초기의 수신증 환자의 요로폐쇄 진단에 있어 Tc-99m MAG3 신장 스캔시 실질통과지연 소견의 유용성 (Delayed Parenchymal Transit During Tc-99m MAG3 Renography is a Valuable Sign in Diagnosing Urinary Obstruction in Patients with Early Hydronephrosis) |
Author |
이원우,문대혁,김재승,류진숙,이희경, |
Won Woo Lee, M.D., Dae Hyuk Moon, M.D., Jae Seung Kim, M.D.,Jin-Sook Ryu, M.D. and Hee Kyung Lee, M.D. |
Affiliation |
울산대학교 의과대학, 서울아산병원 핵의학과 Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea |
Abstract |
Purpose: Diuretic renography (DR) can be false negative in patients with upper urinary tract obstruction
due to low compliance of the renal pelvis. Delayed parenchymal transit (DPT) may be a valuable sign in
case of false negative DR. We compared the diagnostic values of DR and DPT during Tc-99m MAG3
diuretic scan in adults with suspected unilateral obstructive uropathy. Materials and Methods: Fifty-four
patients (male:female=30:24, age: 40.7±15.5 yrs) who underwent Tc-99m MAG3 diuretic scan due to
suspicious unilateral obstructive uropathy were analyzed. DR with a T1/2 of > 15 min was considered as
positive for obstruction. DPT was considered to be present when there was delayed appearance of
radioactivity in the renal pelvis and prolonged retention of radioactivity in the renal parenchyma. The renal
area ratio was defined as the ratio of pixel number of hydronephrotic kidney over that of normal
contralateral at 1∼2 min images. Definition of obstruction was improved hydronephrosis after intervention,
or aggravated hydronephrosis without intervention. Non-obstruction was defined as unchanged
hydronephrosis over 6 months. Results: Twenty-six renal units had obstruction and 28 no obstruction. The
sensitivities of DR and DPT were 69% (18/26) and 50% (13/26) respectively. Two renal units with DPT but
negative DR showed the renal area ratio of <1.1. Among the 20 obstructive renal units with DPT or positive
DR, 13 with DPT had lower renal area ratio than 7 renal units without DPT (0.97±0.20 vs 1.30±0.41,
p<0.05). Differential renal function was not significantly different between these groups. DPT correctly
diagnosed all renal units with non-obstruction (specificity 100%), while the specificity of DR was 89%
(25/28). Conclusion: DPT during Tc-99m MAG3 diuretic scan may be a valuable sign in diagnosing urinary
obstruction especially in patients with false negative DR and early HN. (Korean J Nucl Med
2002;36;306-13) |
Keyword |
Diuretic renography, Parenchymal transit, MAG3, Urinary obstruction |
Full text Article |
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