMany studies have suggested that post-transplantation renal allograft function is associated with long-term allograft outcomes. However, accurate examination through non-invasive methods remains rare. The aim of the present study is to assess the association between 99mTc mercaptoacetyltriglycine (MAG3) effective renal plasma flow (ERPF) and first-year post-transplantation renal allograft function. MethodsWe conducted a retrospective cohort study at our center between January 2011 and December 2016. Kidney transplant recipients without an ERPF examination within 14 days post-transplantation, or those with less than 1 year of follow-up were excluded. Eligible cases were divided into 3 groups according to first-year eGFR <45, 45 < eGFR <60, eGFR >60. The Kruskal-Wallis test and χ2 were used for comparisons between continuous and categorical variables. ResultsA total of 123 patients were analyzed. Each group received 41 patients. The baseline characteristics were comparable in the 3 groups, except for repeated transplantation and delayed graft function. The results of the ERPF median (interquartile range) for the 3 groups were 193 (140.0–244.5) in the eGFR < 45 group, 236 (182.5–301.0) in the 45 < eGFR < 60 group, and 294 (202.5–384.5) in the eGFR > 60 group (P < .001). The receiver operating characteristic analysis showed that a cutoff ERPF value of >276 exhibited the best sensitivity (65.85%) and specificity (75.61%) for predicting first-year eGFR > 60 mL/min/1.73 m2, with an area under the receiver operating characteristic curve of .712, P < .0001. ConclusionOur findings suggest that an ERPF value of more than 276 is likely to be associated with a favorable first-year renal graft outcome after transplantation. The 99mTc MAG3 ERPF may be a non-invasive alternative to sequential protocol biopsies.

99mTc MAG3 scintigraphy in a patient with hyperacute antibody mediated Rejection: A description of the correlation between image findings and clinical disease process.

BackgroundHyperacute antibody mediated rejection (HA-AMR) occurs within 24 h after a renal transplant. Technetium-99m Mercaproacetyl triglicine (99mMAG3) scintigraphy is rarely done within this time period and clinicians rely on clinical features and laboratory parameters for diagnosis. To date literature reports on the correlation between clinical features, laboratory parameters and 99mTc MAG3 scintigraphy in patients with HA-AMR is sparce. AimDescribe the scintigraphic features on serial 99mMAG3 renograms together with the clinical and laboratory findings at diagnosis and during treatment of a patient with HA-AMR. MethodFour 99mTc MAG3 renograms performed on days 1, 4, 11 and 66 post transplant were reviewed. Clinical and laboratory parameters (serum creatinine and urine output) were also evaluated during these time points. ResultsPatient was transplanted at 11 a.m. Overnight patient was clinically well, urine output was 5500 mL and creatinine decreased from 866 μmol/L to 795 μmol/L. 99mTc MAG3 renogram however showed markedly delayed and decreased perfusion with poor uptake and cortical defects. Renogram grade (RG),as described by Heaf et al., was 4. Patient was taken back to theatre to exclude vascular pathology. No thrombus was found, however infarcted areas on the surface of the kidney were seen. Patient was commenced on treatment for HA-AMR. On day 4 post transplant and day 3 after initiation of antirejection therapy, urine output decreased to 850 mL/d and creatinine increased to 955 μmol/L. Another 99mTc MAG3 renogram was performed which showed improved perfusion and uptake as well as significant improvement in the cortical defects. On day 11 post transplant the patients creatinine decreased to 635 μmol/L and urine output increased to 1030 mL/d. 99mTc MAG3 renogram showed a further improvement in perfusion, uptake and cortical defects. The patient was discharged on day 15 post transplant with a creatinine of 425 μmol/L. She continued to do well and on day 66 post transplant her creatinine was 246 μmol/L. 99mTc MAG3 renogram at this stage also showed a further improvement in perfusion, uptake and cortical defects. Renogram grade at discharge was 1. Conclusion99mTc MAG3 scintigraphy is recommended for baseline renal function within 24 h after renal transplant. Clinical parameters may take several days before they a representative of an underlying pathological process. 99mTc MAG3 scintigraphic features correlate with underlying disease process and outcome.

Long-term effects of anatrophic nephrolithotomy on selective renal function

To evaluate the long-term changes of selective renal function after anatrophic nephrolithotomy (ANL). A retrospective study was conducted for patients who underwent ANL between January 1995 and December 2016. Inclusion criteria were availability of preoperative and follow-up (1year or more) radio-isotopic renal scans. Stone-free status was evaluated after 1month with KUB and ultrasonography or NCCT. Renal isotope scans using 99mTc MAG3 were performed to measure the changes in selective function of the affected kidney (GFR%). Eligible patients were classified into two groups, group 1 patients with stable or improved function and group 2 patients with deteriorated function (> 5% decrease in GFR%). Univariate and multivariate analyses were performed to determine risk factors for deterioration of renal function. The cutoff value for any significant variable was determined using ROC curve. The study included 50 patients with mean age 43.8 + 13.9years. Complications developed in 26 patients (52%), and stone-free status was documented in 42 patients (84%). After a median follow-up of 2.7years (range 1-11), mean GFR% of all cases significantly decreased from preoperative value of 52.7%+SD 20 to 45.4%+SD 25% during follow-up (P < 0.001). Deterioration of GFR% was documented in 21 kidneys (42%). Cold ischemia time with a cutoff value 50min was the independent risk factor (RR 3.986, 95% CI 1.069-14.869, P 0.039). The results of this study support limiting ANL to a selected group of patients and taking all the possible efforts to minimize cold ischemia time below 50min.

Can transplant renal scintigraphy predict the duration of delayed graft function? A dual center retrospective study.

IntroductionThis study focused on the value of quantitatively analyzed and qualitatively graded renal scintigraphy in relation to the expected duration of delayed graft function after kidney transplantation. A more reliable prediction of delayed graft function duration may result in a more tailored and patient-specific treatment regimen post-transplantation.MethodsFrom 2000 to 2014, patients with early transplant dysfunction and a Tc-99m MAG3 renal scintigraphy, within 3 days post-transplantation, were included in a dual center retrospective study. Time-activity curves of renal scintigraphy procedures were qualitatively graded and various quantitative indices (R20/3, TFS, cTER, MUC10) were combined with a new index (Average upslope). The delayed graft function duration was defined as the number of days of dialysis-based/functional delayed graft function.ResultsA total of 377 patients were included, with a mean age (± SD) of 52 ± 14 years, and 58% were male. A total of 274 (73%) patients experienced delayed graft function≥ 7 days. Qualitative grading for the prediction of delayed graft function≥ 7 days had a sensitivity and specificity of respectively 87% and 65%. The quantitative indices with the most optimal results were cTER (76% sensitivity, 72% specificity), and Average upslope (75% sensitivity, 73% specificity).ConclusionsQualitative renal scintigraphy grading and the quantitative indices cTER and Average upslope predict delayed graft function ≥ 7 days with a high sensitivity. This finding may help to support both clinicians and patients in managing early post-operative expectations. However, the specificity is limited and thus renal scintigraphy does not reliably help to identify patients in whom the course of delayed graft function is longer than anticipated.

COMPLEX RADIONUCLIDE EVALUATION OF STRUCTURAL AND FUNCTIONAL STATE OF THE SINGLE KIDNEY IN CHILDREN

Summary. Introduction. The aim of the work is the determination of functioning of the single kidney (SK) by&#x0D; complex scintigraphic research with using nephrotrophic radiopharmaceuticals (NRP) of different mechanisms of elimination and the detection of its diagnostic significance.&#x0D; Materials and methods. 90 children (range 5-16 years) with SK were examined: dynamic (DRSG) and static (SRSG) scintigraphy with angiography was made them. 150 scintigraphic examinations with different NRP were made: 99mTc-DTPA (diethyleneaminopentacetate) – 51, 99mTc – PP (pyrophosphate) – 40,99mTc – DMSA (dymethylenesuccinateacetate) – 34, 99mTc MAG3 (mer- captoacetyle-3-glycine) – 15, 99mTc-EC (ethylenedicysteine) – 10. Time options of renal blood flow and transport of NRP, SGF, ERP were determined. Control group consists of15 children.&#x0D; Results.The main scintigraphic features ofSK are: presence of single kidney on scintigraphic image; slowdown of time options of renal haemodynamic, increasing of SGF and ERP of SK on 50-60 %; decreasing of standard parameters SGF and ERP on 40-50%. The slowdown of SK excretion ability is associated with retention NRP in parenchyma. Proportions of SK increase on 2-3 sm average, and size of scintigraphic picture – on 40%. The main type of renographic curve in children with SK is parenchymatose, and it is found in 50% ofpatients. The accumulation and distribution of NRP in SK in 73,3 % is quite uniform.&#x0D; Conclisions. Thus, SK in children functions in strain way of all compensation mechanisms that provide blood purification from products of vital functions, which shows the slowdown of main options of the SKfunctioning.

Investigation of Radiation Exposure Dose from Nuclear Medicine Procedures (Tc-99m MAG-3)

Investigation of Radiation Exposure Dose from Nuclear Medicine Procedures (Tc-99m MAG-3)

Investigation of Radiation Exposure Dose from Nuclear Medicine Procedures (Tc-99m MAG-3)

Investigation of Radiation Exposure Dose from Nuclear Medicine Procedures (Tc-99m MAG-3)