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Unilateral acute renal cortical necrosis: correlative imaging
S Lantsberg1, I Rachinsky, L Lupu
1Department of Nuclear Medicine, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Clinical Nuclear Medicine
|March 4, 2000
Summary
Bilateral acute cortical necrosis, a rare cause of acute renal failure, presents unique imaging challenges. Scintigraphy complements CT, aiding diagnosis by showing tubular function and cortical loss, crucial for rare unilateral cases.
Area of Science:
- Nephrology
- Radiology
- Nuclear Medicine
Background:
- Bilateral acute cortical necrosis (ACN) is a rare cause of acute renal failure.
- Imaging findings for ACN, particularly unilateral cases, are not well-established.
- Enhanced CT is considered pathognomonic for ACN.
Observation:
- This study explored scintigraphic evaluation as a complementary diagnostic tool to CT for unilateral ACN.
- Mercaptoacetylglycine (T3) assessed tubular function, while DTPA evaluated glomerular filtration.
- DMSA scans identified cortical loss (halo sign) and viable cortex via collateral flow.
Findings:
- T3 scintigraphy showed evidence of tubular function and kidney shrinkage.
- DTPA did not visualize the kidney, indicating severe glomerular compromise.
- DMSA revealed a photopenic halo, signifying cortical necrosis, with a viable upper pole cortex.
Implications:
- Radiographic and scintigraphic correlation can effectively diagnose ACN and assess its extent.
- Scintigraphy, especially with T3 and DMSA, offers valuable insights into tubular function and cortical viability.
- Contrast-enhanced CT remains the primary diagnostic modality for acute cortical necrosis.