☢️ Scintigrafie Renală Corticală cu DMSA

Updated DMSA Renal Cortical Scan 9/8/2024 ●Indications To assess pyelonephritis and parenchymal scarring. ●Radiopharmaceutical: 3 mCi Tc-99m DMSA administered IV ●Patient Preparation: Have the patient drink 16-20 oz of water 30-60 mins prior to exam to ensure adequate hydration.  Have the patient empty his/her bladder immediately prior to imaging. Instruct the patient to void frequently for a day following the exam. ●Conflicting Examinations/Medications: No Nuclear Medicine exams within the previous 24 hrs. No barium GI exams within the previous 48 hrs. ●Pregnancy/Lactation:  Pregnancy testing is only needed in potentially pregnant patients who state they could be pregnant. See Pregnant, Potentially Pregnant and Lactating Patients policy for specifics. Breast feeding mothers should discard breast milk for 4-24 hrs following Tc-99m DMSA administration. ●Imaging Technique: Collimator - LEHR Photopeak - 140 keV 20% window for Tc-99m Image Preset Counts ◦Flow Images - 2 secs/image for 1 mins (30 images) ◦Static Images - 200k counts/image or 5-10 mins/image ◦SPECT - 32 stops, 20 secs/stop Matrix Size - 128 x 128 (flow), 256 x 256 (static), 64 x 64 (SPECT) Zoom - 1.23 Patient Positioning - supine ●Images/Views (Routine Protocol): Flow Images ◦Begin imaging immediately before radionuclide administration. ◦Obtain posterior images of the abdomen for 60 secs. Static Images ◦Obtain posterior, 30° RPO and 30° LPO images of the abdomen at 2-4 hrs. ◦The worse the patient's renal function, the more delayed imaging will need to be obtained. SPECT Images (Only if Requested) ◦Obtain SPECT images of the abdomen after the 2 hrs static images are obtained. ◦Obtain axial, coronal and sagittal reconstructions and a 3D horizontal spinner. ●Notes:  Morphological agents (DMSA and glucoheptonate) are mainly bound in the proximal tubules (in the renal cortex) for a prolonged time and are suitable for static renal imaging to detect renal masses or parenchymal scars/defects. Because of its high retention in the kidney, the radiation dose of DMSA is significant and the administered dose should be chosen with that in mind.  The kidneys are bilaterally small in numerous chronic renal diseases. The kidneys can be bilaterally enlarged in early diabetic renal disease, acute interstitial nephritis, HIV nephropathy and amyloidosis. Renal cortical defects may be seen in focal pyelonephritis, renal abscess and with post pyelonephritic scarring.