NUCLEAR MEDICINE IN
GENITOURINARY SYSTEM
Main contents

Renal Function Test
Renogram
 Quantitative Function Test
1. Effective renal plasma flow (ERPF)
2. Glomerular filtration rate (GFR)
 Renal Imaging
Anatomy and physiology
Radiopharmaceuticals
Dynamic imaging
Glomerular filtration：99mTc-DTPA
Tubular excretion：131I-OIH, 99mTcMAG3, 99mTc-EC
Static imaging：99mTc-DMSA
Renogram
Principal
Metabolities and useless material first
filtrated by glomeruli or secreted by renal
tubules and then passed outside the body.
Agent
131I-OIH
is an urinary excretory substance,
and can secreted by renal tubules after
injection into the body. The time-activity
curve obtained during the transit, secretion
of 131I-OIH through the kidney and
excretory route called renogram.
Method
1. Patient preparation
Hydration state for more than 6h. Drink 500
ml water 15 min before test for maintenance
a steady state of urine flow.
2. Position
Supine position comfortable for the patient
and easy to inject.
3. Kidneys localization
a. Anatomical
b. X ray
c. Ultrasonic
4. Tracer dose and duration
131I-OIH 5-10uCi injected (i.v.) as a bolus.
The radioactivity over the both kidneys was
recorded as long as 20 min, obtain the timeactivity curve.
Interpretation
Qualitative analyses -- normal curve
1. 1st phase or vascular phase, rapidly rising,
lasting about 30 sec.
2. 2nd phase or uptake/functional phase,
slowly rising, lasting about 3 min.
3. 3rd phase or excretory phase, slowly
descending, lasting about 15 min.
Normal Renogram
Quantitative analyses
Normal values
left (min)
right (min)
peak time (Tmax)
3.24±0.72 3.45±1.13
half excretory time
4.94±1.8
5.06±2.27
Qualitative analyses -- abnormal
curves
1. Parabola type
Slow rising and slow falling.
Mild renal insufficiency.
2. Low level prolonged type
Lowed height of phase 1, while phase 2 and 3
merged each other.
Severe renal injury.
3. Low level descending type
Significant low phase 1 with gradual down
slope, without phase 2 and 3.
Nonfunctional kidney.
4. Constantly rising type
phase 1 normal, continued uprising phase 2,
without phase 3.
Urinary obstruction.
5. High level prolonged type
phase 1 normal, phase 2 rising gradually.
Urinary obstruction with renal insufficiency.
6. Stepwise drop type
phase 1, 2 normal, phase 3 dropped step by
step.
Spasmodic ureter.
Advantage
Simple and cheap.
Disadvantage
The detector position is according to
normal positions of kidney, bladder
and heart. May cause result error if
the organ position is variation.
Mixed uptake of renal parenchyma
and collecting system.
Effective Renal Plasma Flow
(ERPF)
Clearance of the volume (ml) of plasma per
minute during the first pass of the injected
material through the kidney.
Method
131I-OIH renogram with precordial record of
time-activity curve.
Normal value
Total 521.73±153.35 ml/min, decreased with
age.
Clinical usage
1. Diagnosis of renal disease. Decreased in
acute and chronic nephritis, paralleled
with the changes of renogram.
2. Therapeutic monitoring.
3. Monitoring rejection of transplant kidney
Decreased ERPF.
Glomerular Filtrate Rate (GFR)
The volume of plasma (ml) filtrate through
the glomerulus per minute called GFR,
somewhat similar to the creatinine clearance.
Method
99mTc-DTPA injected as a bolus, the time-
activity curve of both kidney obtained and
the GFR calculated.
Normal value
Total 80--100ml/min, decrease with age.
Clinical usage
1. Increased GFR
a. Early stage of diabetes.
2. Decreased GFR
a. Renal insufficiency.
b. Late stage of diabetes.
c. 3nd stage of hypertension.
d. Azotemia and uremia.
Renal Imaging
Morphological study of the kidney to find any
anatomical abnormality and also its function.
It consists of static and dynamic study.
Dynamic renal imaging

Intravenous injection imaging agent.
 Dynamic acquisition of both kidney and
bladder.
 Can display renal perfusion, function and
urine drainage.
Method
•Drink 300ml water 20-30 min before imaging.
•Void bladder before imaging.
•Supine position, put detector behind the patient.
•Intravenously inject 4-8mCi agent.
•First phase：2s per image，total 30 images.
•Second phase: 1 min per image，total 29 images.
Normal image of first phase
Abnormal types of image and interpretation
•Delayed visualization of renal artery, the
kidney image is small and weak.
——pathological changes of the trunk of
renal vascular renal atrophy.
•Focal absence of uptake inside the kidney.
——focal ischemia or other benign lesion.
•Occupation lesion with normal or higher
uptake.
——probable malignant disease.
Normal image of second phase
Abnormal types of image and interpretation
•Kidney is not visualized.
——absence of kidney or the renal perfusion
or function totally absent.
•uptake.
Delayed
appearance and subside of renal
——damaged perfusion or function
•uptake
Persistent uptake in renal parenchyma, but no
in pelvis.
——diffuse renal tubular block.
•Dilation of renal calices, pelvis or ureter.
——urinary obstruction
•Uptake beside the urinary system
——urine leakage
•Delayed visualization of bladder
——upper
urinary
obstruction
significantly decrease of urine flow.
or
Indications
•Investigate the renal function and urine drainage.
•Diagnose of renal vascular disease.
•renal parenchyma disease involvement.
•Diagnose of acute upper urinary obstruction..
•Function of diseased or residual kidney.
•Transplant kidney evaluation
•Diagnose urine leakage.
•Differential diagnose of abdominal tumor.
Calculus Of Bilateral Kidney & Obstruction
Calculus Of Bilateral Kidney & Obstruction
Right Nephrohydrops
Renal Inadequacy
Polycystic Kidney
Polycystic Kidney
Horseshoe Kidney
Pelvic Kidney
Rejection of Transplanted Kidney
Rejection of Transplanted Kidney
Rejection of Transplanted Kidney
None function of Transplanted Kidney