Evaluation of Functional Renal Volume with 99mTc-DMSA SPECT in Patients with Diabetes Mellitus / 대한신장학회잡지

About 40% of patients with diabetes mellitus develops to diabetic nephropathy, and these patients show increment of glomerular filtration rate and renal volume at early phase. 99mTc-DMSA SPECT (single photon emission computed tomography) can measure a functional renal volume because 99mTc- DMSA it is taken up by the viable proximal tubular cells located in the renal cortex. To evaluate the renal volume in early diabetic nephropathy, we compared functional renal volume between diabetic patients and control, renal transplantation donor. 99mTc-DMSA was injected intravenously and SPECT was done after 2 hours in 15 diabetic patients, 18 renal transplantation donors, and 2 patients with end stage renal disease due to chronic glomerulonephritis. In diabetic patients with creatinine clearance more than 30ml/min and proteinuria, right and left renal volume were 247+/-22ml/BSA(m2), 256+/-37ml/BSA (m2), which were greater than those of diabetic patients with normal renal function and without proteinuria, or renal transplantation donors(P<0.05). In conclusion, we measured the functional renal volume by 99mTc-DMSA SPECT. Renal volume of diabetic patients with proteinuria were larger than the volume of control group or diabetic patients with normal renal function and without proteinuria. 99mTc-DMSA SPECT was thought to be useful test a for the measurement of functioning renal volume.

The Efficacy of 99mTc-DMSA SPECT in Diagnosis of Renal Scarringn of Vesicoureteral Reflux in Children / 대한비뇨기과학회지

PURPOSE: The diagnosis of renal scarring is very important for the pediatric patient because it has been associated with the later development of hypertension, renal failure, and end-stage kidney disease. Recent studies indicate that the sensitivity and specificity of the99mTc-DMSA single photon emission computerized tomography (SPECT) is better than IVP, USG, and 99mTC-DMSA Planar ThG Purpose Of this Study iS tO Compare 2 types Of 9%nTh DMSA renal scan(planar and SPECT) and IVP/USG in the diagnosis of renal scars. MATERIALS AND METHOD: We reviewed retrospectively the data of 49 children(72 renal units) with vesicoureteral reflux(VUR) who underwent renal cortical imaging with IVP/USG from January 1987 to August 1996. Patient ages ranged from 3 months to 14 years with a mean age 3.7 years. There were 17 boys and 12 girls(44 venal units) with 99mTc-DMSA planar with IVP/USG, and 12 boys and 8 girls(28 renal units) with 99mTc-DMSA SPECT with IVP/USG. RESULTS: The 99mTc-DMSA planar imaging identified 94.7% sensitivities while 99mTC-DMSA SPECT imaging identified 96.3% Sensitivities. And the IVP/USG identified 75.3% sensitivities. CONCLUSIONS: Recently, the 99mTc-DMSA renal scan has replaced IVP/USG in detecting renal scarring. And we show that 99mTc-DMSA SPECT studies are superior to IVP/USG, 99mTc-DMSA planar studies in detecting renal scarring. We believe that the role of 99mTc-DMSA SPECT will become increasingly important in detecting renal scarring of VUR.

Diagnostic Value of 99mTc-DMSA SPECT in Children with Urinary Tract Infection

PURPOSE: The accurate identification of renal cortical defects in children with urinary tract infection is essential in reducing subsequent morbidity. Imaging of the kidneys with 99mTc-dimercaptosuccinic acid (DMSA) has been demonstrated as the sensitive method available for identification of renal cortical defects. Single photon emission computerized tomography (SPECT) has been suggested as a method by which the accuracy of identification of renal cortical defects can be improved. The aim of this study was to assess the diagnostic value of the 99mTc-DMSA SPECT, comparing the detection rate of cortical defects identified from planar imaging and SPECT data. METHODS: 99mTc-DMSA SPECT, planar imaging and voiding cystourethrogram (VCUG) were performed in 76 patients diagnosed urinary tract infection at the department of pediatrics, Kyung Hee University Hospital, from March, 1994 to Feburary, 1995. Follow-up 99mTc-DMSA SPECT was done in 7 patients. RESULTS: 1) Overall detection rate of 99mTc-DMSA SPECT imaging was 32.9% (25/76), but, planar imaging showed cortical defects in 21.1% (16/76). 2) The patients with renal cortical defects in planar imaging showed all definite or more additional cortical defects in 99mTc-DMSA SPECT imaging. 3) Seven patients presented improvement in 4, no change in 2, and aggrevation in 1 on follow-up studies. 4) Incidence of renal cortical defects was higher in patients with vesicoureteral reflux (VUR); the detection rate was 83.3% (10/12). But, those of without VUR also presented high detection rate as 23.4% (19/60). 5) There is no correlation between renal cortical defects and urine culture findings. CONCLUSIONS: 99mTc-DMSA SPECT imaging is superior to planar imaging, thus 99mTc-DMSA SPECT is a useful initial diagnostic tool in children suggesting urinary tract infection, irrespective of VUR, to identify patients who need more extensive radiological studies and early treatment.