Extravascular chest wall technetium 99m diethylene triamine penta-acetic acid: implications for the measurement of renal function during renography

Bell, SJ; Peters, A. Michael

doi:10.1007/bf00175910

Cited by 4 publications

(8 citation statements)

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“…Unfortunately, this assumption is far from valid. We have demonstrated, within a small ROI over the cardiac blood pool from the posterior projection, that 11% of the total signal is extravascular 90 s after injection, rising to 15% at 2.5 rain, 25% at 5 min and reaching a plateau of 35% at 10 min (Bell and Peters 1991b). Nevertheless, the effect on I K G F R calculation is less than might be expected since the early contamination (i.e.…”

Section: P(t) = ~--~ P(t)"mentioning

confidence: 75%

“…Now what about the extravascular GFR equivalent? Because clearance of DTPA into the extravascular space overwhelms diffusion back into the plasma over the period during which IKGFR is measured (Bell and Peters 1991b) and is, in principle, a process which is identical to the clearance of DTPA into Bowman's capsule, it is included in c~. Using the Rutland/Rehling technique, therefore, background subtraction concerns only the extravascular background signal.…”

Section: P(t) = ~--~ P(t)"mentioning

confidence: 99%

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Quantification of renal haemodynamics with radionuclides

Peters

1991

Eur J Nucl Med

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Non-invasive quantification of renal function with radionuclides is an important role of nuclear medicine. With modern commercial preparations of technetium-99m diethylene triamine penta-acetic acid (DTPA), glomerular filtration rate (GFR) can be measured accurately either from the rate of disappearance of the tracer from plasma or from its rate of uptake into the kidneys. Determination of the latter with the gamma camera allows measurement of individual kidney GFR. Renal blood flow (RBF) can be measured from plasma clearance of hippurate or from first-pass kinetics of intravenously injected tracer using the gamma camera. The filtration fraction can be obtained from separate measurement of GFR and RBF, either globally from plasma clearance studies or of each kidney from gamma camera studies. Because they are central to the understanding of plasma clearance studies, the effective distribution volumes of the various tracers used for renal function studies are also discussed in detail.

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Section: P(t) = ~--~ P(t)"mentioning

confidence: 75%

Section: P(t) = ~--~ P(t)"mentioning

confidence: 99%

Quantification of renal haemodynamics with radionuclides

Peters

1991

Eur J Nucl Med

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“…However, in renography, plasma clearance is far from complete over the typical period of the investigation so that the contribution of unlabelled activity is relatively small compared with the labelled activity still in the blood and therefore need not be subtracted. Techniques for subtracting the extra-cardiac contribution to the heart curve in renography have been described previously (Fleming 1977;Bell and Peters 1991).…”

Section: Discussionmentioning

confidence: 99%

“…Techniques have been described for correcting for extracardiac activity in the cardiac ROI in renography (Fleming 1977;Bell and Peters 1991). These techniques effectively correct for the extravascular contribution to the counts obtained (factor (1) above).…”

Section: Introductionmentioning

confidence: 99%

Estimation of organ input function and plasma clearance from the cardiac curve in dynamic scintigraphy

Fleming

1992

Eur J Nucl Med

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A theoretical description of the relationship between the count rate detected in the cardiac region of interest and the arterial organ input function in dynamic scintigraphy is presented. It is shown that, provided the time-activity curve for the heart is corrected for extra-cardiac and unlabelled activity, it is proportional to the arterial organ input over both the first-pass and equilibrium phases of the passage of an intravenously injected radiopharmaceutical. A practical example demonstrating the value and validity of correcting the cardiac curve in dynamic radio colloid scintigraphy is described. Estimates of the colloid clearance rate to reticuloendothelial sites using the cardiac curve without correction were significantly lower (mean 0.085/min) than those derived from the liver uptake curve (mean 0.213/min). However, corrected cardiac curve clearance rates (mean 0.225/min) were not significantly different from the liver ones. Also, the corrected cardiac curve clearance values correlated linearly with liver curve values (correlation coefficient 0.89, standard error of the estimate 0.021/min), whereas the uncorrected values showed no significant correlation. Thus, correction of the cardiac curve gave clearance rate values that were both more accurate and more precise than those obtained without correction.

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“…A further disadvantage of techniques that do require a blood sample is significant accumulation of extravascular 99mTc-DTPA in the overlying chest wall by the time, 20 min after injection, when the calibration based on the blood sample is made [22]. A further disadvantage of techniques that do require a blood sample is significant accumulation of extravascular 99mTc-DTPA in the overlying chest wall by the time, 20 min after injection, when the calibration based on the blood sample is made [22].…”

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confidence: 99%

Measurement of the ratio of glomerular filtration rate to plasma volume from the technetium-99m diethylene triamine pentaacetic acid renogram: comparison with glomerular filtration rate in relation to extracellular fluid volume

1994

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Measurement of the ratio of glomerular filtration rate to plasma volume from the technetium-99m diethylene triamine pentaacetic acid renogram: comparison with glomerular filtration rate in relation to extracellular fluid volume Abstract. Individual kidney glomerular filtration rate (IKGFR) can be measured from the renogram from the rate of uptake of technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA). A blood sample is required to derive IKGFR in millilitres per minute, which is then usually normalised to body surface area. We describe a technique which does not require a blood sample, is already normalised for plasma volume and uses the robust Patlak plot for measuring renal uptake. The rate of kidney uptake, dR(t)/dt, at time = 0, as a fraction of the injected dose, is equal to the fraction of the plasma volume (PV) filtered per minute, i.e. IKGFR/PV. The gradient dR(O)/dt cannot be accurately measured directly but is equal to [o~. LV(0)], where c~ is the renal uptake constant (proportional to IKGFR) and LV is the count rate over a left ventricular ROI. LV(0) was obtained by extrapolation of LV(t), while ~ is the slope of the Patlak plot up to 3 min. GFR/PV (i.e. right plus left kidneys) in patients with normal renal function was about 0.04 rain -I, as would be expected from normal values of GFR (120 ml/min) and plasma volume (3 1). GFR/PV correlated significantly with the ratio of GFR to extracellular fluid volume (ECV), measured from the terminal exponential of the plasma clearance curve (GFR/PV = 3.2.GFR/ECV + 5.3 ml/min/1 [r = 0.82, n = 82]). GFR/PV (r = 0.74) and GFR/ECV (r = 0.82) both correlated inversely and non-linearly with plasma creatinine in 43 studies where the measurement was made within 1 week of the 99mTc-DTPA study. They also correlated significantly with the plasma cyclosporin trough level in 14 patients with dermatomyositis on the 30 occasions when this measurement was made within 1 week of the renogram (r = -0.38, P <0.05 for GFR/PV and r = -0.77, P <0.001 for GFR/ECV). The ratio of GFR/PV to GFR/ECV is the ratio of extracellular fluid volume to plasma volume, and this was 4.0 (SD 0.99). We conclude that both GFR/PV and GFR/ECV can be easily measured with 99mTc-DTPA Correspondence to: A.M. Peters and are physiologically valid expressions of GFR. Although GFR/PV and GFR/ECV correlate with each other, the question is raised as to which of the two fluid volumes is the most appropriate for normalising GFR.

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Extravascular chest wall technetium 99m diethylene triamine penta-acetic acid: implications for the measurement of renal function during renography

Cited by 4 publications

References 3 publications

Quantification of renal haemodynamics with radionuclides

Quantification of renal haemodynamics with radionuclides

Estimation of organ input function and plasma clearance from the cardiac curve in dynamic scintigraphy

Measurement of the ratio of glomerular filtration rate to plasma volume from the technetium-99m diethylene triamine pentaacetic acid renogram: comparison with glomerular filtration rate in relation to extracellular fluid volume

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