Renal Scintigraphy

(Renal Radionuclide Scan)

Tc-99m DMSA
Tc-99m MAG3
Tc-99m DTPA
Overview
• IV administration of technetium (Tc-99m)
• measurement of its distribution in the body with a gamma camera
Indication
• To detect
• bone metastases in prostate cancer
• renal scarring (usually associated with reflux)
• significant urinary obstruction , trauma or damage
• Estimation of differential renal function
• Screening for renal artery stenosis
• Monitoring of renal transplants
• renovascular hypertension
Absolute contraindication
• Pregnancy
• Animal reproduction studies have not been conducted
• the potential to cause fetal harm depends on
• the dose absorbed by the fetus
• the stage of pregnancy
• High doses→more likely to result in fetal harm
Relative contraindications
• ACEi: for renovascular hypertension
• breast-feeding
• Obesity
• Renal impairment (eGFR <30–45)
• MAG3 > DTPA
• MAG3 is recommended for
• Neonates
• impaired renal function
• suspected obstruction
Static / Dynamic renal scintigraphy
Static renal scintigraphy
• Renal morphology
• position, form, size, anomalies
• Tc-99m DMSA (Tc-99m dimercaptosuccinic acid)

Dynamic renal scintigraphy

• Renal function
• renal clearance, arterial perfusion rate
• Tc-99m MAG3 (Tc-99m mercaptoacetyltriglycine)
• Tc-99m DTPA (Tc-99m diethylene-triamine-pentaacetate)
Static renal scintigraphy
Tc-99m DMSA
• evaluation of renal parenchymal disorders (renal cortex - PCT)
• rapidly accumulates in the renal parenchyma
• very small amounts are eliminated from the kidney
• Imaging is performed ∼ 3 hours after injection
• pediatric imaging: scarring, pyelonephritis
• Diseases affecting the proximal convoluted tubules inhibit the DMSA
uptake
• renal tubular acidosis
• Fanconi syndrome
• nephrotoxic drugs (ex. gentamicin and cisplatin)
Dynamic renal scintigraphy
Tc-99m MAG3
• provides renal function, renal angiograms
• rapidly accumulates in the renal parenchyma
• cleared almost exclusively by tubular excretion (97%)
• Serial imaging from the time of injection until the end of the procedure (up
to 30 min)
• cannot measure GFR as it is cleared almost entirely by tubular
secretion
• diagnosis of
• congenital and acquired abnormalities
• renal failure
• urinary tract obstruction
• Calculi
Tc-99m DTPA
• renal visualization for renal perfusion assessment
GFR estimation
• filtered by the glomeruli (100%)
• not absorbed or secreted by the tubules
• Serial imaging from the time of injection until the end of the procedure (up
to 30 min)
• cleared only via glomeruli with no tubular excretion→available for
direct measurement of GFR
Vascular phase Filtration phase Excretion phase
Reference
• Uptodate
• Radiopaedia
• Peter Armstrong - Diagnostic imaging-Wiley-Blackwell (2013)