Technetium-99m dimercaptosuccinic acid scan in evaluation of renal cortical scarring: Is it mandatory to do single photon emission computerized tomography?

Abstract

Objectives:Renal cortical scintigraphy with technetium-99m (Tc-99m) dimercaptosuccinic acid (DMSA) is the method of choice to detect acute pyelonephritis and cortical scarring. Different acquisition methods have been used: Planar parallel-hole or pinhole collimation and single photon emission tomography (SPECT). This study compared planar parallel-hole cortical scintigraphy and dual-head SPECT for detection of cortical defects.Patients and Methods:We retrospectively reviewed 190 consecutive patients with 380 kidneys and 200 DMSA scans referred to rule out renal cortical scarring. The diagnoses were 52 vesicoureteric reflux, 61 recurrent urinary tract infection, 39 hydronephrosis, 20 renal impairment, and 18 hypertension. All patients were imaged 3 h after injection of Tc-99m DMSA with SPECT and planar imaging (posterior, anterior, left, and right posterior oblique views). For each patient, planar and SPECT images were evaluated at different sittings, in random order. Each kidney was divided into three cortical segments (upper, middle and lower) and was scored as normal or reduced uptake. The linear correlation coefficient for the number of abnormal segments detected between planner and SPECT techniques was calculated.Results:From 200 DMSA scans, 100 scans were positive for scar in SPECT images, from which only 95 scans were positive for scar in planner imaging. Out of the five mismatched scans, three scans were for patients with renal impairment and high background activity and two scans were for very small scars. No significant difference was seen in the average number of abnormal segments detected by planar versus SPECT imaging (P = 0.31). The average correlation coefficient between was high (r = 0.91 – 0.92).Conclusions:Tc-99m DMSA renal cortical scanning using SPECT offers no statistically significant diagnostic advantage over multiple views planar imaging for detection of cortical defect.

Tc-99m DMSA SPECT for Follow-Up of Non-Operative Treatments in Renal Injuries: A Prospective Single-Center Study

“…Previous studies have searched for incremental values of DMSA SPECT in addition to planar imaging, mainly among patients with suspected pyelonephritis or cortical scarring following infection [ 15 16 17 ]. Although the results are not directly applicable to patients with renal injuries for which the grades of cortical damages vary to a wider extent, differences in SRF between planar and SPECT have been reported, similar to our observation: Reichkendler et al [ 12 ] showed a mean bias of 2.1%, which increased in kidneys with SRF beyond the normal range (SRF difference > 10%); a negative correlation between the difference and mean of SRF values on Bland-Altman plot was described by Cao et al [ 18 ].…”

Therapeutic effect of antihypertensive drug on diabetic nephropathy: Functional and structural kidney investigation

“…Renal cortical imaging with 99m Tc-DMSA is the gold standard for renal cortical scarring imaging. Gamma radiation, appropriate half-life, availability of 99m Tc made, 99m Tc-DMSA is a radiopharmaceutical commonly used to detect renal scarring or acute pyelonephritis and provide accurate differential renal function ( Saleh Farghaly and Mohamed Sayed, 2015 ).…”

Clinical Usefulness of ^99mTc-DMSA Renal SPECT Using High Sensitivity-All Purpose Collimator for Pediatric Patients

“…However, because SPECT has to obtain information of kidney from every angle and recompose images, test time requirement is naturally long, so it is not clinically useful for unconscious patients or pediatric patients. The clinical effectiveness of kidney SPECT has not been much studied yet, but it was reported that SPECT has increased sensitivity to kidney cortex defect [10][11][12][13]. Therefore, the present study 18.5-22.9 were selected.…”