technetium-tc-99m-gluceptate and Acute-Disease

Comparative clinical studies have shown renal cortical scintigraphy, using technetium-99m (99mTc)-labeled glucoheptonate or dimercaptosuccinic acid (DMSA), to be significantly more sensitive than either intravenous pyelography or renal sonography in the diagnosis of acute pyelonephritis. However, due to uncertainties about the diagnostic accuracy of the clinical and laboratory parameters used in these studies, true sensitivity of renal cortical scintigraphy was unknown. Therefore, we evaluated the accuracy of [99mTc]DMSA scintigraphy in the diagnosis of experimentally induced acute pyelonephritis in piglets using strict histopathologic criteria as the standard of reference. The sensitivity and specificity of the DMSA scan for the diagnosis of acute pyelonephritis were 91% and 99%, respectively, with an overall 97% agreement between the scintigraphic and histopathologic findings. Based on the results of this experimental study, we used the [99mTc]DMSA scan as the standard of reference for the diagnosis of acute pyelonephritis, and conducted a prospective clinical study of 94 children hospitalized with the diagnosis of acute febrile urinary tract infection (UTI). The aims of this study were (1) to determine the relationship among vesicoureteral reflux, P-fimbriated Escherichia coli, acute pyelonephritis, and renal scarring, and (2) to evaluate the diagnostic reliability of the clinical and laboratory parameters commonly used in the diagnosis of acute pyelonephritis. We documented acute pyelonephritis in 62 (66%) of 94 patients. Vesicoureteral reflux was demonstrated in 29 (31%) of the total group and in only 23 (37%) of 62 patients with acute pyelonephritis. The prevalence of P-fimbriae in the E coli isolates was 64% in the patients with acute pyelonephritis and 78% in those with a normal DMSA scan. Even in patients without reflux, P-fimbriae were found in 71% of isolates from the patients with acute pyelonephritis and in 75% of those with a normal renal scan. Follow-up DMSA scans were obtained in 33 patients with acute pyelonephritis in 38 kidneys. We found complete resolution of the acute inflammatory changes in 58% of the involved kidneys and renal scarring in the remaining 42%, including 40% of the kidneys associated with reflux and 43% of those without reflux.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Acute Disease; Animals; Humans; Kidney Cortex; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Succimer; Sugar Acids; Technetium Tc 99m Dimercaptosuccinic Acid; Vesico-Ureteral Reflux

To compare the findings of renal ultrasonography (RUS), 99mTc glucoheptonate renal scan (GHS), and voiding cystourethrography (VCUG) in children with urinary tract infection.. Prospective, masked, clinical study.. Single center, multidisciplinary, inpatients.. Consecutive cases (N = 50) of children aged 2 months to 15 years (8 boys, 42 girls) with pyelonephritis in whom uroradiologic investigation was indicated.. All patients underwent GHS, 48 had RUS, and 2 had intravenous pyelography. All but one of the patients had a VCUG. Fifteen children were found to have vesicoureteral reflux (6 unilaterally, 9 bilaterally). Of 96 kidneys evaluated by both GHS and RUS, 53 were abnormal by GHS versus 28 by RUS (p < 0.001). Findings of both GHS and US were normal in 36 kidneys and abnormal in 21 kidneys. In 32 kidneys only GHS showed abnormalities. In 7 kidneys only RUS showed abnormalities; 5 of them had mild to moderate pelvic dilation caused by reflux, which was confirmed in all 5 by VCUG. The VCUG demonstrated reflux in another four units with normal GHS and RUS findings. All combined, GHS and VCUG detected 62 of 64 abnormal renal units (96.9%). In the other two cases, RUS showed only focal hyperechogenicity of questionable importance.. In the event that one elects to use GHS for the uroradiologic evaluation of children with urinary tract infection, it can be supplemented by VCUG alone, and RUS can be saved for special cases.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Kidney; Kidney Cortex; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Sugar Acids; Ultrasonography; Urethra; Urinary Bladder; Urinary Tract Infections; Urography

This report describes an unusual case of extensive vascular thrombosis involving the abdominal aorta and its branches. An 81-year-old man was admitted for anuric acute renal failure and congestive heart failure. An initial renal scan, performed to assess for the possibility of renal arterial embolus, showed scintigraphic evidence of obstruction of the proximal abdominal aorta, as well as markedly decreased perfusion to both kidneys and to the liver and spleen. The patient's condition progressively deteriorated and he expired. An autopsy showed total thrombotic occlusion of a mildly atherosclerotic nonaneurysmal abdominal aorta extending from the level of the superior mesenteric artery distally to the iliac arteries. There was involvement of the renal arteries and the splenic and superior mesenteric arteries by thrombosis. Thus, renal scintigraphy accurately detected the level of obstruction, which was further confirmed by autopsy.

Topics: Acute Disease; Aged; Aged, 80 and over; Aorta, Abdominal; Aortic Diseases; Humans; Male; Organotechnetium Compounds; Radioisotope Renography; Renal Artery Obstruction; Sugar Acids; Technetium Tc 99m Pentetate; Thrombosis

The purpose of this study was to evaluate the role of quantitative 99Tcm-glucoheptonate (99Tcm-GH) scintigraphy in the assessment of patients with Behçet's disease who suffered from ocular inflammation (uveitis). The study consisted of 13 patients with uveitis and five control subjects. There were a total of 25 eyes with chronic uveitis. Of these 25 eyes, 10 were in a state of remission, and the other 15 were in an acute phase of the illness. The study was performed by administering 370 MBq (10 mCi) 99Tcm-GH intravenously. Planar images were acquired 6 h later. Eye/scalp indices were quantified by drawing regions of interest (ROIs) around each eye and normalizing the mean counts per pixel by the mean counts in the scalp. The mean eye/scalp indices were 1.87 +/- 0.19 in controls and 1.98 +/- 0.19 in the affected eyes that were in remission (P = 0.23, nonsignificant). However, during the acute phase of the illness, the mean eye/scalp index was 2.18 +/- 0.28. The difference between controls and the eyes that were in the acute phase of the illness was significant (one way analysis of variance, P = 0.007). The mean value of the index for affected eyes in remission was not significantly different to that for eyes in the acute phase (P = 0.068, nonsignificant). These preliminary findings suggest that, despite previously published reports in animals with experimentally induced uveitis, 99Tcm-GH scintigraphy may not be a very sensitive method for evaluating human ocular inflammations.

Topics: Acute Disease; Adult; Aged; Behcet Syndrome; Female; Follow-Up Studies; Humans; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Uveitis

Infection is the most common disease of the urinary tract in children, and various imaging techniques have been used to verify its presence and location. On retrospective analysis, 50 consecutive children with documented upper urinary tract infection had abnormal findings on renal cortical scintigraphy with 99mTc-glucoheptonate. The infection involved the renal poles only in 38 and the poles plus other renal cortical areas in eight. Four had abnormalities that spared the poles. Renal sonograms were abnormal in 32 of 50 children. Excretory urograms were abnormal in six of 23 children in whom they were obtained. Vesicoureteral reflux was found in 34 of 40 children in whom voiding cystourethrography was performed. These data show the high sensitivity of renal cortical scintigraphy with 99mTc-glucoheptonate in documenting upper urinary tract infection. The location of the abnormalities detected suggests that renal infections spread via an ascending mode and implies that intrarenal reflux is a major contributing factor.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sugar Acids; Technetium; Tomography, X-Ray Computed; Ultrasonography; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Patients with acute pyelonephritis may present with a spectrum of clinical signs and symptoms. There are few noninvasive diagnostic studies, however, to confirm or exclude this diagnosis. A small number of patients, generally those with severe disease, will demonstrate radiographic changes on excretory urography, but the lack of sensitivity of the IVP in early, acute pyelonephritis is well documented. Several radionuclide techniques have been proposed to assist in the earlier detection of this clinical problem including imaging with Mercury-197 chlormerodrin, Gallium-67 citrate, Technetium-99m glucoheptonate. Technetium-99m DMSA, and, more recently, Indium-111 labeled white blood cells. The success of the renal cortical imaging agents as well as those which localize in infection are described in this report. There appears to be a complimentary role or the cortical imaging agents and the radiopharmaceuticals which localize in bacterial infection. Cortical agents offer the advantage of specific assessment of functioning renal tissue and a convenient, rapid method for following the response to treatment in a noninvasive manner. A pattern is described which may be diagnostic; correlation with Gallium-67 citrate of Indium-111 WBCs may increase the probability of infection as the cause for the cortical abnormality. The measurement of differential renal function using cortical agents provides additional information to assist the clinician in predicting the late effects of infection. Improved sensitivity and specificity, and a reproducible method for following the response to therapy in patients with acute pyelonephritis are the advantages of the techniques described.

Topics: Acute Disease; Adolescent; Adult; Bacterial Infections; Child; Child, Preschool; Female; Gallium Radioisotopes; Humans; Indium; Infant; Infant, Newborn; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Pyelonephritis; Radioisotopes; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed

Nine patients with acute segmental renal infarction were examined by renal scanning and excretory urograms. The diagnosis of segmental infarction by intravenous urography is difficult. Radionuclide imaging is the preferred noninvasive method for demonstrating and sizing the renal infarct.

Topics: Acute Disease; Adult; Aged; Female; Humans; Infant, Newborn; Infarction; Kidney; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Urography