Influence of early (F+0) intravenous furosemide injection on the split renal function using 99mTc-DTPA renography

Abstract

In busy nuclear medicine departments, the F+0 protocol for diuretic renography is routinely used to shorten the acquisition time. The aim of this study was to evaluate the influence of the F+0 protocol on the split renal function (SRF) during a dynamic renal scan using technetium-99m diethylene triamine pentaacetic acid (Tc-DTPA) compared with that using the standard technetium-99m dimercaptosuccinic acid (Tc-DMSA). A total of 102 patients referred for a dynamic renal scan for varied etiologies were divided into two groups: the F+0 group, comprising 53 patients who were injected with furosemide just before Tc-DTPA injection, and the F+10 group, comprising 49 patients who were injected with the diuretic at the 10th minute after radiotracer injection. All patients were also subjected to a static cortical Tc-DMSA scan with geometric quantification of SRF. A highly significant statistical difference (P<0.001) was obtained on comparing the mean value of the difference in SRF calculated using DTPA and DMSA between the F+0 and F+10 groups, being 5.0±2.6 and 1.5±0.6%, respectively. All 49 patients in the F+10 group had a difference in split function of 5% or less, whereas 17/53 patients representing 32.1% of the F+0 group had a difference in SRF of greater than 5%. Early (F+0) furosemide injection before administration of Tc-DTPA has a significant influence on the estimation of SRF of the diseased kidney (either obstructed or functionally impaired) when compared with furosemide injection after standard Tc-DMSA administration. Care should be taken during interpretation of the scan findings when accurate split function is required.

Timing of diuretics in diuresis renography

“…The included articles were published between the years 1978 and 2020 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The number of participants varied between 14 and 320.…”

“…The number of participants varied between 14 and 320. The radiopharmaceutical 99m Tc-MAG3 was administered in six studies [11, 17-19, 24, 25], 99m Tc-DTPA in five studies [9,12,13,20,22], 123 I-OIH in four studies [15,16,21,23], 99m Tc-EC in one study [10] and one study did not mention which radiopharmaceutical had been administered [14]. Five studies had a retrospective study design [15,17,22,24,25] and 12 studies had a prospective study design [9-14, 16, 18-21, 23].…”

“…Five studies had a retrospective study design [15,17,22,24,25] and 12 studies had a prospective study design [9-14, 16, 18-21, 23]. Four articles included both children and adults in their studies [16,17,20,22], Table 3. The F − 15 method was the method that was studied and described most in the published articles.…”

“…Liu et al compared the F + 0 method with F − 15 method and reported that a greater part of the patients could complete the diuresis renography with the F + 0 method since more examinations were reported to be disrupted with the F − 15 method due to voiding issues [17]. Three articles reported results concerning administering the diuretics 10 min after the radiopharmaceutical i.e., the F + 10 method [19,20,24]. Tartaglione et al reported that the F + 10 method (in seated position) could reduce the equivocal findings of the F − 15 method (in supine position) and lead to fewer bladder filling related problems.…”

Comparison Between Diuretic Urography (IVP) and Diuretic Renography for Diagnosis of Ureteropelvic Junction Obstruction in Children

“…Technetium-99 m diethylene triamin pentaacetic acid (DTPA) is usually used for detection of upper urinary tract obstruction. A bladder catheter should be inserted, especially if VUR and/or suspected UVJO are present ( 12 , 26 ).…”