Download - Curs Engleza Renal Scintigraphy Final
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RENAL SCINTIGRAPHY
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Definition
Administration of small amounts of
radioactive substances, called
radiotracers, into the body and then
imaging the kidneys and bladder with adetector- gammacamera.
The images obtained can help in the
diagnosisand treatmentof certainkidney diseases.
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Purpose
It reveals size, position, shape and
function of the kidneys
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Precautions
pregnancy
breastfeeding
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Method Description radiopharmaceuticals.
emit radioactive signals, gamma rays, which can
be collected and counted by a special device,
called gamma camera.
The images of the kidney that the camera
produces are called renal scans.
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Preparation
No preparation is necessary for a kidney
nuclear medicine scan.
to study renal artery stenosis, the patient
must not take angiotensin converting enzyme
inhibitors one week before the scan
drinking fluids
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Risks
Nuclear medicine procedures are very
safe.
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Advantages of renal scintigraphy
include:
minimal radiation exposure
non-invasive easily reproduced
no adverse effects reported
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The most commonly performed
investigations are:
dynamic renal imaging(renography) -
for functionalinformation static renal imaging-
for morphologicalinformation
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Radionuclides
For dinamic study Tc-99m DTPA : the measurement of clearance
corresponds to the glomerular filtration rate- GFR
Tc-99m MAG3 : the measurement of clearance
evaluates the effective renal plasma flow - ERPFFor static study
Tc-99m DMSA : the capacity of renal tubuly totake up those molecules; affords a kidney scanand an evaluation of renal function
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Major indications include:
obstructive uropathy - before and after
surgery
renovascular hypertension - before andafter angioplasty
acute renal failure after treatment
vesicoureteral reflux in children kidney transplant
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STATIC RENAL SCINTIGRAPHY provides morphologicalinformation on each
kidney. TC 99m DMSA: fixed in the proximal renal tubular
cells.
DMSA imaging enables assessment of:
size and position of the kidneys
differential function- expressed as a percentage of the total
function. The upper limit of normal is 5% either side of 50%.
A kidney functioning at 15% of more is still useful; one
whose function is less than 7% is not.
parenchymal defects- scars, cysts, tumors, ischemic areasin renal hypertension
morphological abnormalitiessuch as duplex and horseshoe
kidney
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Figura 1. Scintigrama renal normal Figura 2. Scintigram renal cu Tc99mGH -
rinichi stng mut scintigrafic
Figura 3.Scintigram renal cu Tc99m DMSA - polichistoz renal
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RENOGRAM
The production and excretion of urine is a dynamic
physiological process which can be easily assessed byperforming a Dynamic Renogram study.
This involves taking serial images of the urinary systemfor 25 minutes.
This test is extremely useful in evaluating:
the gross anatomical architecture of the kidneys,
their relative function,
individual GFR and the pattern of urine excretion.
The observations can be displayed in a movie like fashion
or "cine mode" which is useful in identifying organicobstructions to the urine outflow system.
Procedure: Good oral hydration is essential. There is noneed for overnight fasting. Patients need to lie down onthe camera for a period of 25 minutes after an IV injection
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Segments of renogram;
OAvascular phase;
AB- parenchimal uptake phase (evaluation of tubular secretion);
BCDexcretion phase.
Criteria for interpretation: - Renal activity to Peak (RAP)
- Time to peaknormal 3-5 min
- Renal residual activity (RA)less 50%
- T1/2 of peaknormal 16-20 min
Elementary semiology:
Increased transit time: delayed Peak, increased RSA
Impaired secretion: decreased renal activity at peak,
decreased maximal activity
Obstructive pattern: increased residual activity
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16Figura 7. Diverse aspecte ale curbelor nefrografice
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VESICO-URETERIC REFLUX
SCINTIGRAPHY(VUR)
Is indicated in the diagnosis of reflux
vesico-ureteral.
Dinamic renal scan Tc 99m DTPA:
evacuation segment with irregularities;
Static scan by using the cortical imaging
agent Tc 99m DMSA - show diffusebilateral renal scarring;
Mictional nephrography: returning the RF.
back to the kidney .
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Figura 11.Nefroscintigrama micional (reapariia radiotrasorului n
sistemul pielo-ureteral, n timpul evacurii vezicii urinare)
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CAPTOPRIL RENAL
SCINTIGRAPHY (1)
This test is used to evaluate presence of renal artery
stenosis and its physiological sig-nificance, which is one of
the important etio-logical factors in young hypertensives.
The test consists of a Baseline and Post captopril study; Adequate oral hydration;
No antihypertensives based on angiotensin converting
enzyme inhibitors (ACE), one week before the scan;
The sensitivity and specificity of this test is 85% and 80%
respectively.
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CAPTOPRIL RENAL
SCINTIGRAPHY (2) Renal scintigraphy after ACE inhibition
demonstrates a decrease in glomerular filtration in
the presence of a physiologically significant renal
artery stenosis. Renal scintigraphy may be performed using
radiolabeled agents that are excreted primarily by
glomerular filtration (e.g., technetium 99m
diethylenetriamine pentaacetic acid - 99mTc-DTPA) or tubular secretion (orthoiodohippurate-
131 - IOH, or 99mTc-mercapto-acetyltriglycine -
99mTc - MAG.3).
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CAPTOPRIL RENAL
SCINTIGRAPHY (3)
Renal function in an ischemic kidney is abruptly reducedafter one dose of an ACE in-hibitor.
With 99mTc-DTPA, the postcaptopril study demonstratesa marked reduction in uptake of DTPA on the affectedside.
Tubular agents like 99mTc-Mag.3 on the other hand,demonstate progressive accumulation in the affectedkidney during the course of the study.
Reduced glomerular filtration rate causes slow transit oftubular fluid through the tubules, which leads toretention of radio-tracing agent in the tubules.
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Figura 15.Stadializarea nefrogramei n HTA renovascular
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Figura 16.Nefroscintigrama
n HTA renovascular (n
condiii bazale i la captopril)
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Transplant Renogram
evaluation of kidney donors andrecipients.
differentiating Acute Tubular Necrosis
(ATN) from Graft Rejections.
hyperacu te or acute reject ion :
Reduced perfusion while function is
relatively maintained.
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Radionuclide Evaluation of Renal
Function
Estimation of glomerular filtration rate (GFR),
Effective Renal Plasma Flow (ERPF)
Tubular Extraction Rate (TER)
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