Tc-99m DMSA SPECT for Follow-Up of Non-Operative Treatments in Renal Injuries: A Prospective Single-Center Study

Area of Science:

• Nuclear Medicine
• Radiology
• Nephrology

Background:

• Assessing renal cortical integrity after injury is crucial for predicting outcomes.
• Planar dimercaptosuccinic acid (DMSA) scintigraphy relies on split renal function (SRF) estimation.
• Limitations exist in planar DMSA for precise cortical integrity assessment.

Purpose of the Study:

• To evaluate the added value of volumetric and quantitative analyses using DMSA SPECT.
• To compare SPECT-derived cortical integrity with planar scintigraphy.
• To correlate SPECT parameters with renal function and renal failure risk.

Main Methods:

• Prospective study of 47 patients with non-operatively managed renal injuries.
• DMSA planar and SPECT imaging performed 3-6 months post-injury.
• Measurements included planar SRF, SPECT SRF, cortical volume, and absolute cortical uptake.

Main Results:

• SPECT SRF was significantly lower than planar SRF, especially in severe injuries.
• Discrepancies observed between SRF and volumetric/quantitative DMSA indices.
• Absolute cortical uptake correlated best with glomerular filtration rate (GFR).
• SRF did not reliably indicate GFR decrease or renal failure risk.

Conclusions:

• Quantitative DMSA SPECT offers more clinically relevant information than planar imaging.
• Volumetric and quantitative SPECT parameters provide a comprehensive assessment of renal cortical integrity.
• SPECT enhances the evaluation of renal injury sequelae.