Nuclear medicine methods in the urogenital system
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1 Nuclear medicine methods in the urogenital system
2 Anatomy of the kidneys I.
3 Anatomy of the kidneys II.
4 The types of examinations Static examinations (scintigraphy): 1) the radiopharmaceutical is administered 2) we wait an optimal time-period 3) the imaging of the organ is performed from different directions ( planar, SPECT or SPECT/CT) radiopharmaceutical Dynamic studies: series of frames of the function of the examined organ are taken and stored from the time the isotope is injected until an optimal time
5 Renal scintigraphy I. Radiofarmaceutical: MBq 99mTc-DMSA (dimercaptosuccinic acid accumulates in the proximal tubular cells) Acquisition time: 120 minutes after the injection Planar imaging from 4 different directions: - anterior, posterior - RPO (right posterior oblique) - LPO (left posterior oblique) Evaluation: - size, shape, position, homogenity - focal parenchymal defects (> 1.5 cm) - quantitative value of renal function
6 Indications: Renal scintigraphy II. Determine relative (%) renal function of the left and right kidneys Pyelonephritis Renal ectopia Renal infarction Hypertension Horseshoe kidney Acute renal failure Multicystic dysplastic kidneys Renal trauma Tumors and metastases
7 Normal renal scintigram
8 Enlarged solo kidney on the left side in a newborn (congenital)
9 Nonfunctioning kidney on the left side in adult (acquired)
10 Left ptotic kidney with deteriorating function, focal parenchymal defect in the right kidney
11 Hydro - nephrosis on the left side parenchymal failure
12 Multicystic disease in the left kidney
13 Small focal parenchymal defects pyelonephritis
14 Horseshoe kidney
15 Renal scintigraphy III. Determine relative renal function in the left and right kidney from the DMSA imaging: Posterior view: ROI of the left and the right kidney Anterior view: ROI of the left and the right kidney again Calculating of the parameters by computer
16 Normal ratio Relative ratio of the renal function: Posterior view: left kidney: 48.4% right kidney: 51.6% Anterior view: left kidney: 50.7% right kidney: 49.3% Average: left kidney: 49.5% right kidney: 50.5%
17 Ratio of reduced kidney function on the right side Relative ratio of the renal function: Posterior view: left kidney: 83.8% right kidney: 16.2% Anterior view: left kidney: 88.5% right kidney: 11.5% Average: left kidney: 86.3% right kidney: 13.7% Operation is absolutly indicated under 10%!
18 Dynamic studies Follow up the physiological or pathophysiological functions of an organ or organ system by radioactive substance Gamma-camera-computer system ROI (region of interest) technique Time-activity curves, T maximum, T 1/2
19 Camera-renography I. Glomerular or tubular function of the kidneys are investigated (370 MBq 99mTc-DTPA, 99mTc-EC, 99mTc-MAG3) Time-activity curve = renogram Phase I. = perfusion Phase II. = filtration or secretion function Phase III. = excretion function
20 Normal renal function Perfusion Renography
21 Camera-renography II. Indications: Functional or anatomical obstructions Hypertension renal perfusion One-side kidney diseases (nephrolithiasis, pyelonephritis) Clearence-studies (GFR) Vesico-ureteral reflux Kidney transplantation
22 Camera-renography III. Accumulation curve = increased activity of the kidney is found during the examination time period Obstruction of the renal cavity: morphological - no or a few excretion after Furosemid functional - excretion is found after Furosemid
23 right - sided pyeloureteral stenosis, ( anatomical ) left - sided functional excreation disorder
24 Bilateral vesicoureteral stenosis
25 Impaired function, no excretion on the left side
26 Camera-renography IV. Vesico-ureteral reflux (VUR): the patient has to micturate in front of the gamma camera the urine goes back to the ureters or the pyelon during the miction examination by computer: activity is rising in the ROI of the ureter
27 VUR in the left ureter Before the miction During the miction Ureter Bladder
28 Right sided VUR Renography Miction
29 Camera-renography V. Measurement of glomerular filtration (GFR) Radiofarmaceutical: 99mTc-DTPA Method: camera-renography+cupping in two time (60. min, 120. min) Calculation: GFR(ml/min)=k*V k=(logm1-logm2)*(t2-t1) V=250*(S1+S2+S3+S4)/A0 A0=M1*exp(k*T1)
30 Camera-renography VI. Renovascular hypertension: Stenosis of renal artery increased renin secretion increased angiotensin I to II conversion is moderate by ACE (angiotensin convertase enzym) Angiotensin II narrows only the vas efferens of the glomerulus the intraglomerular pressure does not decrease Effect of ACE inhibitor: decreased angiotensin II secretion decreased intraglomerular pressure decreased intraglomerular filtration Failure of the kidney function on the renogram
31 Examination of renovascular hypertony Baseline study In influence of ACE-inhibitor
32 PET/CT 18F-FDG : Cervix cc. Endometrium cc. Ovarium cc. Testis tumor Renal cc. (primer renocellular cc: 60 % FDG enhancement) C-11 cholin, Ga-68 DMSA Prostata cc.
33 SUV FDG accumulation non FDG avid! Melanoma HG NHL HD Colorectal CA NSCLC Oesophageal CA Head/Neck CA HG sarcoma Ductal inv. breast CA Thyroid CA TesticularCA Pancreatic CA Recurrent ovarial CA LG NHL Bronchoalveolar CA Cervical CA Renal cell CA Renal cell CA (30-40%) Prostate CA (80-85%) Lobular breast CA Mucinosus breast CA Prostate CA Primer ovarial CA Diff. Thyr. CA LG sarcoma HCC
34 Cervix cc
35 Prostata cc, 11C-cholin
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