Cortical Imaging Flashcards
indications
- eval renal trauma
- eval renal infarction
- eval renal scarring
- differentiating acute or chronic pyelonephritis
typical cause of acute pyelonephritis
reflux of infected urine
symptoms of acute pyelonephritis
fever, flank pain and positive urine cultures
typical cause of chronic pyelonephritis
recurrent renal infections
RP(s) and dose
99mTc- DMSA
185 MBq in adults or
1.85 MBq/kg
99mTc-Gluco
370-740 MBq
why is the RP of choice used?
DMSA: retained in renal cortex to allow for anatomic detail
Gluco: allows for morphology and functional
prep
none
imaging protocol for DMSA
- delayed imaging 2-4H post injection (statics)
normal images
normal, homogenous uptake throughout renal parenchyma, although renal pyramids are photopenic
pathology?
sudden onset of inflammation in kidneys due to infection
acute pyelonephritis
causes of acute pyelonephritis
- E. coli from bowel
- urethral blockage leading to reflux
- catheters
nm appearance of acute pyelonephritis
- single, multiple or diffuse photopenic areas in renal cortical tissue
- enlarged areas of the kidneys
active infection vs. scarring
infections look less defined
scarring looks more defined as well as more cortical thinning/flattening, reduced kidney sizes
false positives
- radiation nephritis as it creates a generalized or focal region of decreased function
- variations of kidney shapes
what are lobulations?
incomplete fusion of the lobes of kidneys during development
dysplastic kidney
cysts forming in kidneys until no functioning tissues are left
appearance of dysplastic kidneys
- kidneys will be smaller in size and may show multiple photopenic areas
pathology that causes multiple, bilateral enlargement of the kidneys due to fluid-filled cysts
cystic disease
cystic disease in infants
- diffusely enlarged kidneys
- renal failure
- improper development of bile ducts
- facial anomalies such as pointed nose, small chins, low-set floppy ears
cystic disease in adults
- symptomatic between 30-50
- flank pain, hematuria, proteinuria, nocturne, HTN, UTIs
appearance of cystic disease with DMSA
cold spherical photopenic spots on delays
cystic disease with MAG3 and DTPA
for renal perfusion and function
diuretic admin needed if cysts cause alterations in collecting systems
malignant, slow-growing tumour found in renal cortex
renal cell carcinoma
symptoms of Renal cell carcinomas
- painless hematuria
- flank pain
- fever
- HTN
- weight loss
- edema
which RP is used for morphology?
DMSA and or gluco (but not as good as dmsa)
renal cell carcinoma with DSMA
decreased activity in malignant area
renal cell carcinoma with MAG3
increased visualization of the tumour masses on perfusion scintigraphy
yet on delayed = decreased counts
cancer of the embryonic renal cells
Wilm’s tumour
Nephroblastoma
symptoms of Wilm’s tumour
palpable abdominal mass
fever, pain and HTN
hematuria and vomiting can also occur
normal appearance on renal cortical scan
homogeneous renal cortex that can be less intense in the upper pole due to attenuation from liver/spleen
collecting system and renal medulla = photopenic
appearance of renal scars
- photopenic cortex that persists 6 months after an infection
- contours sharp margins
- kidney may be smaller
appearance of acute pyelonephritis
- generalized decreased uptake with indistinct margins
- kidneys may be larger
- resolution should occur
appearance of cystic disease
photopenic spheres
appearance of renal cell carcinoma
decreased uptake in region of tumour with morphological agents
with functional agents, there will be an increased flow
which pathology won’t present with photopenic areas?
column of bertin
