OJMI  Vol.4 No.1 , March 2014
Improved Quantification of Glomerular Filtration Rate and Differential Renal Function of Ectopic Kidneys in a Dual Head Gamma Camera
ABSTRACT
Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is an accepted method to measure Glomerular Filtration Rate (GFR) of the kidneys. The depth and position of ectopic kidneys may vary. This may lead to variation in tissue attenuation and error in the computed GFR and Differential Renal Function (DRF) of each kidney. Objective: The present study was undertaken in patients with ectopic kidneys to improve the accuracy of GFR and DRF calculation in a renogram with single injection of Tc-99m DTPA on a dual head gamma camera. Materials and Method: The study was conducted on 55 patients with ectopic kidneys. Images were acquired on a dual head gamma camera simultaneously in anterior and posterior views. Both anterior and posterior image datasets were used to compute the GFR of the ectopic kidney by Gates method. Depth correction of the ectopic kidney was done using the lateral view image. Total GFR was calculated as the sum of the anterior dataset ectopic kidney GFR and the posterior dataset normal kidney GFR. DRF was calculated again, by using the anterior dataset GFR of the ectopic kidney and posterior dataset for normal kidneys. The total GFR calculated by our method was compared to the patient’s eGFR (based on serum creatinine, age and sex). Result: The GFR calculated by anterior data set in the ectopic kidney was significantly higher than that calculated by posterior dataset (p < 0.001). Similarly, the differential GFR of the ectopic kidney was higher when the anterior dataset was used (p < 0.001). The ectopic kidney GFR of 34 (61.8%) of the 55 patients was greater than 35 ml/min, whereas in 21 patients (38.2%), it was less than 35 ml/min. The total GFR calculated by using both anterior and posterior data set was compared with the eGFR; the correlation coefficient was 0.74 in patients with ectopic kidney GFR of >35 ml/min and 0.83 in those with <35ml/min. Conclusion: The GFR of ectopic kidney as calculated from the anterior data set was significantly higher in comparison to the GFR calculated from the posterior data set (p < 0.001). Using the anterior dataset GFR, the DRF values for the ectopic kidneys was also significantly higher (p < 0.001). This method improves the accuracy of the GFR and DRF values and helps to differentiate a normally functioning ectopic kidney from a poorly functioning one. Compared to the total GFR as calculated by the present method, the eGFR showed a better correlation in patients with ectopic kidney GFR < 35.0 ml/min.

Cite this paper
Sonai Muthu, G. and Mitra, S. (2014) Improved Quantification of Glomerular Filtration Rate and Differential Renal Function of Ectopic Kidneys in a Dual Head Gamma Camera. Open Journal of Medical Imaging, 4, 14-22. doi: 10.4236/ojmi.2014.41003.
References
[1]   Ziessman, H.A., O’Malley, J.P. and Thrall, J.H. (2006) Genitourinary System. “Nuclear Medicine-The Requisites”. 3rd Edition, Elseiver Mosby, Philadelphia, 215-224.

[2]   O’ Reilly, P.H. (1992) Diuresis Renography: Recent Advances and Recommended Protocols, British Journal of Urology, 69, 113-120. http://dx.doi.org/10.1111/j.1464-410X.1992.tb15479.x

[3]   Shulkin, B.L., Mandell, G.A., Cooper, J.A., Leonard, J.C., et al. (2008) Procedure Guideline for Diuretic Renography in Children 3.0. Journal of Nuclear Medicine Technology, 36, 162-168.
http://dx.doi.org/10.2967/jnmt.108.056622

[4]   Blaufox, M.D., Aurell, M. and Bubeck, B. (1996) Report of Radionuclides in Nephrology Committee on Renal Clearance, Journal of Nuclear Medicine, 37, 1883-1890.

[5]   Gates, G.F. (1982) Glomerular Filtration Rate: Estimation from Fractional Accumulation of 99mTc DTPA. American Journal of Roentgenology, 565-570.

[6]   Gruenewald, S.M., Collins, L.T. and Fawdry, R.M. (1985) Kidney Depth Measurement and Its Influence on Quantitation of Function from Gamma Camera Renography. Clinical Nuclear Medicine, 6, 398-401.
http://dx.doi.org/10.1097/00003072-198506000-00002

[7]   Awedh, M., Kouris, K., et al. (1990) Factors Affectring the Gates’ Measurement of Glomerular Filtration Rate. American Journal of Physiologic Imaging, 1, 36-41.

[8]   Graneurus, G. and Moomen, M. (1991) Effects of Extra Renal Background Subtraction and Kidney Depth Correction in the Measurement of GFR by Gamma Camera Renography. Nuclear Medicine Communications, 12, 519-527.
http://dx.doi.org/10.1097/00006231-199106000-00006

[9]   Piepsz, A., Kinthaert, J., Tondeur, M., et al. (1996) The Robustness of the Patlak-Rutland Slope for the Determination of Split Renal Function. Nuclear Medicine Communications, 14, 817-822.
http://dx.doi.org/10.1097/00006231-199609000-00014

[10]   ACR-SPR Practice Guideline for the Performance of Renal Scintigraphy, Resolution 51, Revised 2013: 1-7.
http://www.acr.org/guidelines

[11]   Piepsz, A., Blaufox, M.D., Gordon, I., et al. (1999) Consensus on Renal Cortical Scintigraphy in Children with Urinary Tract Infection. Seminars in Nuclear Medicine, 29, 160-174.
http://dx.doi.org/10.1016/S0001-2998(99)80006-3

[12]   Lythgoe, M.F., Gradwell, M.J., Evans, K. and Gordon, I. (1998) Estimation and Relevance of Depth Correction in Paediatric Renal Studies. European Journal of Nuclear Medicine, 25, 115-119.
http://dx.doi.org/10.1007/s002590050202

[13]   Dostbil, Z., Pembegül, N., Kücükoner, M., et al. (2011) Comparison of Split Renal Function Measured by 99mTc-DTPA, 99mTc-MAG3 and 99mTc-DMSA Renal Scintigraphies in Paediatric Age Groups. Clinical Psychology Review, 20-25.

[14]   Lesley, A.S., Coresh, J., Greene, T. and Andrew, S.L. (2006) Assessing Kidney Function—Measuredand Estimated Glomerular Filtration Rate. The New England Journal of Medicine, 354, 2475-2483.

[15]   Zhao, X., Shao, Y., Wang, Y., et al. (2012) New Normal Values Not Related to Age and Sex, of Glomerular Filtration Rate by 99mTc-DTPA Renal Dynamic Imaging, for the Evaluation of Living Kidney Graft Donors. Hellenic Journal of Nuclear Medicine, 210-214.

[16]   Botev, R., Mallie, J.-P., et al. (2009) Estimating Glomerular Filtration Rate: Cockcroft-Gault and Modifying Diet in Renal Disease Formulas Compared to Inulin Clearance. Clinical Journal of the American Society of Nephrology, 4, 899-906. http://dx.doi.org/10.2215/CJN.05371008

[17]   Russell, C.D., Bischoff, P.G., Kontzen, F., Rowell, K.L., Yester, M.V., Lloyd, L.K., et al. (1985) Measurement of Glomerular Filtration Rate Using 99mTc-DTPA and the Gamma Camera: A Comparison of Methods. European Journal of Nuclear Medicine, 10, 519-521.

[18]   Fawdry, R.M., Grueneward, S.M., Collins, L.T. and Roberts, A.J. (1985) Comparative Assessment of Techniques for Estimation of Glomerular Filtration Rate with Tc-99m-DTPA. European Journal of Nuclear Medicine, 11, 7-12.
http://dx.doi.org/10.1007/BF00440953

[19]   Mulligan, J.S., Blue, P.W. and Hasbargen, J.A. (1990) Methods for Measuring GFR with Technetium-99m-DTPA: An Analysis of Several Common Methods. Journal of Nuclear Medicine, 31, 1211-1219.

[20]   Goates, J.J., Morton, K.A., Whooten, W.W., Greenberg, H.E., Datz, F.L., Handy, J.E., et al. (1990) Comparison of Methods for Calculating Glomerular Filtration Rate: Technetium-99m-DTPA Scintigraphic Analysis, Protein-Free and Whole-Plasma Clearance of Technetium-99m-DTPA and Iodine-125-Iothalamate Clearance. Journal of Nuclear Medicine, 31, 424-429.

[21]   Duran, E., Prigent, A. and Gaillard, J. (1997) Comparison between 9 Methods for Estimation of Glomerular Filtration Rate (GFR) with Simultaneous Injection of 51Cr-EDTA and 99mTc-DTPA. In: Taylor Jr., A., Nally, J. and Thomsen, H., Eds., Radionuclides in Nephrourology, Reston, 112-120.

[22]   Itoh, K., Tsushima, S., Tsukamoto, E. and Tamaki, N. (2000) Reappraisal of Single-Sample and Gamma Camera Methods for Determination of the Glomerular Filtration Rate with 99mTc-DTPA. Annals of Nuclear Medicine, 14, 143-150. http://dx.doi.org/10.1007/BF02987852

[23]   Russell, C.D., Bischoff, P.G., Kontzen, F.N., Rowell, K.L., Yester, M.V., Lloyd, L.K., et al. (1985) Measurement of Glomerular Filtration Rate: Single Injection Plasma Clearance Method without Urine Collection. Journal of Nuclear Medicine, 26, 1243-1247.

[24]   De Santo, N.G., Anastasio, P., Cirillo, M., Santoro, D., Spitali, L., Mansi, L., et al. (1999) Measurement of Glomerular Filtration Rate by the 99mTc-DTPA Renogram Is Less Precise than Measured and Predicted Creatinine Clearance. Nephron, 81, 136-140. http://dx.doi.org/10.1159/000045268

[25]   Virga, G., La Milia, V., Russo, R., Bonfante, L., Cara, M. and Nordio, M. (2010) Comparison between Creatinine-Based Equations for Estimating Total Creatinine Clearance in Peritoneal Dialysis: A Multicentre Study. Nephrology Dialysis Transplantation, 25, 262-269. http://dx.doi.org/10.1093/ndt/gfp391

[26]   Aydin, F., Güngor, F., Cengiz, A.K., Tuncer, M., Mahsereci, E., Ozdem, S., et al. (2008) Comparison of Glomerular Filtration Rate Measurements with the Two Plasma Sample and Single Plasma Sample, Gamma Camera Gates, Creatinine Clearance, and Prediction Equation Methods in Potential Kidney Donors with Normal Renal Function. Nuclear Medicine Communications, 29, 157-165.
http://dx.doi.org/10.1097/MNM.0b013e3282f1bbde

[27]   Prigent, A., Cosgriff, P., et al. (1999) Consensus Report on Quality Control of Quantitative Measurements of Renal Function Obtained from Renogram. International Consensus Committee from the Scientific Committee of Radionuclides in Nephrourology. Seminars in Nuclear Medicine, 29, 146-159.
http://dx.doi.org/10.1016/S0001-2998(99)80005-1

 
 
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