Urinary System

Scintigraphy

 Urinary tract studies

 Renal scintigraphy
 Testicular scan
 Radionuclide cystography
 Common indications

 Assess renal function and urodynamics
 Diuretic renography: evaluate urinary tract obstruction
 Captopril renography:To detect renovascular
hypertension
 Radionuclide cystography:To detect vesico-ureteric
reflux
 Techniques

 Basic renogram includes a series of images of the kidney
as the tracer is removed from the blood, transits the
kidney and enters the bladder
 Renogram curves quantitating tracer movement through
each kidney are generated to complement the images
 Integration of clinical presentation, imaging and
physiological data derived from the scan provides
important diagnostic and prognostic information for
patients with known or suspected renal disease
 Technetium -99m (MAG3 & DTPA) are the commonly
used RPs. Iodine 131 is also sometimes used
 Patient lies supine in the scanner and IV injection of
RP is given
 Images are acquired dynamically for 20-30 min

 Post-void views are also taken at the end of the study
 Renal clearance measurements are done to provide
renal function assessment (GFR, ERPF and MAG3)
 Diuresis renogram

 Done to evaluate renal function and differentiation
between obstructive and non-obstructive causes of renal
or ureteral dilatation
 Urine outflow obstruction may be suspected on clinical
findings - this leads to obstructive uropathy or
obstructive nephropathy
 It is based on a high endogenous urine flow rate
stimulated by the administration of furosemide
 The administration to a well-hydrated patient with an
empty bladder of RP and 20 minutes later furosemide is
given
 The pattern of washout of the RP is monitored to
assess first the functioning of the collecting system
and then the transport capacity of the upper urinary
tract



 Technique

 Tracer:Tc-99m –DTPA, Tc-99m-MAG3
 Route:iv
 Needs good hydration
 Dynamic study for 30minutes
 Posterior view for normally positioned kidneys
 Anterior view for transplanted kidneys
 Testicular scan

 Tracer is Tc-99m pertechnatate
 Route:iv
 Aim: To distinguish between testicular torsion and
acute epididymo-orchitis
 Acute torsion: Low uptake, Low flow
 Acute Epididymo-orchitis:High flow, high uptake
 

 Low flow, low tracer uptake

 Radionuclide cystography
 Method of evaluating for vesicoureteral reflux

 Direct RC requires catheterization while indirect RC
does not require bladder catheterization
 In supine position a catheter is inserted into the
urinary bladder
 RP is injected via the catheter until the UB is full (RP
mixed in a volume of saline or irrigating solution
 Filling-phase and voiding-phase images are taken
with the patient either seated or lying in the supine
position.
 Schilling test
 A medical investigation used for patients with

vitamin B12 (cobalamin) deficiency to determine
whether the patient has pernicious anemia
 Malabsorption of vit B12 may be due to gastric
lesions which impair the secretion of intrinsic factor
or to lesions of the small intestines which interfere
with with the absorption of B12/intrinsic factor
complex
 Procedure 1
 Patient is given oral dose of radioactive B12 followed

by an IM injection of non-radioactive B12 to ensure
maximum urinary exccretion of the absorbed
radioactive vitamin over the next 24 hours
 A normal result shows at least 10% of the
radiolabeled vit B12 in the urine in the first 24 hours
 In patients with pernicious anemia or with deficiency
due to impaired absorption, less than 10% or
radiolabelled vit B12 is detected.
 Cobalt – 57 and cobalt – 58 are suitable lables for B12
when measuring radioactivity by scintillation
counting.
 Procedure 2
 If an abnormality is found – thus B12 in the urine is

only present in low levels, the test is repeated this
time with additional oral intrinsic factor
 In this second urine collection is normal, this shows a
lack of intrinsic factor production – pernicious
anemia
 A low result on the second test implies
malabsorption which could be caused disease
 Procedure 3
 If stage 2 is abnormal stage 3 is done in which a

patient is given antibiotics for 2 weeks.
 It can tell whether abnormal bacterial growth has
caused the low vitamin B12 levels.
 Procedure 4
 This stage determines whether the low vitamin B12

levels are caused by problems with the pancreas
 Involves taking pancreatic enzymes for three days
followed by a radioactive dose of vit b12
 Urine sample is collected over the following 24 hours
Gastrointestinal
scintigraphy

Gastrointestinal bleeding scintigraphy is performed on

patients with suspected GI bleeding
 to determine the bleeding is active
 To localize the bleeding site
 Approximate the bleeding volume for prognostic
purposes
 Endoscopy is negative or inconclusive
This compliments clinical signs and symptoms and
laboratory findings
RP: 99mTc-RBCs and 99mTc-sulfur colloid
Route: IV
 Procedure
 Tracer is given IV

 After the injection rapid image acquisition is done with
the patient in the supine position Antero-posteriorly
 Images are obtained at 5 min intervals for about 1 hour
 Depending on the condition of the patient imaging may
continue thereafter to precisely locate site of bleeding