The accuracy of 99mTc-DTPA scintigraphy in the evaluation of acute renal graft complications

Abstract

Purpose: Renal scintigraphy has been used for many years in the evaluation of renal transplants and can help in the diagnosis of graft complications, leading to prompt clinical management and preventing further deterioration of renal function. The purpose of this study was to evaluate the overall accuracy of renal scintigraphy with 99m Tc-DTPA in the diagnosis of acute renal graft complications. Materials and Methods: Seventy-six scintigraphic studies performed in 55 patients (ages ranging from 6 to 65 years), were reviewed. Scintigraphy results were compared to biopsies performed within 5 days of imaging.99m Tc-DTPA study was performed within a mean time of 19 days after kidney transplants. Dynamic images were performed in the anterior position of the abdomen and pelvis every 2 seconds for 80 seconds (flow phase) and every 15 seconds for 30 minutes (functional phase), after an intravenous injection of 370 MBq (10 mCi) of 99m Tc-DTPA. Results: The scintigraphic results were concordant with the biopsies in 86% of the cases studied. The sensitivities of renal scintigraphy for detection of acute tubular necrosis (ATN), acute rejection (AR) and cortical necrosis (CN) were 98%, 87% and 100%, respectively. Specificities and accuracies for detection of ATN, AR and CN were 89%, 86% and 100%, and 95%, 87% and 100%, respectively.Conclusion: Renal scintigraphy with 99m Tc-DTPA showed a good overall accuracy in the detection of acute renal graft complications. It can be used as a reliable tool in the routine evaluation of these patients.

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I.In vivoimaging methods

“…Dynamic renal scintigraphy with 99m Tc-DTPA or MAG3 shows poor specificity for AR diagnosis [21, 64–66]. Aktas et al [36] suggested that serial radionuclide imaging may help distinguish parenchymal causes of graft failure.…”

“…Third, the compound stability of the tracer and radionuclide half-life have to be taken into account before reliably measuring the accumulation of labelled leukocytes [13, 55]. Finally, background activity as well as the degree of attenuation of target organ activity may limit the interpretation [66]. In 2004, Lopes de Souza et al [38] used 99m Tc-labelled WBCs to evaluate AR in KTRs.…”

Role of Diethylentriamine Penta-Acetic Acid Renograms in Differentiation between Acute Tubular Necrosis and Acute Rejection in Early Post Allograft Renal Transplantation in A Single Tertiary Center

“…Our study demonstrated the most powerful significant parameter is delayed excretion (P<0.001), either because of parenchymal retention of the tracer due to damaged tubules as in cases of ATN or because of calyceal retention of the tracer as in cases of acute rejection due to activated T cell activity. If retention of the tracer is hindered in both parenchyma and calyces, the combined pathologies are suspected, and this copes with Sanches et al study at 2003 (14) .…”

Determinants of the intercept and slope of glomerular filtration rate in recipients of a live donor kidney transplant

“…This result indicates a diagnostic benefit of ING for assessment of functional side distribution in the context of LD evaluation; however, we are aware of the limited sample size which may have precluded detection of subtle differences. For another ING-based parameter-MTT to quantify the dynamics of parenchymal tracer transit-we found no association with any of the endpoints, suggesting that this parameter may have a limited diagnostic value in the evaluation of normal functioning kidneys; however, impaired renal transit may help to dissect certain disease states, such as acute tubular injury or cyclosporine toxicity in renal transplants [29].…”