Nuc Med Renal Scans
Radionuclide Cystography
Image aquisition
FOV
kidneys top quadrants
bladder in bottom quandrant
Supine or posterior imaging
4 phase
POST VOiD
Void
PRevoid
filling
Cover bed and collimators with chucks
Foley Catheter
Contraindication
Evaluation and detection of vesicoureteral reflux
Tc99m Tc-DTPA
Tc99m SC
1 mCi
Direct and indirect
Indirect is
Direct is
Vesicoureteral Reflux Study
Radionuclide Renal Cortical scintigraphy
SPECT image processing looking for cold lesions
image aquisition
Spect
rotate 180degrees, step and shoot 40 views per head, 3 degrees /stop, 20-40 sec/stop
500 k counts
2 hours delay
void before imaging
well hydrated
Contraindication
UTI's within 30 days
dehydration
Indication
Confirmation of column of Bertin
renal pyramids
differentiation of renal mass from normal variant
pyelonephritis
inflammation of kidney
Dose
Tc99m-DMSA
5 mCi
morphologic imaging
Functional renogram with ACE inhibition
Same as renogram, just pre dose patient with ACE inhibitor
Prep
discontinue meds 4 days prior
diuretics
Ace inhibitors
monitor patient BP at beginning of test
repeat every 15 min during test and document
NPO 4-6 hours
hydration
Indication: evaluates for unexplained renal hypertension
AKA RENAL ARTERY STENOSIS
ACE Inhibitors
Enalapril 40ug/kg IV or Captopril 50 mg PO
blocks conversion of A1 to A2
causing to lowering of GFR
GFR drops causiing
decrease in kidney output (compared to baseline)
Captopril 1 hour prior
Enalapril 15 min prior
funcional renogram with diuretic
time curve includes t1/2 and diuretic 1/2 marks
administer slow injection of lasix
20 minutes after scan begins
same as functional renogram
Checking for obstruction
kidney will no empty even with lasix
if obstructed
physical
hydronephrosis
mechanical
Stones
Functional Renogram
processing
ROI's
time activity curve
patient prep
void before and after imaging
hydrate
IV
imaging
aquiqisition
post void image per protocol
dynamic
15-30 seconds a frame for 30 mins
flow
2 seconds a frame for 1 to 2 mins
Gamma Camera
patient is supine
FOV kidneys in upper hemisphere
elbows as a marker
140 keV window 20%
LEHR
Radionuclide
Tc99m DTPA
Glomerular
Tc99m Mag3
10-20 mCi
IV BOLUS
Tubular
Contraindications
Diuretics
Dehydration
Inidication
Acute and chronic renal failure
Unilateral/bilateral renal disease (space occupying lesions included)
Obstructive uropathy
Renovascular hypertension
Status post renal transplantation
