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Questions and Answers
What is the primary purpose of renal imaging?
What is the primary purpose of renal imaging?
Which of the following statements about renal imaging advantages is true?
Which of the following statements about renal imaging advantages is true?
What condition is static renal imaging particularly useful for evaluating?
What condition is static renal imaging particularly useful for evaluating?
Which radiopharmaceutical is primarily utilized to assess glomerular filtration capabilities?
Which radiopharmaceutical is primarily utilized to assess glomerular filtration capabilities?
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In the context of renal imaging, what does 'effective renal plasma flow (ERPF)' best refer to?
In the context of renal imaging, what does 'effective renal plasma flow (ERPF)' best refer to?
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Which patient factor is critical to disclose before renal imaging procedures?
Which patient factor is critical to disclose before renal imaging procedures?
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Which of the following metabolic waste products is NOT normally removed from circulation by the kidneys?
Which of the following metabolic waste products is NOT normally removed from circulation by the kidneys?
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Which renal function indication is specifically related to the evaluation of blood flow to each kidney?
Which renal function indication is specifically related to the evaluation of blood flow to each kidney?
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What effect does the radiopharmaceutical pentetate have on tracer concentration during renal perfusion imaging?
What effect does the radiopharmaceutical pentetate have on tracer concentration during renal perfusion imaging?
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How can vascular tumors be identified in renal perfusion imaging?
How can vascular tumors be identified in renal perfusion imaging?
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Which radiopharmaceutical is known for accumulating gradually in the tubular cells?
Which radiopharmaceutical is known for accumulating gradually in the tubular cells?
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What is the significance of obtaining a blood pool image immediately after the flow acquisition?
What is the significance of obtaining a blood pool image immediately after the flow acquisition?
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In a renal perfusion imaging study, what is the normal pattern of radiopharmaceutical distribution?
In a renal perfusion imaging study, what is the normal pattern of radiopharmaceutical distribution?
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Study Notes
Genitourinary System: Renal Imaging
- Purpose: Evaluate kidney structure, location, and function.
- Advantages: Safe, easy to perform, and minimal discomfort.
- Kidney Location: Retroperitoneal organs between the 12th thoracic and 4th lumbar vertebrae. Right kidney is slightly lower than the left due to the liver.
- Blood Supply: Renal arteries branch from the descending aorta.
- Blood Drainage: Renal veins drain into the inferior vena cava.
- Nephron Function: Microscopic kidney units filter waste and excess fluid.
- Patient Positioning: Supine, kidneys centered over the detector for posterior projection.
- Radiopharmaceutical Administration: 10-15 mCi IV Bolus
- Image Acquisition: Sequential images every 2 seconds for 30-60 seconds. A blood pool image is obtained immediately after the flow acquisition.
Indications for Renal Imaging
- Functional Imaging: Assess relative blood flow and renal function, obstructive uropathy, renal transplant function, renal function of potential donors, and renovascular hypertension.
- Static Imaging: Evaluate renal trauma, congenital abnormalities, tumors, cysts, and in patients allergic to contrast media.
Contraindications and Precautions
- Transient Contrast-Induced Acute Tubular Necrosis: Patients with a history of this after a renal arteriogram should wait several days before a radionuclide study.
Radiopharmaceuticals:
- Technetium-99m (99mTc)-Pentetate (DTPA): Assesses glomerular filtration and relative kidney blood flow. Cleared primarily by glomerular filtration. Gradual increase in tracer concentration and disappearance.
- 99mTc-Mertiatide (MAG3): Excreted via tubular secretion; high first-pass extraction and fast plasma clearance. Taken up promptly by kidneys and excreted into the collecting system and bladder.
- 99mTc-Succimer (DMSA): Binds to renal cortex tubules, with 50% binding within 2 hours. Useful for imaging lesions, cysts, tumors, and overall renal anatomy. Accumulates gradually in tubular cells with minimal excretion in urine.
Patient Preparation
- Procedure Explanation: Explain the procedure to the patient.
- Medical History: Note any previous abdominal surgeries, especially involving the kidneys.
- Vital Signs: Monitor patient's blood pressure.
- Laboratory Values: Check creatinine, urea, and nitrogen levels, as elevated levels indicate potential poor renal function.
Normal Findings
- Radiopharmaceutical Distribution: The radiopharmaceutical bolus perfuses each kidney in a vascular blush, arriving at approximately the same time and with equal intensity.
- Tracer Concentration and Disappearance: Varies based on the specific radiopharmaceutical used. Pentetate shows a gradual increase due to glomerular filtration; Mertiatide is taken up quickly and excreted into the collecting system/bladder. Succimer accumulates gradually in the tubular cells with minimal excretion in urine.
Abnormal Findings
- Vascular Tumors and arteriovenous malformations (AVMs): Areas of increased activity in the flow sequence.
- Cysts and Avascular Tumors: Areas of decreased activity in the flow sequence.
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Description
This quiz focuses on the evaluation and imaging of the renal system. It covers kidney anatomy, blood supply, function of nephrons, and indications for renal imaging. Additionally, it addresses contraindications and precautions related to renal imaging procedures.
