NUCLEAR MEDICINE IN

GENITOURINARY SYSTEM

Main contentsMain contents

Renal Function TestRenogram

Quantitative Function Test1. Effective renal plasma flow (ERPF)2. Glomerular filtration rate (GFR)

Renal Imaging

Anatomy and physiology

Radiopharmaceuticals

Dynamic imaging

Glomerular filtration ： 99mTc-DTPA

Tubular excretion ： 131I-OIH, 99mTc-MAG3, 99mTc-EC

Static imaging ： 99mTc-DMSA

RenogramRenogram

PrincipalMetabolities and useless material first filtrated by glomeruli or secreted by renal tubules and then passed outside the body.

Agent131I-OIH is an urinary excretory substance, and can secreted by renal tubules after injection into the body. The time-activity curve obtained during the transit, secretion of 131I-OIH through the kidney and excretory route called renogram.

Method1. Patient preparation

Hydration state for more than 6h. Drink 500 ml water 15 min before test for maintenance a steady state of urine flow.

2. Position

Supine position comfortable for the patient and easy to inject.

3. Kidneys localization

a. Anatomical

b. X ray

c. Ultrasonic

4. Tracer dose and duration131I-OIH 5-10uCi injected (i.v.) as a bolus. The radioactivity over the both kidneys was recorded as long as 20 min, obtain the time-activity curve.

InterpretationInterpretation

Qualitative analyses -- normal curve1. 1st phase or vascular phase, rapidly rising,

lasting about 30 sec.

2. 2nd phase or uptake/functional phase, slowly rising, lasting about 3 min.

3. 3rd phase or excretory phase, slowly descending, lasting about 15 min.

Normal Renogram

Quantitative analysesQuantitative analysesNormal valuesNormal values

left (min)left (min) right (miright (min)n)

peak time (Tmax)peak time (Tmax) 3.24±0.723.24±0.72 3.45±1.13.45±1.133

half excretory timehalf excretory time 4.94±1.84.94±1.8 5.06±2.25.06±2.277

Qualitative analyses -- Qualitative analyses -- abnormal curvesabnormal curves

1. Parabola type1. Parabola typeSlow rising and slow falling.Slow rising and slow falling.Mild renal insufficiency.Mild renal insufficiency.

2. Low level prolonged type2. Low level prolonged typeLowed height of phase 1, while Lowed height of phase 1, while phase 2 and 3 merged each other.phase 2 and 3 merged each other.Severe renal injury.Severe renal injury.

3. Low level descending type 3. Low level descending type Significant low phase 1 with gradual Significant low phase 1 with gradual down slope, without phase 2 and 3. down slope, without phase 2 and 3. Nonfunctional kidney.Nonfunctional kidney.

4. Constantly rising type4. Constantly rising type phase 1 normal, continued uprising phase 1 normal, continued uprising phase 2, without phase 3.phase 2, without phase 3.Urinary obstruction.Urinary obstruction.

5. High level prolonged type5. High level prolonged type phase 1 normal, phase 2 rising graduall phase 1 normal, phase 2 rising gradually.y.Urinary obstruction with renal insufficiUrinary obstruction with renal insufficiency.ency.

6. Stepwise drop type6. Stepwise drop typephase 1, 2 normal, phase 3 dropped stephase 1, 2 normal, phase 3 dropped step by step.p by step.Spasmodic ureterSpasmodic ureter..

Advantage

Disadvantage

Simple and cheap.

The detector position is according to normal positions of kidney, bladder and heart. May cause result error if the organ position is variation.

Mixed uptake of renal parenchyma and collecting system.

Effective Renal Plasma FlowEffective Renal Plasma Flow(ERPF) (ERPF)

Clearance of the volume (ml) of plasma per minute during the first pass of the injected material through the kidney.

MethodMethod131I-OIH renogram with precordial reco131I-OIH renogram with precordial record of time-activity curve.rd of time-activity curve.

Normal valueNormal valueTotal 521.73±153.35 ml/min, decreaseTotal 521.73±153.35 ml/min, decreased with age.d with age.

Clinical usageClinical usage1. Diagnosis of renal disease. Decrease1. Diagnosis of renal disease. Decrease

d in acute and chronic nephritis, parad in acute and chronic nephritis, paralleled with the changes of renogram.lleled with the changes of renogram.

2. Therapeutic monitoring.2. Therapeutic monitoring.

3. Monitoring rejection of transplant ki3. Monitoring rejection of transplant kidneydneyDecreased ERPF.Decreased ERPF.

Glomerular Filtrate Rate (GFGlomerular Filtrate Rate (GFR)R)

The volume of plasma (ml) filtrate through the glomerulus per minute called GFR, somewhat similar to the creatinine clearance.

MethodMethod99m99mTc-DTPA injected as a bolus, the Tc-DTPA injected as a bolus, the

time-activity curve of both kidney time-activity curve of both kidney obtained and the GFR calculated.obtained and the GFR calculated.

Normal valueNormal value

Total 80--100ml/min, decrease with Total 80--100ml/min, decrease with age.age.

Clinical usageClinical usage1.1. Increased GFRIncreased GFR

a. Early stage of diabetes.a. Early stage of diabetes.

2.2. Decreased GFRDecreased GFRa. Renal insufficiency.a. Renal insufficiency.b. Late stage of diabetes.b. Late stage of diabetes.c. 3nd stage of hypertension.c. 3nd stage of hypertension.d. Azotemia and uremia.d. Azotemia and uremia.

Renal ImagingRenal Imaging

Morphological study of the kidney to find any

anatomical abnormality and also its function.

It consists of static and dynamic study.

Dynamic renal imaging

Intravenous injection imaging agent.Dynamic acquisition of both kidney and

bladder.Can display renal perfusion, function and

urine drainage.

Method

•Drink 300ml water 20-30 min before imaging.

•Void bladder before imaging.

•Supine position, put detector behind the patient.

•Intravenously inject 4-8mCi agent.

•First phase ： 2s per image ， total 30 images.

•Second phase: 1 min per image ， total 29 images.

Normal image of first phase

Abnormal types of image and interpretation

•Delayed visualization of renal artery, the kidney image is small and weak.

——pathological changes of the trunk of renal vascular renal atrophy.

•Focal absence of uptake inside the kidney.

——focal ischemia or other benign lesion.

•Occupation lesion with normal or higher uptake.

——probable malignant disease.

Normal image of second phase

•Kidney is not visualized.

——absence of kidney or the renal perfusion or function totally absent.

•Delayed appearance and subside of renal uptake.

——damaged perfusion or function

•Persistent uptake in renal parenchyma, but no uptake in pelvis.

——diffuse renal tubular block.

Abnormal types of image and interpretation

•Dilation of renal calices, pelvis or ureter.

——urinary obstruction

•Uptake beside the urinary system

——urine leakage

•Delayed visualization of bladder

——upper urinary obstruction or significantly decrease of urine flow.

Indications

•Investigate the renal function and urine drainage.

•Diagnose of renal vascular disease.

•renal parenchyma disease involvement.

•Diagnose of acute upper urinary obstruction..

•Function of diseased or residual kidney.

•Transplant kidney evaluation

•Diagnose urine leakage.

•Differential diagnose of abdominal tumor.

Calculus Of Bilateral Kidney & Obstruction

Calculus Of Bilateral Kidney & Obstruction

Right Nephrohydrops

Renal Inadequacy

Polycystic Kidney

Polycystic Kidney

Horseshoe Kidney

Pelvic Kidney

Rejection of Transplanted Kidney

Rejection of Transplanted Kidney

Rejection of Transplanted Kidney

None function of Transplanted Kidney