Renal functional compensation after unilateral radical nephrectomy of renal cell carcinoma / 北京大学学报(医学版)

OBJECTIVE@#To investigate factors influencing renal functional compensation(RFC) of the preserved kidney after radical nephrectomy (RN).@*METHODS@#A total of 286 patients treated with RN in Peking University People's Hospital were retrospectively analyzed. Preoperative body mass index (BMI), systolic blood pressure (SBP), history of smoking, history of chronic diseases and other basic information, as well as preoperative blood biochemistry, urine routine, imaging examination results were recorded. All the patients underwent 99mtechnetium-diethylenetriamine pentaacetic acid (99mTc-DTPA) renal scans before operation. The surgical method, pathology and blood creatinine values from 1 month to 60 months after RN were recorded. Preoperative and postoperative estimated glomerular filtration rate (eGFR) was calculated by the chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Renal functional compensation was defined as percent change in eGFR of the preserved kidney after RN compared with the preoperative eGFR. Univariate and multivariate regression analyses were used to identify predictive factors of RFC.@*RESULTS@#Median age was 61 years and 65.4% of the patients were male. Early stage (T1 or T2) tumors were found in 83.6% of the cases. 18.5% of the patients had preoperative diabetes mellitus, 39.5% had hypertension, 19.2% had a history of smoking, and 27.6% were found to have renal cyst on the contralateral side. In the study, 226 cases underwent laparoscopic radical nephrectomy and 60 cases underwent open radical nephrectomy. Renal clear cell carcinoma was the most common pathological type, accounting for 88.5%. The median tumor maximum diameter was 4.5 cm (0.7-13.5 cm). Median renal function compensation was 27% one month after radical nephrectomy. Functional stability was then observed to 5 years. The results of univariate analysis showed that age, gender, preoperative blood uric acid, preoperative urine protein, contralateral renal cyst, and percentage of split renal function of contralateral kidney were correlated with RFC (P < 0.05). Among them, UA level and split renal function of contralateral kidney were strongly negatively correlated with RFC. The results of multivariate linear regression analysis showed age (P < 0.001), blood uric acid (P < 0.001), urine protein (P=0.002), preoperative eGFR (P < 0.001) and the split renal function of contralateral kidney (P < 0.001) were independent predictors of RFC.@*CONCLUSION@#The basic examinations, such as blood biochemistry, urine routine and renal scan before RN are of great significance in predicting the compen-satory ability of the preserved kidney after RN, which is supposed to be taken into consideration when making clinical decision.

A comparative study of different methods of estimating glomerular filtration rate in a subset of Filipinos with normal renal function

@#Kidney function is commonly quantified using the glomerular filtration rate (GFR). However, the gold standard of measuring GFR, inulin clearance, is not practical for daily clinical use. This study compares different methods of GFR estimation based on serum creatinine, plasma levels of 99mTc-diethylenetriaminepentaacetic acid (DTPA), and camera acquisition of 99mTc-DTPA uptake. Seventy-five Filipino adults between ages 20 and 35 presumed to have normal kidneys were recruited. Each subject underwent gamma camera scintigraphy using the Gates and Inoue protocols after receiving a dose of 99mTc-DTPA. Blood samples were subsequently extracted at 1 hour and 3 hours after tracer injection, and GFRs were calculated based on single- and double-plasma sampling methods (SPSM and DPSM, respectively). Serum creatinine was also measured to derive GFR using the CKD-EPI, MDRD, and CockroftGault equations. Each method was correlated with a reference standard (DPSM) based on accuracy, linear regression, bias, and precision. SPSM tends to overestimate GFR unlike the other methods evaluated, but otherwise shows the most favorable diagnostic performance among the six methods when correlated with DPSM. The Inoue method appears modestly better than the routinely utilized Gates protocol, though both methods exhibit lack of precision. The CKD-EPI formula shows similar, if not slightly superior, diagnostic properties to the MDRD and Cockroft-Gault equations, thus confirming its validity for use in this Filipino population subset. Further studies are needed, particularly involving SPSM and CKD-EPI, to determine the applicability of our findings in Filipinos with varying degrees of kidney function. It is hoped that modifications to these methods can be made that are tailor-fit to derive more accurate and population-specific GFR values.

Influence of bladder fullness on the detection of urinary tract obstruction by dynamic renal scintigraphy / Influência da repleção vesical na pesquisa de obstrução do trato urinário utilizando cintilografia renal dinâmica

Abstract Objective: To investigate the influence of bladder fullness on the diagnosis of urinary tract obstruction during dynamic renal scintigraphy with a diuretic stimulator. Materials and methods: We studied 82 kidneys in 82 patients submitted to dynamic renal scintigraphy with a diuretic stimulator. We compared the proportional elimination of the radiopharmaceutical 99mTc-DTPA from the kidneys before and after bladder emptying in post-diuretic images, classifying each image as representing an obstructed, indeterminate, or unobstructed kidney. Results: The overall elimination of 99mTc-DTPA from the kidneys was 10.4% greater after bladder emptying than before. When the analysis was performed with a full bladder, we classified 40 kidneys as obstructed, 16 as indeterminate, and 26 as unobstructed. When the 40 kidneys classified as obstructed were analyzed after voiding, 11 were reclassified as indeterminate and 3 were reclassified as unobstructed. Of the 16 kidneys classified as indeterminate on the full-bladder images, 13 were reclassified as unobstructed after voiding. Conclusion: In dynamic renal scintigraphy with a diuretic stimulator, it is important to obtain images after voiding, in order to perform a reliable analysis of the proportional excretion of 99mTc-DTPA from the kidneys, avoiding possible false-positive results for urinary tract obstruction.

Resumo Objetivo: Verificar a influência da repleção vesical no diagnóstico da obstrução do trato urinário durante a cintilografia renal dinâmica com estímulo de diurético. Materiais e métodos: Foram estudados, retrospectivamente, 82 rins de 82 pacientes submetidos a cintilografia renal dinâmica. Compararam-se as porcentagens de excreção do radiofármaco DTPA-99mTc pelos rins antes e após o esvaziamento vesical nas imagens pós-diurético, classificando-os como obstruídos, indeterminados ou não obstruídos. Resultados: A avaliação da excreção do radiofármaco pelos rins mostrou que houve aumento de 10,4% na taxa de excreção global quando a bexiga foi esvaziada. Dos 82 rins estudados, 40 foram considerados obstruídos, 16 indeterminados e 26 como não obstruídos, na análise com a bexiga repleta. Na análise das imagens após micção, dos 40 classificados como obstruídos, 11 passaram a ser classificados como indeterminados e 3 como não obstruídos. Além disso, dos 16 rins apontados como indeterminados nas imagens com a bexiga repleta, 13 passaram a ser considerados não obstruídos com a bexiga vazia. Conclusão: É fundamental uma imagem após a micção na cintilografia renal dinâmica para uma análise fidedigna da porcentagem de excreção do radiofármaco pelo rim, evitando-se possíveis falso-positivos para obstrução do trato urinário.

The clinical study of the new formula for estimating the glomerular filtration rate for adult Chinese / 中国基层医药

Objective To explore the clinical application value of the new formula for estimating glomerular filtration rate(eGFR) for adult Chinese(AC-eGFR).Methods GFR from 117 patients in hospital suffering from the difference diseases was determined accurately using clearance rate of 99mTc-DTPA(Tc-GFR).The serum cystatin C,creatinine and blood urea nitrogen were determined by the biochemical apparatus.Simultaneously,GFR was calculated by the eleven formulas such as AC-eGFR,CKD-EPI formula etc..Then,the results were compared and analyzed.Results eGFR from the eleven formulas could all give expression to GFR accurately in some extent,AC-eGFR,CKDEPI-eGFR and Larsson A et al-eGFR were more accurate than others and could take place of Tc-GFR clinically.Robert TT-eGFR,Filler Get al-eGFR and Grubb Aet al-eGFR were worse than others.Conclusion AC-eGFR,CKDEPI-eGFR and Larsson A et al-eGFR were all accurate,simple,fast,safe,cheap and rational method for estimatingGFR,which should apply and popularize clinically.

Effect of a plant origin drug on the biodistribution of 99mTc-DTPA in Wistar albino rats

In recent years all over the world, medicinal plants are used quite a lot but side effects of biological and chemical contents and radiopharmaceutical interactions for each consumer in question aren't entirely well-known. The studies of plant origin drug interaction with radiopharmaceuticals are highly relevant and desired. One of them is passiflora syrup (Passiflora incarnata L., Passifloraceae) which is widely used for depression, insomnia, anxiety and menopause period. The aim of current study is to evaluate possible effects of passiflora syrup on the biodistribution of 99mTc-DTPA and its blood cells uptake. DTPA was labeled with 99mTc radionuclide. Biodistribution studies were performed on male Wistar albino rats which were treated via oral feeding-gavage-method with either passiflora syrup or 0.9 % NaCl as control group for ten days. Blood samples were obtained by cardiac blood withdrawal from the rats and they were radiolabeled. The biodistribution results showed that the passiflora syrup decreased the uptake of 99mTc-DTPA in kidneys and in blood cells. 99mTc-DTPA being used widely as a kidney diagnostic agent in nuclear medicine seems to be interacting with orally taken passiflora. Passiflora syrup may modify the uptake of 99mTc-DTPA by kidney. The knowledge of this negative effect may contribute to reduce the risk of misdiagnosis and/or repetition of the examinations in nuclear medicine.

Correlative analysis between contrast-enhanced ultrasonography and 99mTc-DTPA renography in evaluation of renal insufficiency / 中华肾脏病杂志

Objective To evaluate the contrast-enhanced ultrasonography (CEUS) in quantitative diagnosis of chronic renal insufficiency. Methods Correlation of CEUS indexes with glomerular filtration rate (GFR) detected by 99mTc-DTPA renography was examined. Thirty-three cases of clinical chronic renal insufficiency were enrolled in the study. They were 15 males and 18 females with average age of (43.33±6.78) years. After intravenous bolus injection of 1 ml SonoVue,CEUS of renal cortex blood perfusion was performed successfully, and a time-intensity curve (TIC)was created with PHILIPS iU22 system's QLAB software. A 148 to 222 MBq dose of 99mTc-DTPA was injected as a bolus from antecubital vein. Renal scintigraphic images were collected immediately and GFR was obtained. Results The significant correlation coefficients between GFR and CEUS quantitative indexes were as follows: rAUC (area under curve)=0.886 (P＜0.05), rA (slope rate of ascending curve, A) =0.804(P＜0.05). However, rDPI (derived peak intensity, DPI)=0.021 (P＞0.05), rTTP (time to peak, TTP) =0.043 (P＞0.05), rα (slope rate of descending curve,α)=0.039 (P＞0.05). Conclusion CEUS can precisely display the hemodynamic change of chronic renal insufficiency, which is well correlated with GFR by 99mTc-DTPA renography.

Alveolus-capillary permeability on both normal and HIV seroreactive individuals

The aim of this study was to evaluate the alveolus-capillary permeability by the lung clearance rate of 99mTc-DTPA(Technetium99m-diethylene triamine penta-acetate), (LCR-DTPA), both in normal and in asymptomatic HIV seroreactive patients. Thirty individuals were studied, 21 seronegative normal volunteers and 9 HIV seroreactive patients presenting normal chest radiography and no respiratory infection symptoms. LCR-DTPA was determined by inhaling 99mTc-DTPA and obtaining images in a gamma camera. The 99mTc-DTPA clearance rate in normal individuals was 0.99±0.15 percent.min-1 and in patients 2.31±1.25 percent.min-1. There was a significant statistical difference between the two groups (p< 0.05). Two patients who presented LCR-DTPA higher than 4.3 percent.min-1 presented pneumocystis pneumonia one month later. Seroreactive AIDS patients, previously asymptomatic that presented pneumonia later showed higher LCR-DTPA than the seroreactive who did not develop the illness. These results suggested that LCR-DTPA could be a predictive method for the clinical development of pneumocystis pneumonia in asymptomatic HIV seroreactive patients.

A integridade funcional da barreira alvéolo-capilar pode ser alterada por diversas condições patológicas e por outros fatores como a irritação do epitélio alveolar, provocada pelo fumo etc, levando a um aumento da permeabilidade alvéolo-capilar. O objetivo deste trabalho foi verificar a permeabilidade do epitélio pulmonar através da determinação da taxa de depuração pulmonar do aerossol de 99mTc-DTPA (LCR-DTPA) em indivíduos normais e em pacientes assintomáticos HIV sororreativos. Foram estudados 30 indivíduos, sendo 21 voluntários normais e 9 HIV sororreativos sem sintomas de infecção oportunista, com radiografias de tórax normais ou sem sinais sugestivos de infecção pulmonar. A LCR-DTPA foi determinada após inalação de 99mTc-DTPA sob a forma de aerossóis e contagem externa da radiação, em função do tempo, em gama câmara. A LCR-DTPA dos controles foi de 0.99±0.15 por cento.min-1 e nos pacientes sororreativos,de 2.31±1.15 por cento.min-1 houve diferença significativa entre os dois grupos (p< 0.05). Dois pacientes tiveram LCR-DTPA acima de 4,3 por cento.min-1, estes desenvolveram um mês após o exame. Observou-se que os pacientes sororreativos por Imunodeficiência Adquirida (SIDA), sem sintomas específicos para pneumocistose que posteriormente desenvolveram a doença, a LCR-DTPA foi significativamente maior que a dos outros HIV pneumocistose clínica sororreativos que não desenvolveram a doença (p<0.01). Estes resultados sugerem que a LCR-DTPA pode ser um método preditivo do desenvolvimento clínico da pneumocistose, não invasivo, de fácil realização e cômodo, para o paciente HIV sororreativo assintomático.

Schistosomiasis haematobia in Brazilian patients: clinical and renal functional evaluation with 99mTc-DTPA

The present study was carried out at the Army Central Hospital, Rio de Janeiro, Brazil, from September 2000 to December 2001, employing diethylenetriamine penta-acetic acid labeled with technetium-99m (99mTc-DTPA) to evaluate the renal function of nineteen symptomatic patients infected with S. haematobium during a peace mission in Mozambique. Results evidenced that the most frequent clinical manifestations were hematuria (68.4 percent) and low back pain (68.4 percent) and 73.7 percent patients had altered dynamic renal scintigraphy expressed by an increase in the excretory phase independently of the symptoms duration; furthermore, none of them had mechanical obstructive pattern. Schistosoma haematobium glomerulopathy could be considered a pathological finding without correlation with the disease clinical manifestations.(AU)

Effectiveness of Radionuclide Cisternography to Detect the Leakage Site of CSF in Spontaneous Intracranial Hypotension; Preliminary Report / 핵의학분자영상

PURPOSE: Although radionuclide cisternography (RNC) is an useful study to detect cerebrospinal fluid (CSF) leakage in the patient with spontaneous intracranial hypotension (SIH), it sometimes fails to demonstrate the site of CSF leakage. The aim of the study is to improve the detection of leakage site of CSF and to reduce time for the study in RNC using modified protocol (m-RNC). MATERIALS AND METHODS: The study consists of 8 studies of 7 patients (38+/-8 years, M:F=2:5) with SIH, who underwent m-RNC following administration of 185-222 MBq of 99mTc-DTPA into the lumbar subarachnoid space. Sequential images were obtained the whole spine with the head including urinary bladder at 10 minute, 30 minute, 1 hour, 2 hour, 4 hour and 6 hour. Radioactivity of extradural space and urinary bladder was evaluated. RESULTS: Leakage site of CSF was identified in all 8 cases by m-RNC. Leakage site was cervicothoracic junction (CTJ, n=3), CTJ with C1-2 (n=2), CTJ with thoracic spine, thoracolumbar spine and lumbar spine (each n=1). All cases presented leakage sites within 1 hour and multiple sites, where CTJ was included in 6 cases. Only one case presented additional site in 6 hour image. Early radioactivity within the urinary bladder was noted in 6 cases, but that was following after identification of the leakage site. CONCLUSION: Radionuclide cisternography is sensitive to detect the leakage site of CSF and is expected to improve the detection of CSF leakage site and reduce time for the study using modified protocol.

Determination of Appropriate Sampling Frequency and Time of Multiple Blood Sampling Dual Exponential Method with 99mTc-DTPA for Calculating GFR / 핵의학분자영상

PURPOSE: To determine appropriate sampling frequency and time of multiple blood sampling dual exponential method with 99mTc-DTPA for calculating glomerular filtration rate (GFR). MATERIALS AND METHODS: Thirty four patients were included in this study. Three mCi of 99mTc-DTPA was intravenously injected and blood sampling at 9 different times, 5ml each, were done. Using the radioactivity of serum, measured by gamma counter, the GFR was calculated using dual exponential method and corrected with the body surface area. Using spontaneously chosen 2 data points of serum radioactivity, 15 collections of 2-sample GFR were calculated. And 10 collections of 3-sample GFR and 12 collections of 4-sample GFR were also calculated. Using the 9-sample GFR as a reference value, degree of agreement was analyzed with Kendall's tau correlation coefficients, mean difference and standard deviation. RESULTS: Although some of the 2-sample GFR showed high correlation coefficient, over or underestimation had evolved as the renal function change. The 10-120-240 min 3-sample GFR showed a high correlation coefficient (tau=0.93), minimal difference (Mean+/-SD=-1.784+/-3.972), and no over or underestimation as the renal function changed. The 4-sample GFR showed no better accuracy than the 3-sample GFR. CONCLUSIONS: In the wide spectrum of renal function, the 10-120-240 min 3-sample GFR could be the best choice for estimating the patients' renal function.

99mTc-DTPA Galactosyl Human Serum Albumin Scintigraphy in Mushiroom Poisoning Patient: Comparison with Liver Ultrasonography / 대한핵의학회잡지

99mTc-galactosyl human serum albumin (Tc-GSA) is a radiopharmaceutical that binds to asialoglycoprotein receptors, which are specifically present in the hepatocyte membrane. Because these receptors are decreased in hepatic parenchymal damage, the degree of Tc-GSA accumulation in the liver correlates with findings of liver function test. Hepatic images were performed with Tc-GSA in patients with acute hepatic dysfunction by Amantia Subjunquillea poisoning, and compared with these of liver ultrasonography (USG). Tc-GSA (185 MBq, 3 mg of GSA) was injected intravenously, and dynamic images were recorded for 30 minutes. Time-activity curves for the heart and liver were generated from regions of interest for the whole liver and precordium. Degree of hepatic uptake and clearance rate of Tc-GSA were generated by visual interpretation and semiquantitative analysis parameters (receptor index: LHL15 and index of blood clearance: HH15). Visual assessment of GSA scintigraphy revealed mildly decreased liver uptake in all of subjects. The mean LHL15 and HH15 were 0.886 and 0.621, graded as mild dysfunction in 2, and mild to moderate dysfunction in 1 subject. In contrast, liver USG showed no remarkable changes of hepatic parenchyme. Tc-GSA scintigraphy was considered as a useful imaging modality in the assessment of the hepatic dysfunction.

Evaluation of Lung Epithelial Permeability in Patients with Type 2 Diabetes Mellitus using 99mTc-DTPA Aerosol Scintigraphy / 대한내분비학회지

BACKGROUND: Diabetes mellitus is often accompanied by complicated microangiopathy, such as, retinopathy, nephropathy, peripheral neuropathy, cardiovascular autonomic neuropathy or macroangiopathy, as well as by coronary artery disease and cerebrovascular disease. However, there have been few reports concerning the pulmonary involvement of diabetes. Recently, capillary basement membrane thickening, nonenzymatic glycosylation of tissue proteins, abnormalities of endothelial cells and increased damage by free radicals were reported as the underlying basis for the reduced lung permeability. 99mTc-DTPA aerosol scintigraphy is a noninvasive, accurate method, which evaluates the permeability of lung epithelial membranes. The clearance rate of 99mTc-DTPA in lungs may correlate inversely with the lung's epithelial permeability. We investigated the relationship between microangiopathies and the lung epithelial permeability in patients with diabetes using 99mTc-DTPA aerosol scintigraphy. METHODS: The study group comprised of 33 patients with type 2 diabetes mellitus, with no clinical evidence of past or present respiratory disease. The patients were divided into two groups in relation to the complications. Group 1: 16 patients with more than one of the complications of retinopathy, nephropathy, cardiovascular autonomic neuropathy and/or peripheral neuropathy, and comprised of 3 males and 13 females, with a mean age of 52.9 +/- 9.6 years. Group 2: 17 patients with no complications, and comprised of 5 males and 12 females with a mean age of 52.8 +/- 11.5 years. Group 3: as a control group, comprised of 11 healthy people: 4 males 4 and 7 females with a mean age of 44.2 +/- 12.5 years. 99m-Tc-DTPA aerosol scintigraphy was performed in the subjects by inhalation of 30 mCi 99mTc-DTPA aerosol and oxygen (9 l/min) using an aero-vent jet nebulizer as the lung delivery system. To evaluate the diabetic complications, CAN (Cardiovascular Autonomic Neuropathy), and NCV (Nerve Conduction Velocity) tests for peripheral neuropathy, fundoscopy for retinopathy and 24 hours urine microalbumin for nephropathy were performed. RESULTS: The mean durations of diabetes in Groups 1 and 2 were 11.1 +/- 4.7 years and 3.8 +/- 2.1 years, respectively (p<0.05). The mean clearance rates of 99mTc-DTPA were found to be 72.1 +/- 19.5min, 52.6 +/- 19.7 min, and 47.1 +/- 10.9 min for Groups 1, 2, and 3, respectively. The mean clearance rate of Group 1 was significantly longer than for Groups 2 and 3 (p<0.05). In other words, the pulmonary epithelial permeability was reduced in diabetic patients with complications compared to the patients without complication and/or the normal controls. Significant positive correlation was found between the pulmonary clearance rate of 99mTc-DTPA, and peripheral neuropathy and cardiovascular autonomic neuropathy (p<0.05). Conclusions: The lungs may be a target organ for diabetes, and impaired pulmonary epithelial permeability seems to be closely related to other diabetic microangiopathies. Therefore, we recommend that 99mTc-DTPA aerosol scintigraphy be used as a technique for assessing lung injury in diabetic patients.

Development of Program for Renal Function Study with Quantification Analysis of Nuclear Medicine Image / 대한핵의학회잡지

PURPOSE: In this study, we developed a new software tool for the analysis of renal scintigraphy which can be modified more easily by a user who needs to study new clinical applications, and the appropriateness of the results from our program was studied. MATERIALS AND METHODS: The analysis tool was programmed with IDL5.2 and designed for use on a personal computer running Windows. For testing the developed tool and studying the appropriateness of the calculated glomerular filtration rate (GFR), 99mTc-DTPA was administered to 10 adults in normal condition. In order to study the appropriateness of the calculated mean transit time (MTT), 99mTc-DTPA and 99mTc-MAG3 were administered to 11 adults in normal condition and 22 kidneys were analyzed. All the images were acquired with ORBITOR, the Siemens gamma camera. RESULTS: With the developed tool, we could show dynamic renal images and time activity curve (TAC) in each ROI and calculate clinical parameters of renal function. The results calculated by the developed tool were not different statistically from the results obtained by the Siemens application program (Tmax: p=0.68, Relative Renal Function: p=1.0, GFR: p=0.25) and the developed program proved reasonable. The MTT calculation tool proved to be reasonable by the evaluation of the influence of hydration status on MTT. CONCLUSION: We have obtained reasonable clinical parameters for the evaluation of renal function with the software tool developed in this study. The developed tool could prove more practical than conventional, commercial programs.

Clearance rate of inhaled 99mTc-DTPA in systemic sclerosis / 대한내과학회지

BACKGROUND: We measured the clearance rate of inhaled 99mTc-diethyl triaminepentaacetic acid (DTPA) aerosol in patients with systemic sclerosis. We also investigated its correlation with respiratory function test and acute phase reactant proteins. METHODS: Ten patients with systemic sclerosis, ten patients with rheumatoid arthritis, and ten healthy controls were included. Dynamic scintigrams (20 seconds/frame, up to 30 minutes) were obtained following inhalation of 99mTc-DTPA aerosol through a radioaerosol delivery system. The time to half clearance (T1/2) was calculated from the time-activity curves. High resolution computed tomography, pulmonary function test and laboratory tests such as ESR, CRP, and complement (C3/C4) were performed. RESULTS: 1) Mean T1/2 values of 99mTc-DTPA clearance after inhalation were 28.1+/-3.8, 57.9+/-20.9, and 64.3+/-13.0 minutes in systemic sclerosis, rheumatoid arthritis and normal controls, respectively. Mean T1/2 value in systemic sclerosis was significantly reduced compared with those of rheumatoid arthritis group (p<0.001) and normal controls (p=0.001).2) No significant correlations were found between mean T1/2 and FEV1/FVC, FVC or DLco in patients with systemic sclerosis. 3) There was no significant correlation between mean T1/2 and ESR or CRP in patients with systemic sclerosis. And in patients with rheumatoid arthritis, mean T1/2 value correlated significantly with ESR and CRP. CONCLUSION: The clearance rate of inhaled 99mTc-DTPA was significantly increased in patients with systemic sclerosis and had no significant correlation with pulmonary function test and acute phase reactants, but was found to have significant correlations with ESR and CRP in patients with rheumatoid arthritis.

Evaluation of Lung Permeability in Patients with Connective Tissue Disease using 99mTc-DTPA Aerosol Scintigraphy / 대한류마티스학회지

OBJECTIVE: The association between the connective tissue diseases and lung diseases is well established. DLCO and 99mTc-DTPA aerosol scintigraphy are used for evaluation of the alvelolar-capillary permeability. This study evaluated the changes in permeability of alveolar-capillary membrane and the utility of the 99mTc-DTPA aerosol clearance to detect lung involvement in patients with connective tissue diseases. METHODS: The patient group consisted of the patients with any proven connective tissue diseases (27 rheumatoid arthritis, 17 systemic lupus erythematosus, 7 other connective tissue diseases) and the control group consisted of healthy 12 persons. The patients and controls were non-smokers and had no concomitant diseases that could affect the result (diabetes, any lung diseases etc). Chest X-ray, spirometric measurements of lung volumes, flow idices, diffusing capacities and 99mTc-DTPA aerosol scintigraphy were performed in the patient group and control group. 99mTc-DTPA aerosol (1110 MBq) was used with the aero-vent jet nebulizer as a lung delivery system. Patients in sitting position inhaled for 5 minutes at normal tidal oral breathing, Scintigraphic data were recorded using the Picker Prism 2000 gamma cammera, 15 frames of the lung were obtained as the area of interest anteriorly and posteriorly (120 msec at each frame, for 30 minutes). 99mTc-DTPA clearance rate was calculated as the time to half clearance (T1/2). RESULTS: The mean clearance rates of 99mTc-DTPA were 64.0+/-24.1 min (RA 70.7+/-26.2 min, SLE 61.6+/-14.0 min, Others 43.9+/-24.7 min), and 47.0+/-10.3 min in the patient group and the control group respectively. Significant correlation was not found between the pulmonary clearance rate of 99mTc-DTPA and other parameters (disease duration, ESR, CRP, DLCO and FEV1/FVC). CONCLUSION: 99mTc-DTPA clearance in the patient group (RA, SLE, others) was significantly decreased than that in control group (p<0.05). In the patient group with normal chest X-ray, 99mTc-DTPA clearance in the connective tissue disorders was significantly decreased than control group (p<0.05). We suggest that 99mTc-DTPA aerosol scintigraphy may be one of useful technique for early detection of the lung involvement in the connective tissue disorders.

Evaluation of Lung Permeability in Patients with Connective Tissue Disease using 99mTc-DTPA Aerosol Scintigraphy / 대한류마티스학회지

OBJECTIVE: The association between the connective tissue diseases and lung diseases is well established. DLCO and 99mTc-DTPA aerosol scintigraphy are used for evaluation of the alvelolar-capillary permeability. This study evaluated the changes in permeability of alveolar-capillary membrane and the utility of the 99mTc-DTPA aerosol clearance to detect lung involvement in patients with connective tissue diseases. METHODS: The patient group consisted of the patients with any proven connective tissue diseases (27 rheumatoid arthritis, 17 systemic lupus erythematosus, 7 other connective tissue diseases) and the control group consisted of healthy 12 persons. The patients and controls were non-smokers and had no concomitant diseases that could affect the result (diabetes, any lung diseases etc). Chest X-ray, spirometric measurements of lung volumes, flow idices, diffusing capacities and 99mTc-DTPA aerosol scintigraphy were performed in the patient group and control group. 99mTc-DTPA aerosol (1110 MBq) was used with the aero-vent jet nebulizer as a lung delivery system. Patients in sitting position inhaled for 5 minutes at normal tidal oral breathing, Scintigraphic data were recorded using the Picker Prism 2000 gamma cammera, 15 frames of the lung were obtained as the area of interest anteriorly and posteriorly (120 msec at each frame, for 30 minutes). 99mTc-DTPA clearance rate was calculated as the time to half clearance (T1/2). RESULTS: The mean clearance rates of 99mTc-DTPA were 64.0+/-24.1 min (RA 70.7+/-26.2 min, SLE 61.6+/-14.0 min, Others 43.9+/-24.7 min), and 47.0+/-10.3 min in the patient group and the control group respectively. Significant correlation was not found between the pulmonary clearance rate of 99mTc-DTPA and other parameters (disease duration, ESR, CRP, DLCO and FEV1/FVC). CONCLUSION: 99mTc-DTPA clearance in the patient group (RA, SLE, others) was significantly decreased than that in control group (p<0.05). In the patient group with normal chest X-ray, 99mTc-DTPA clearance in the connective tissue disorders was significantly decreased than control group (p<0.05). We suggest that 99mTc-DTPA aerosol scintigraphy may be one of useful technique for early detection of the lung involvement in the connective tissue disorders.

The Measurement of 99mTc-DTPA Pulmonary Clearance in Normals, Asymptomatic Smokers and Diabetic Patients / 대한핵의학회잡지

PURPOSE: We measured pulmonary epithelial permeability by Tc-DTPA radioaerosol clearance in patients with diabetes and correlated with the presence of microangiopathy to understand the pathophysiology of pulmonary microangiopathy and evaluate Tc-DTPA radioaerosol clearance as a diagnostic test to assess pulmonary microangiopathy. MATERIALS AND METHODS: We performed ' Tc-DTPA radioaerosol scan in 10 normal subjects, 10 asym-ptomatic smokers, 20 diabetic patients without history of smoking (10 with microangiopathy, 10 without microangiopathy). Tc-DTPA clearance half-time (T1/2) was calculated, then compared with the result of chest radiography and pulmonary function test. RESULTS: Chest radiography and pulmonary function test were normal in all subjects. There were no significant difference of clinical or laboratory characteristics between these groups except age. The diabetic patients with micraangiopathy were significantly older (p0.05). No significant correlation was found between the T1/2and spirometric parameters including DLcc>, FVC, FEV>, FEV(/FVC (%) and FEF)5-75g in all subjects, and between the T1/2 and duration of diabetes in diabetic patients. CONCLUSION: Eventhough the influence of age cant be excluded, delayed Tc-DTPA clearance half-time (T1/2)in diabetic patients with microangiopathy indicates decreased pulmonary cspillary permeability as one of the pathophysiologic results of pulmonary microangiopaththy. Further studies are needed in larger number of age matched control and diabetic patients to evaluate the diagnostic efficacy.

Comparison of Split Renal Function on DTPA Renal Scan and Endogenous Creatinine Clearance Ratio in Obstruction of Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: Split renal function on diuretic renography has been considered to be a good tool for evaluating renal function, selecting treatment modalities and assessing efficacy of surgery in hydronephrosis, especially in ureteropelvic junction(UPJ) obstruction. However, contradictory supranormal function on renography has provided controversy with urologists. Is the phenomenon the result of fact or artifact? The authers thought that contradictory supranormal renal function measured with 99mTc-DTPA Is fundamentally related with a question. How accurately does the split renal function test represent the real renal function, namely, glomerular filtration rate(GFR)? To know relation of split renal function with real renal function(GFR) and to disclose clinical significance of contradictory supranormal renal function on diuretic renal scan, a prospective study was performed. MATERIALS AND METHODS: Diuretic renography was done in 14patients with upper urinary tract obstruction including UPJ obstruction, ureteral stone and lower urethral obstruction. Afer the first diuretic renography using 99mTc-DTPA percutaneous nephrostomy was performed on affected kidney, which was followed by the second diuretic renography. Endogenous creatinine clearance tests were done on the patients. Urine was collected through the nephrostomy tube, self voiding or indwelling Foley catheter, respectively So the endogenous creatinine clearance was determined respectively on both the renal unit. Also the endogenous creatinine clearance ratio of affected kidney was determined to compare with split renal function on renography. RESULTS: In 7patients, ratio of endogenous creatinine clearance on affected kidney was less than 40%. In the other 7patients, the ratio was more than 48%. In patients with less than 40% of endogenous creatinine clearance ratio on affected kidney, split renal function was overestimated by 10.3% to 27.5%(19.5+/-4.9%) comparing to endogenous creatinine clearance ratio. In the other 7patients split renal function had a little difference from endogenous creatinine clearance ratio (4.5+/-2.5%). The endogenous creatinine clearance ratio was not closely related with split renal function(correlation coefficients: 0.65). Split renal function of the first renography was closely related with that of the second renography(correlation coefficients: 0.88). Contradictory supranormal function occurred in 4cases. In 2cases it was real finding, in the other it was not. CONCLUSIONS: It appears that split renal function is overestimated in poor renal function and split renal function is closely related with real renal function in good renal function slate. Supranormal renal function is real finding in part, not in part. Clinical significance of split renal function should be cautiously and basically reevaluated through further study.

Pulmonary Oxygen Toxicity in Rats: Changes of Lung Clearance of 99mTc-DTPA and Bronchoalveloar Lavage / 대한마취과학회지

Animal study was performed to determine the changes in rat lung permeability in hyperoxic condition. 3 groups of rats (n=8 each) were exposed to 100% oxygen for 24 hr(group 2), 48 hr(group 3) and 72 hr(group 4), respectively, and compared with control (group 1 at room air, n=8). The time course of development of solute flux was evaluated by the clearance of 99mTc-labeled diethylenetriamine pentaacetate ( 99mTc-DTPA) from the lung, Afterwards, bronchoalveolar lavage (BAL) was performed to measure the concentration of albumin and determine the evidence of cell injury and inflammation in lung. BAL fluids were analyzed to determine several markers of cell injury and inflammation including total and differential cell counts, lactate dehydrogenase (LD), alkaline phosphatase (ALP), extracellular potassium (K+) and globulin (total protein minus albumin). 99mTc-DTPA clearance was significantly increased by exposure for 48 hours of hyperoxia. Albumin concentration ratio (BAL albumin concentration divided by serum albumin concentration) was increased sharply after 48 hr. Significant changes in WBC counts and differential counts were not found until 48 hr of hyperoxia. Elevated LD concentration was observed at 48 hr and thereafter, and ALP, K+, and globulin concentration ratio (BAL globulin /serum globulin) was significantly high only in group 4. Mortality was not observed until 72 hr when 3 of 8 rats were dead. It is concluded that significant 99mTc-DTPA clearance, and cellular and biochemical findings of BAL could not be observed until 48 hr in rats exposed to 100 % oxygen.

Evaluation of Renal Function before and/or after Operation Using 99mTc-DTPA Renal Scan / 대한비뇨기과학회지

Radioactive chelate such as 99mTechnetium-diethylene triaminepentaacetic acid (99mTc-DTPA) is an excellent renal imaging agent which is not metabolized and is excreted exclusively in the urine by glomerular filtration. In addition to defining the gross structure and function of the collecting system, the 99mTc-DTPA dynamic renal scan permits evaluation of early renal perfusion, regional glomerular function and gross renal structure. Twenty cases were studied with 99mTc-DTPA renal scan before and/or after urological surgery in order to evaluate their renal function. Of 20 cases, 5 cases were described precisely. The 99mTc-DTPA dynamic renal scan is a sensitive examination for determining the surgical approach method and predicting renal salvageability. It is also helpful as a follow-up method of postoperative recovery of renal function.