DOCSLIB.ORG

Scan Ultrasound and Radlonuclide Imaging Techniques

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Scan Ultrasound and Radlonuclide Imaging Techniques jIUn/ADJUNCTIVE MEDICAL KNOWLEDGE The Complementary Use of B—Scan Ultrasound and Radlonuclide Imaging Techniques AngelitaDingcongSandersandRogerC.Sanders Johns Hopkins Medical Institutions, Baltimore, Maryland Too often a single noninvasive imaging technique the kidneys will be enlarged and numerous cystic fails to provide enough information to permit a diag areas will be present. Differentiation between the nosis to be made, whereas a judicious combination two conditions is usually simple: the cysts in a poly of two or more techniques will frequently provide cystic kidney vary markedly in size and in the enough data to obviate the need for such invasive smoothness of the wall, whereas several character procedures as angiography or exploratory laparot istic ultrasonic configurations may be seen in hydro omy. In this article we shall endeavor to correlate nephrosis when it is severe (2). Multiple cystic struc the use of nuclear medicine techniques with sonogra tures of similar size radiating from the center of the phy in several organ systems. In most instances we kidney occur if the bulk of the pressure changes have believe that nuclear medicine and ultrasound should been borne by the calyces, or, if the pelvis is most play complementary roles, although one or the other affected, a large cystic “sac-like―area surrounded by may be uniquely suited to the diagnosis of some a small rim of renal parenchyma will be seen. A conditions. We will attempt to put these noninvasive third configuration occurs in hydronephrosis due to procedures in perspective and develop a guide to obstruction of the ureteropelvic junction : both the their most efficient utilization. Certain conditions are extrarenal and intrarenal pelves dilate, causing two best diagnosed by sonography, such as obstetric adjacent cystic areas with a “dumbbell―shape. problems and abdominal aneurysms. Since ultra Although ultrasound is sufficiently reliable for the sound cannot pass through gas or bone, pulmonary diagnosis of hydronephrosis (1 ), only anatomic and bone lesions must be investigated by nuclear changes are shown, and the degree of renal function medicine or radiologic techniques. Most organs in cannot be assessed. If some renal function persists, the abdomen, thyroid, and breast can be examined nuclear techniques are helpful in three ways: advantageously with both nuclear medicine and 1. A e9mTc-DTPA scan allows one to detect ultrasound. We will consider only those conditions the level of the obstruction. Only severely wherein both these techniques can be used with mu dilated ureters can be visualized with ultra tual benefit, and not those where one or the other sound. has little or no role. This communication will be 2. A 9OmTc..DMSAscan delineates the amount concerned with an assessment of how the two mo of functioning parenchyma in each kidney dalities should be used together for best patient man (3) and permits the surgeon to decide agement in these areas. whether a drainage procedure is indicated. KIDNEY 3. A sonographicdiagnosisof polycystickid ney can be supported if numerous areas of Genitourinary diagnosis involves several problems decreased uptake are seen within the renal in which ultrasound and nuclear medicine play im outline (3) (Fig. 1). portant complementary roles. Kidneys not visualized adequately on excretory urography (IVP) in the presence of renal failure should be studied next with Received Aug. 18, 1976; original accepted Sept. 21, 1976. ultrasound to exclude bilateral hydronephrosis or For reprintscontact: Roger C. Sanders, Dept. of Radiol ogy, Johns Hopkins Medical Institutions, 601 N. Broadway, polycystic kidneys (Fig. I ) (1 ). In both conditions Baltimore, MD 21205. Volume 18, Number 3 205 SANDERS AND SANDERS 4 FIG. 1. Polycystickidney.(Top)Transversepronesection,5 cm (S) is vertebral column. Arrows indicate septa. (Bottom) Right pos. abov iliac crest, showstypical sonographic changes of polycystic tenor oblique and left posterior oblique views of @Tc-DM$A kidneys. Both kidneysare markedly enlarged with multiple cysts(C) scan on same patient showstypical appearance of polycystickid. of varying sizes. Pelvicalyceal echoes (P), although disorganized, are neys: distortion of renal outline with multiple defects correspond. still recognizable. Sound.obsorbingstructure between two kidneys in9 to cystsseenon sonogram. Renal failure due to vascular disorders (e.g., for an ectopic kidney in the pelvis. Should none be thrombosis) may be diagnosed if the kidneys are found, perhaps because of overlying bowel gas, a found to be small or normal in size by ultrasound ODmTc-DTPA scan with flow study, done in the an and if there is no perfusion to the renal bed by a tenor projection using a diverging collimator, will ø9mTcO4flow study. In acute renal failure, the degree show both renal beds and the pelvis, where an cc of ‘311-Hippuranconcentration in the kidneys may topic kidney might be. be of diagnostic significance regarding eventual renal In the absence of hematuria, demonstration or function (4) . In end-stage renal failure, where ultra suspicion of a renal mass on an 1W should lead to sound has shown small but otherwise normal kid an ultrasonic examination to determine whether the neys, there is as yet no means of distinguishing among mass is cystic or solid (7) . Cystic lesions show large the many causes, such as chronic pyelonephritis, posterior-wall echoes, smooth walls, and no internal chronic glomerulonephritis, or renal artery stenosis, echoes. Solid lesions, although they usually contain since all will show diminished flow on the 9omTc@ numerous echoes, may also be more or less echo DTPA flow study. End-stage kidneys retain some free; however, their posterior-wall echo is small perfusion but show equally poor function. because sound has been absorbed. An attenuated In the absence of renal failure, a single kidney posterior-wall echo has been found to correlate with failing to visualize on excretory urography should solid avascular neoplasms (8) , and the accuracy in first be studied with ultrasound, since hydronephro distinguishing cysts from solid lesions has been re sis can be diagnosed easily and a number of the ported as 95% (9). Solid lesions are due to neo other possible causes have typical appearances (5). plasms and arteriography is required to establish the In addition, ultrasound provides information about neighboring organs which may not be available with a 99mTc-DTPA scan (Fig. 2). The sonographic ap pearance of multicystic kidney is that of a cystic mass with multiple cysts of varying sizes within it (6). Sincetherenalarteryisatretic,a 9DmTc@DTPA flow study will show no perfusion on the affected side. If a neoplastic mass occupies the whole kidney, the sonogram will show distortion of the renal out line and central pelvic echoes and, in general, extra echoes within the renal parenchyma. A recent uni lateral renal infarct causes little change in the sono graphic appearance of the kidney, but a oomTc@DTPA flow study will show absence of perfusion to the FIG.2. Bilateraladrenalhemorrhageandrightrenalinfarctin affected kidney (Fig. 2). A small end-stage kidney neonate with oliguria. (L.ft) “@Tc.DTPAflow study, 30.sec frame, shows left kidney (1k) but not right kidney. Visibly avascular is usually detectable by ultrasound if the kidney is areas, thought to be intrarenal, are present in superior aspect of not too small (below approximately 3 cm) . A 9omTc@ left kidney and in region of right kidney (arrows). (Right) Longi. tudinal sonogram through right kidney (rk) in prone position shows DTPA flow study will show a very little or absent cystic lesion (C) above grossly normal kidney and separated by perfusion to the affected side. If none of these mdi w.ll.deflned interface (arrows).(Sonogramof left side was similar.) Bilateral adrenal hemorrhages were found at surgery, with multiple cations is seen, a sonographic search should be made smallarterial emboli in right kidney. 206 JOURNAL OF NUCLEAR MEDICINE ADJUNCTIVE MEDICAL KNOWLEDGE pattern of vascular supply and the presence or ab sence of inferior vena caval involvement. The lower limits of consistent visualization of cysts using gray scale equipment is about 1.5 cm, although 1-cm cysts may sometimes be seen. Solid lesions less than 2 cm in diameter may not be shown by ultrasound but may be detected by a renal image taken with °9mTcDM5A(dimercaptosuccinicacid), especially if the lesion is peripherally located. The o9mTc@ DMSA accumulatesin the proximaland distalcon voluted tubular cells and thus normally outlines the extent of the renal cortex (10) ; consequently, mass FIG.3. Lymphoc.le.(Left) @Tc-DTPAscanshowslargeavas lesions in the cortex will be visualized. Small lesions cular area (arrows) above transplant (1). (Right) Transvsrse sono. deeper in the kidney and close to the pelvicalyceal graphic ssction through renal transplant shows irregularly shaped cysticlesion(C)with septumin its lower aspect(arrow). system may not be detected with a DMSA scan (3). Ultrasound is probably more sensitive in detecting deep lesions, particularly if they distort the pelvic line study for perfusion and function should be oh echoes. Occasionally a suspected intrarenal mass is tamed within 24 hr of renal transplantation to assess due to a hypertrophied column of Bertin. Sonogra acute tubular necrosis. This also provides a con phy and radionuclide imaging will show the presence venient comparison with future studies so that acute of cortical tissue instead of the decreased activity rejection or other complications can be detected that would accompany a true mass (11). early (15). Acute tubular necrosis (ATh) is charac A lesion at the upperpole of the left kidneymay terized on the scan by good perfusion and dispro be difficult to detect by ultrasound because of over portionately poor function, with gradual improve lying ribs and lung. Should the NP indicate a mass ment of function over a period of time, depending on in this area and if the sonogram is negative, a @mTc@its severity. The prognosis appears to be related to DMSA scan is helpful.The upperpole of the right the duration of ischemia during transplantation (18).
Load more

Recommended publications
  • Nuclear Medicine for Medical Students and Junior Doctors
    NUCLEAR MEDICINE FOR MEDICAL STUDENTS AND JUNIOR DOCTORS Dr JOHN W FRANK M.Sc, FRCP, FRCR, FBIR PAST PRESIDENT, BRITISH NUCLEAR MEDICINE SOCIETY DEPARTMENT OF NUCLEAR MEDICINE, 1ST MEDICAL FACULTY, CHARLES UNIVERSITY, PRAGUE 2009 [1] ACKNOWLEDGEMENTS I would very much like to thank Prof Martin Šámal, Head of Department, for proposing this project, and the following colleagues for generously providing images and illustrations. Dr Sally Barrington, Dept of Nuclear Medicine, St Thomas’s Hospital, London Professor Otakar Bělohlávek, PET Centre, Na Homolce Hospital, Prague Dr Gary Cook, Dept of Nuclear Medicine, Royal Marsden Hospital, London Professor Greg Daniel, formerly at Dept of Veterinary Medicine, University of Tennessee, currently at Virginia Polytechnic Institute and State University (Virginia Tech), Past President, American College of Veterinary Radiology Dr Andrew Hilson, Dept of Nuclear Medicine, Royal Free Hospital, London, Past President, British Nuclear Medicine Society Dr Iva Kantorová, PET Centre, Na Homolce Hospital, Prague Dr Paul Kemp, Dept of Nuclear Medicine, Southampton University Hospital Dr Jozef Kubinyi, Institute of Nuclear Medicine, 1st Medical Faculty, Charles University Dr Tom Nunan, Dept of Nuclear Medicine, St Thomas’s Hospital, London Dr Kathelijne Peremans, Dept of Veterinary Medicine, University of Ghent Dr Teresa Szyszko, Dept of Nuclear Medicine, St Thomas’s Hospital, London Ms Wendy Wallis, Dept of Nuclear Medicine, Charing Cross Hospital, London Copyright notice The complete text and illustrations are copyright to the author, and this will be strictly enforced. Students, both undergraduate and postgraduate, may print one copy only for personal use. Any quotations from the text must be fully acknowledged. It is forbidden to incorporate any of the illustrations or diagrams into any other work, whether printed, electronic or for oral presentation.
    [Show full text]
  • Advantages of Hybrid SPECT/CT Vs SPECT Alone Heather A
    The Open Medical Imaging Journal, 2008, 2, 67-79 67 Open Access Advantages of Hybrid SPECT/CT vs SPECT Alone Heather A. Jacene*,1, Sibyll Goetze1,2, Heena Patel1, Richard L. Wahl1 and Harvey A. Ziessman1 1Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hop- kins University, Baltimore, MD, USA 2Current Address: Department of Radiology, University of Alabama, Birmingham, AL, USA Abstract: We present our initial two year clinical experience with SPECT/CT, compare the interpretation to SPECT alone, provide illustrative cases, and review the published literature. Hybrid SPECT/CT has added clinical value over SPECT imaging alone primarily due to more precise anatomical lesion localization. After reading this report, the reader will appreciate the advantages of SPECT/CT imaging for clinical practice. We have reviewed SPECT/CT studies of 144 adult patients referred for various clinical indications in a busy nuclear medicine practice. The SPECT and fused SPECT/CT images were reviewed and interpreted separately to determine if addition of the fused CT images added in- cremental information, e.g., more definitive anatomic localization, more definitive diagnostic certainty, or changed final image interpretation compared to the SPECT images alone. Our analysis showed that SPECT/CT provided additional in- formation for image interpretation in 54% (78/144) of cases. In most of these (68/78), the CT data improved localization of abnormal and physiologic findings. Diagnostic certainty was improved in 34/144 cases (24%) and image interpretation was beneficially altered in 18/144 cases (13%). The fusion of anatomical and functional information by hybrid SPECT/CT positively impacts image interpretation and adds diagnostic value over SPECT alone.
    [Show full text]
  • Diagnostic Performance of Contrast-Enhanced Ultrasound For
    www.nature.com/scientificreports OPEN Diagnostic performance of contrast‑enhanced ultrasound for acute pyelonephritis in children Hyun Joo Jung1, Moon Hyung Choi2, Ki Soo Pai1 & Hyun Gi Kim2,3* The objective of our study was to evaluate the performance of renal contrast‑enhanced ultrasound (CEUS) against the 99m-labeled dimercaptosuccinic acid (DMSA) scan and computed tomography (CT) in children for the diagnosis of acute pyelonephritis. We included children who underwent both renal CEUS and the DMSA scan or CT. A total of 33 children (21 males and 12 females, mean age 26 ± 36 months) were included. Using the DMSA scan as the reference standard, the sensitivity, specifcity, positive predictive value, and negative predictive value of CEUS was 86.8%, 71.4%, 80.5%, and 80.0%, respectively. When CT was used as the reference standard, the sensitivity, specifcity, positive predictive value, and negative predictive value of CEUS was 87.5%, 80.0%, 87.5%, and 80.0%, respectively. The diagnostic accuracy of CEUS for the diagnosis of acute pyelonephritis was 80.3% and 84.6% compared to the DMSA scan and CT, respectively. Inter-observer (kappa = 0.54) and intra-observer agreement (kappa = 0.59) for renal CEUS was moderate. In conclusion, CEUS had good diagnostic accuracy for diagnosing acute pyelonephritis with moderate inter‑ and intra‑observer agreement. As CEUS does not require radiation or sedation, it could play an important role in the future when diagnosing acute pyelonephritis in children. Urinary tract infection (UTI) is a common cause of illness with fever in children. It frequently develops in boys during their frst year of life and is more frequent in girls of older ages 1.
    [Show full text]
  • Radionuclides in Nephrourology, Part 2: Pitfalls and Diagnostic Applications
    Journal of Nuclear Medicine, published on March 3, 2014 as doi:10.2967/jnumed.113.133454 CONTINUING EDUCATION Radionuclides in Nephrourology, Part 2: Pitfalls and Diagnostic Applications Andrew T. Taylor Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the common clinical indications of suspected obstruction and renovascular hypertension; (2) the status of radionuclide renal imaging in the evaluation of the transplanted kidney and the detection of infection; and (3) potential pitfalls. Financial Disclosure: This review was partially supported by a grant from the National Institutes of Health (NIH/NIDDK R37 DK38842). Andrew T. Taylor is entitled to a share of the royalties for the use of QuantEM software for processing MAG3 renal scans, which was licensed by Emory University to GE Healthcare in 1993. He and his coworkers have subsequently developed in-house, noncommercial software that was used in this study and could affect their financial status. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict-of-interest policies. The author of this article has indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity.
    [Show full text]
  • Introducing PET/CT at AIMS, Kochi
    Nuclear medicine investigations use small amounts of FDA approved sterile radioactive materials for imaging. These investigations are safe, can be used in all age groups even extremes of age and are painless. Small amounts of radiopharmaceuticals are introduced into the body by injection, swallowing, or inhalation. These radiopharmaceuticals are substances, which are organ specific and get bound within a period of time to the organ and facilitate imaging. The amount of radiopharmaceutical used is carefully selected to provide the least amount of radiation exposure to the patient but ensure an accurate test. A special camera (PET, SPECT gamma camera) is then used to take pictures of your body. The camera detects the radiopharmaceutical in the organ, bone or tissue and forms images that provide data and information about the area in question. Nuclear medicine differs from an x-ray, ultrasound or other diagnostic test because it determines the presence of disease based on biological changes rather than changes in anatomy. Hence it helps in early detection of a disease much before other anatomical imaging modality picks up. GAMMA CAMERA (SPECT/CT) GAMMA CAMERA APPLICATIONS: Cardiac Applications: Coronary Artery Disease Measure Effectiveness of Bypass Surgery Measure Effectiveness of Therapy for Heart Failure Detect Heart Transplant Rejection Select Patients for Bypass or Angioplasty Identify Surgical Patients at High Risk for Heart Attacks Identify Right Heart Failure Measure Chemotherapy Cardiac Toxicity Evaluate Valvular Heart Disease Identify
    [Show full text]
  • Value of Imaging After Urinary Tract Infections. Arch Dis Child: First Published As 10.1136/Adc.72.5.393 on 1 May 1995
    Archives ofDisease in Childhood 1995; 72: 393-396 393 Long term follow up to determine the prognostic value of imaging after urinary tract infections. Arch Dis Child: first published as 10.1136/adc.72.5.393 on 1 May 1995. Downloaded from Part 2: scarring Malcolm V Merrick, Alp Notghi, Nicholas Chalmers, A Graham Wilkinson, William S Uttley Abstract under 1 year or in children of any age Long term follow up of children with with bladder control. No case can be urinary tract infections, in whom imag- made for any abbreviated schedule of ing investigations were performed at pre- investigation. These risk factors should sentation, has been used to identify be taken into account when designing fol- features that distinguish those at greatest low up protocols. risk of progressive renal damage. No (Arch Dis Child 1995; 72: 393-396) single investigation at presentation was Keywords: vesicoureteric reflux, urinary tract able to predict subsequent deterioration infection, reflux nephropathy. but, by employing a combination of imaging investigations, it was possible to separate groups with high or low proba- bility of progressive damage. In the low Imaging investigations are generally con- risk group the incidence of progressive sidered essential in the work-up of children damage was 02% (95% confidence with a urinary tract infection.' Much attention interval (CI) 0 to 1.3%). The combination has been paid to the importance of identifying of both scarring and reflux at vesicoureteric reflux before the development of presentation, or one only of these but overt reflux nephropathy, although the limita- accompanied by subsequent documented tions of the tests that detect reflux have been urinary tract infection, was associated largely overlooked.2 The prognostic impor- with a 17-fold (95% CI 2*5 to 118) increase tance of focal scarring is widely recognised; in the relative risk of progressive renal that of diffuse scarring is less well docu- damage compared with children without mented.3 However, most series with follow up these features.
    [Show full text]
  • Intra- and Interobserver Variability in Interpretation of DMSA Scans Using a Set of Standardized Criteria
    Pediatr Radiol (1993) 23:506-509 Pediatric Radiology Springer-Verlag 1993 Intra- and interobserver variability in interpretation of DMSA scans using a set of standardized criteria K. Patel, M. Charron, A. Hoberman, M. L. Brown, K.D. Rogers Division of Nuclear Medicine and Department of Pediatrics, Children's Hospital and University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA Received: 24 May 1993/Accepted: 10 August 1993 Abstract. A set of criteria was developed to standardize various limitations with respect to sensitivity, accuracy or assessment of DMSA renal scintigraphy which were per- feasibility [6-8]. formed to evaluate children for acute pyelonephritis and More recently, the Tc-99m dimercaptosuccinic acid renal scarring. This study was undertaken to assess intra- (DMSA) scintigraphy has been shown to be an accurate and interobserver variability in the interpretation of method to diagnose acute pyelonephritis in experimental DMSA renal scintigraphy using these criteria. Renal con- and clinical studies [9-14]. However, various authors have tours and parenchyma were assessed in three zones. Con- used different criteria for the interpretation of DMSA tours were assessed as normal or abnormal and parenchy- renal scintigraphy. real defects were evaluated in terms of character, shape In this study, criteria developed by Maid [15], Conway and degree in three regions (upper and lower pole and [16], and other authors [17, 18] were unified and modified midzone). Two nuclear medicine physicians blindly re- into a set of standardized criteria for interpreting renal viewed 57 DMSA scintigraphy on two occasions each. Dis- cortical scintigrams (DMSA or glucoheptonate), in an at- agreement of each observer's evaluation of the same scinti- tempt to (1) enhance accuracy and reliability of interpre- graphy on two different occasions was described as in- tation, and (2) enable more valid comparison of results of traobserver variability, and the comparison between read- different studies.
    [Show full text]
  • Proceduresof Choice in Renal Nuclear Medicine
    Proceduresof Choice in Renal Nuclear Medicine M. Donald Blaufox Department ofNuclear Medicine, Albert Einstein College ofMedicine/Montefiore Medical Center, Bronx, New York radionuclide method for measuring residual urine, which The uronephrologicapplicationsof nuclear medicine have was described more than 20 years ago, has not achieved reached a stage of maturity where procedures of choice for general use and may now be largely obsolete. Testicular manyspecificclinicalproblemscan be identified.This review imaging is established in genitourinary imaging while the attempts to achieve this aim as objectively as possible. It application of radionuclides to studies of patients with must be emphasizedthat the opinionsexpressedhere are impotence and related diseases is rapidly moving toward those of the author and in many areas there may be a lack of clinical practice and will likely expand this area of use in consensus. the future. J NuclMed 1991;32:1301—1309 The specific pathologic conditions in which nuclear medicine may play a role are listed in Table 2. In reviewing procedures of my choice in renal nuclear medicine, it is necessary also to evaluate these procedures he most important concept in studying the kidney is in relation to radiographic and other diagnostic imaging a recognition of the intimate relationship between struc procedures. The complementary modalities to be consid ture and function. Although procedures which are primar ered are ultrasound, urography, angiography, and corn ily functional and procedures dependent on imaging are puted tomography (CT). At this time, there are few data discussed separately here, no renal study can be evaluated that would support the utilization of magnetic resonance properly without considering its physiologic basis.
    [Show full text]
  • Semiquantitative Analysis of Power Doppler Ultrasonography Versus Tc-99M DMSA Scintigraphy in Diagnostic and Severity Assessment of Acute Childhood Pyelonephritis
    495 Original Article Semiquantitative analysis of power doppler ultrasonography versus Tc-99m DMSA scintigraphy in diagnostic and severity assessment of acute childhood pyelonephritis Hui Zhu1, Minguang Chen2, Hongxia Luo1, Yin Pan1, Wenjie Zheng2, Yan Yang1 1Department of Ultrasound, 2Department of Pediatrics, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China Contributions: (I) Conception and design: H Zhu, Y Yang; (II) Administrative support: Y Yang; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Wenjie Zheng. Department of Pediatrics, the Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, China. Email: [email protected]. Yan Yang, Department of Ultrasound, the Second Affiliated Hospital of Wenzhou Medical University 109 Xueyuan Western Road, Wenzhou, China. Email: [email protected]. Background: This study aimed to compare the diagnostic and predictive value of power Doppler ultrasonography (PDU) with Tc-99m dimercaptosuccinic acid (DMSA) renal scintigraphy in pediatric acute pyelonephritis (APN) using a semiquantitative analysis system. Methods: A total of 92 children and infants (184 kidneys) were hospitalized with possible APN. All children were examined by PDU and DMSA scintigraphy within 72 hours of admission. An empiric 9-point semiquantitative analysis system was used to sort kidneys into four grades (grade 0–III). Patients with several episodes of APN and congenital structural anomalies were excluded. Results: Of 184 kidneys, we found 68 abnormal (grade I–III) and 116 normal (Grade 0) with DMSA scintigraphy, and 84 abnormal and 100 normal with PDU.
    [Show full text]
  • Having a DMSA Kidney Scan As an Outpatient
    Medical Physics and Clinical Engineering Department – Information for patients Having a DMSA kidney scan as an outpatient A DMSA kidney scan is a nuclear medicine test of the kidneys. It can be used to detect any damaged areas of the kidneys, for example as a result of repeated urinary tract infections. It is also able to see whether both kidneys are working equally well. Is it safe for me to have the scan? For this scan it is necessary to inject a small amount of radioactive tracer, called a radiopharmaceutical, in order to take the pictures. The small risk from this radiation dose is outweighed by the information that will be gained by having the scan. There is a table of radiation risks at the end of this leaflet. Ask if you want any more information. All investigations are vetted to make sure this is the appropriate test for you. If you don’t understand why you need to have this scan please speak to the doctor who referred you. For female patients If you know that you are pregnant, or there is any chance that you may be pregnant, please contact the department where you will be having the scan. Do this as soon as possible as the scan can be postponed if it is not urgent. Also contact the department if you are breastfeeding, as we may give you special instructions. Preparation for your scan There are no special preparations for a DMSA kidney scan. You can eat, drink and take any medicines as normal. Your injection A small amount of radioactive tracer will be injected into a vein in your arm or hand.
    [Show full text]
  • 6.01.502 Single Photon Emission Computed Tomography (SPECT) for Non-Cardiac Indications
    MEDICAL POLICY – 6.01.502 Single Photon Emission Computed Tomography (SPECT) for Non-cardiac Indications Effective Date: June 1, 2021 RELATED MEDICAL POLICIES: Last Revised: May 4, 2021 6.01.54 Dopamine Transporter Imaging with Single-photon Emission Computed Replaces: N/A Tomography Select a hyperlink below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE REVIEW | REFERENCES | HISTORY ∞ Clicking this icon returns you to the hyperlinks menu above. Introduction SPECT is a type of nuclear imaging test that uses a radioactive dye, also called a tracer, and a special camera to create a three-dimensional (3-D) image of the organs in the body. The images created by tracking the dye in the blood stream can show areas of increased/decreased blood flow and progressive changes in the body. SPECT is proposed to help diagnose or monitor certain tumors, bone disorders, and heart problems. SPECT imaging of the brain for mental health disorders is used as a research tool in clinical trials. Research has not shown the utility of SPECT brain imaging for differential diagnosis or for assessing or predicting an individual’s risk of getting a mental health disorder. Dopamine transporter imaging with single-photon emission computed tomography (DAT- SPECT) is addressed in another policy (see Related Medical Policies). Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers. A provider can be a person, such as a doctor, nurse, psychologist, or dentist.
    [Show full text]
  • Imaging in Pediatric Urology
    PEDIATRIC UROLOGY 0031-3955/97 $0.00 + .20 IMAGING IN PEDIATRIC UROLOGY Eglal Shalaby-Rana, MD, Lisa H. Lowe, MD, Anna Nussbaum Blask, MD, and Massoud Majd, MD The pediatric genitourinary tract may be affected by many disor- ders, most of which are congenital and some acquired. Patients pre- senting with signs and symptoms related to the genitourinary tract often need imaging for diagnosis and management. In this article, a problem- oriented approach is used to discuss the following clinical urologic problems: (1) urinary tract infection (UTI), (2) hydronephrosis or hy- droureter, (3) genitourinary trauma, (4) swollen scrotum, and (5) hema- turia. THE CHILD WITH URINARY TRACT INFECTION UTI is one of the most frequently encountered clinical problems in children. Despite the common occurrence of UTI, the diagnostic work- up and management remain a constant challenge for pediatricians. There are many approaches to evaluating children with UTIs; however, the ultimate goal of the diagnostic work-up is to identify kidneys at risk for acute pyelonephritis (AP) and subsequent renal scarring. The task may become simpler by addressing two important questions: Is the infection limited to the bladder, or does it involve the kidney resulting in acute From the Department of Diagnostic Imaging and Radiology, Children’s National Medical Center and The George Washington University Medical School, Washington DC (ESR, A M , MM); and the Department of Radiology, Children’s Medical Center of Dallas, University of Texas-Southwestern, Dallas, Texas (LHL) PEDIATRIC CLINICS OF NORTH AMERICA VOLUME 44 * NUMBER 5 * OCTOBER 1997 1065 1066 SHALABY-RANA et a1 pyelonephritis; and are there underlying anatomic abnormalities in the urinary tract that predispose to infection, most importantly vesicoure- teral reflux (VUR) and obstruction.
    [Show full text]