Tumor Imaging

98 Pages·2015·5.2 MB·English

RENAL SCINTIGRAPHY

Kevin P Banks, MD
Department Radiology
San Antonio Military Health System & Health Education Consortium
Assistant Professor of Radiology & Nuclear Medicine
Uniformed Services University of Health Sciences
I HAVE NO
DISCLOSURES.
Learning Objectives
œ Review common types of renal scintigraphic exams
and their clinical applications
� Review components of dynamic renography exam
interpretation & normal versus abnormal values
� Discuss pitfalls in diuretic renography that can
cause false positive results
� Review use & interpretation of renal anatomic
scintigraphy
� Discuss radionuclide cystography technique and
diagnosis of vesicoureteral reflux
GU
OBSTRUCTION
IMAGING
Indication for Diuretic Renal
Scintigraphy
§ Differentiate obstructive vs Non-obstuctive
hydronephrosis
Obstructive Hydronephrosis

§Congenital stenosis
§Stricture
§Lithiasis
§Tumor
Non-Obstructive Hydronephrosis

� Congenital dilation
� Vesicoureteral reflux (VUR)
� Urinary tract infection (UTI)
� Non-compliant bladder
� Prior obstruction
Principles of
Diuretic Renography
˜Physiologic Conditions: Urine (radiotracer) pools in
dilated collecting system either due to reservoir
effect or obstruction of outflow

˜Furosemide (Lasix): Induces increased urine flow
œ Dilated non-obstructed system � diuresis
produces rapid washout of activity
œ Obstructed system � fixed narrowing prevents
significant increased flow and thus prolongs
retention of tracer
Protocol/Procedure

q 10 mCi of Tc-99m MAG3 (peds: 100-150 uCi/kg, min
[1]
1.0 mCi)

q 40 mg IV Lasix (peds: 1 mg/kg)

q Supine imaging with camera posterior

q Image for 20-30 min following injections of radiotracer
& diuretic

q Post-void image

[1] Gelfand MJ, Parisi MT, and Treves ST. Pediatric Radiopharmaceutical Administered Doses: 2010 North American Consensus
Guidelines. JNM 2010;52(2):318-322
Protocol/Procedure
[2]
SNM Procedure Guidelines

3 different approaches for time of injection of diuretic furosemide
(F) in relation to injection of radiopharmaceutical (Tc-99m MAG3 ):

� 20 min after radiopharmaceutical (F+20)
SFU
ø or later when dilated system is filled

� 15 min before the injection of radiopharmaceutical (F-15)

[3,4]
� Simultaneous injection of Tc-99m MAG3 & diuretic (F+0)
[2] Shulkin BL, Mandell GA, Cooper JA. Procedure guideline for diuretic renography in children 3.0. JNMT 2008;36(3):162-168
[3] Sfakianakis GN et al: A renal protocol for all indications: MAG3 with simultaneous injection of furosemide (MAG3-F0): a
fifteen year experience. J Nucl Med 2007:48(suppl 2): 125P.
[4] Turkolmez S, Atasever T, Turkolmez K, Gogus O. Comparison of three different diuretic renal scintigraphy protocols in
patients with dilated upper urinary tracts. Clin Nucl Med 2004:29(3):154-160.