Cortical Imaging

Question 1

indications

Answer 1

• eval renal trauma
• eval renal infarction
• eval renal scarring
• differentiating acute or chronic pyelonephritis

Question 2

typical cause of acute pyelonephritis

Answer 2

reflux of infected urine

Question 3

symptoms of acute pyelonephritis

Answer 3

fever, flank pain and positive urine cultures

Question 4

typical cause of chronic pyelonephritis

Answer 4

recurrent renal infections

Question 5

RP(s) and dose

Answer 5

99mTc- DMSA
185 MBq in adults or
1.85 MBq/kg

99mTc-Gluco
370-740 MBq

Question 6

why is the RP of choice used?

Answer 6

DMSA: retained in renal cortex to allow for anatomic detail

Gluco: allows for morphology and functional

Question 7

prep

Answer 7

none

Question 8

imaging protocol for DMSA

Answer 8

• delayed imaging 2-4H post injection (statics)

Question 9

normal images

Answer 9

normal, homogenous uptake throughout renal parenchyma, although renal pyramids are photopenic

Question 10

pathology?

sudden onset of inflammation in kidneys due to infection

Answer 10

acute pyelonephritis

Question 11

causes of acute pyelonephritis

Answer 11

• E. coli from bowel
• urethral blockage leading to reflux
• catheters

Question 12

nm appearance of acute pyelonephritis

Answer 12

• single, multiple or diffuse photopenic areas in renal cortical tissue
• enlarged areas of the kidneys

Question 13

active infection vs. scarring

Answer 13

infections look less defined
scarring looks more defined as well as more cortical thinning/flattening, reduced kidney sizes

Question 14

false positives

Answer 14

• radiation nephritis as it creates a generalized or focal region of decreased function
• variations of kidney shapes

Question 15

what are lobulations?

Answer 15

incomplete fusion of the lobes of kidneys during development

Question 16

dysplastic kidney

Answer 16

cysts forming in kidneys until no functioning tissues are left

Question 17

appearance of dysplastic kidneys

Answer 17

• kidneys will be smaller in size and may show multiple photopenic areas

Question 18

pathology that causes multiple, bilateral enlargement of the kidneys due to fluid-filled cysts

Answer 18

cystic disease

Question 19

cystic disease in infants

Answer 19

• diffusely enlarged kidneys
• renal failure
• improper development of bile ducts
• facial anomalies such as pointed nose, small chins, low-set floppy ears

Question 20

cystic disease in adults

Answer 20

• symptomatic between 30-50
• flank pain, hematuria, proteinuria, nocturne, HTN, UTIs

Question 21

appearance of cystic disease with DMSA

Answer 21

cold spherical photopenic spots on delays

Question 22

cystic disease with MAG3 and DTPA

Answer 22

for renal perfusion and function
diuretic admin needed if cysts cause alterations in collecting systems

Question 23

malignant, slow-growing tumour found in renal cortex

Answer 23

renal cell carcinoma

Question 24

symptoms of Renal cell carcinomas

Answer 24

• painless hematuria
• flank pain
• fever
• HTN
• weight loss
• edema

Question 25

which RP is used for morphology?

Answer 25

DMSA and or gluco (but not as good as dmsa)

Question 26

renal cell carcinoma with DSMA

Answer 26

decreased activity in malignant area

Question 27

renal cell carcinoma with MAG3

Answer 27

increased visualization of the tumour masses on perfusion scintigraphy
yet on delayed = decreased counts

Question 28

cancer of the embryonic renal cells

Answer 28

Wilm’s tumour
Nephroblastoma

Question 29

symptoms of Wilm’s tumour

Answer 29

palpable abdominal mass
fever, pain and HTN
hematuria and vomiting can also occur

Question 30

normal appearance on renal cortical scan

Answer 30

homogeneous renal cortex that can be less intense in the upper pole due to attenuation from liver/spleen
collecting system and renal medulla = photopenic

Question 31

appearance of renal scars

Answer 31

• photopenic cortex that persists 6 months after an infection
• contours sharp margins
• kidney may be smaller

Question 32

appearance of acute pyelonephritis

Answer 32

• generalized decreased uptake with indistinct margins
• kidneys may be larger
• resolution should occur

Question 33

appearance of cystic disease

Answer 33

photopenic spheres

Question 34

appearance of renal cell carcinoma

Answer 34

decreased uptake in region of tumour with morphological agents
with functional agents, there will be an increased flow

Question 35

which pathology won’t present with photopenic areas?

Answer 35

column of bertin