99mTc-MAG3 SPECT/CT in a case of urolithiasis

Ochoa-Figueroa, M.A.; Davidsson, A.; Sánchez-Rodríguez, V.

doi:10.1016/j.remnie.2018.07.001

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Thyroid (A) and parathyroid (B1 and B2) scintigraphy were performed, same protocol as in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. A study was completed with acquisition of SPECT/CT (C), in which, as in planar images, no parathyroid hyperfunction was evident. Likewise, two cervical ultrasounds were performed (at 13 and 24 months after surgery) that did not show significant lesions. In view of the persistence of the biochemical alteration and the negativity of the conventional morpho-functional studies, it was decided to perform a PET/CT study with 18F-Fluorocholine (32 months after the surgery, <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Villasboas-Rosciolesi, A. García-Burillo, O. González-López, E. Caubet-Busquet, J. Castell-Conesa" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Villasboas-Rosciolesi" ] 1 => array:2 [ "nombre" => "A." 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After an exhaustive gynaecological examination, the lesion was filiated as a nabothian cyst, which can be cause of false positives findings in post-ablation iodine-131 scans." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. García-Gómez, T. Cambil-Molina, J. Jiménez Gallardo, T. Martín-Hernández, J. Castro-Montaño" "autores" => array:5 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "García-Gómez" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Cambil-Molina" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Jiménez Gallardo" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Martín-Hernández" ] 4 => array:2 [ "nombre" => "J." 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Davidsson, V. Sánchez-Rodríguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "Ochoa-Figueroa" "email" => array:1 [ 0 => "migue8a@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Davidsson" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Sánchez-Rodríguez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Clinical Physiology, Institution of Medicine and Health Sciences, Linköping, Sweden" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Diagnostic Radiology, Linköping University Hospital, Linköping, Sweden" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Spect/Tc con 99mTc-MAG3 en un caso de urolitiasis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1635 "Ancho" => 1500 "Tamanyo" => 133183 ] ] "descripcion" => array:1 [ "en" => "(A) First 16min acquisition. Ascending scintigraphic curves bilaterally which are typical of obstruction. Blue curve right kidney, red curve left kidney. (B) Second 16min acquisition, administration of furosemide at minute 0 (F0) is performed. It is observed how the curves descend bilaterally after diuretic stimulation. Blue curve right kidney, red curve left kidney." ] ] ] "textoCompleto" => "Traditionally in diagnostic imaging, the diagnosis of urolithiasis is mainly done by computed tomography (CT) due to its high sensitivity, specificity and wide availability.<a class="elsevierStyleCrossRef" href="#bib0020">1</a> Despite this, CT has a PPV of only 56% for the diagnosis of urinary obstruction while diuretic renogram (DR) has a PPV of 90.6%.<a class="elsevierStyleCrossRefs" href="#bib0025">2,3</a> The rising of multimodality equipment integrated with a diagnostic CT within nuclear medicine such as single photon emission computed tomography (SPECT) – CT have the potential to benefit these patients by being able to diagnose the obstruction and its cause in a single examination. We present the case of a 58-year-old diabetic male who during a routine control of his diabetes describes to the healthcare personnel to have occasional pain in the left flank and dark urine. The staff proceeded to perform a urine test, which revealed hematuria and proteinuria. Subsequently, it is referred to an abdominal CT, which shows the presence of calcium stones in the left kidney. Given these findings, the patient is referred to the Nuclear Medicine Department to evaluate the renal function, where a DR is performed four months after the abdominal CT. The DR is carried out after the i.v. injection of 76 MBq of 99mTc-mercaptoacetyltriglicine (MAG3) observing accumulation of the tracer in the renal parenchyma during the 16min of the test with bilaterally ascending curves (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), reason why a new acquisition was done with administration of 40mg of furosemide at minute 0, observing a good response to the diuretic stimulus with descendant curves (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Given this finding, an abdominal SPECT/CT study (GE Discovery 670 Pro DR16 slice, GE Healthcare, Waukesha WI, USA) was performed to try to explain the origin of the anomalies observed in the images of the right kidney. The SPECT/CT images show the already known lithiasis in the left kidney (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and thanks to the high definition of the CT, a 2mm lithiasis is additionally detected in the right ureter (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), thus explaining the right ascending curve. The left kidney is responsible for 48% of kidney function and the right kidney for 52%. After the findings found in the right kidney, the abdominal CT performed initially was reviewed again without observing any lithiasis as well as any secondary signs of right side obstruction. The lithiasis in the right kidney was managed by placing a double J catheter and by extracorporeal shock wave lithotripsy on the left side. SPECT/CT with integrated diagnostic CT equipment allows both studies to be carried out in a single session, obtaining all the advantages of both examinations at once like in the presented case, where the origin of the ascending curve from the right kidney is clarified and information of the renal function is obtained. Prospective studies with a larger number of patients are necessary to confirm the value of SPECT/CT in patients with renal lithiasis in acute and chronic scenarios.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ochoa-Figueroa MA, Davidsson A, Sánchez-Rodríguez V. SPECT/TC con 99mTc-MAG3 en un caso de urolitiasis. Rev Esp Med Nucl Imagen Mol. 2019;38:116–117." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1635 "Ancho" => 1500 "Tamanyo" => 133183 ] ] "descripcion" => array:1 [ "en" => "(A) First 16min acquisition. Ascending scintigraphic curves bilaterally which are typical of obstruction. Blue curve right kidney, red curve left kidney. (B) Second 16min acquisition, administration of furosemide at minute 0 (F0) is performed. It is observed how the curves descend bilaterally after diuretic stimulation. Blue curve right kidney, red curve left kidney." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 911 "Ancho" => 1200 "Tamanyo" => 76583 ] ] "descripcion" => array:1 [ "en" => "Axial image of SPECT/CT showing a calcium lithiasis in the left renal pelvis (Arrow), which was previously known, as well as greater retention of tracer by the left kidney compared to the right." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 903 "Ancho" => 1200 "Tamanyo" => 101596 ] ] "descripcion" => array:1 [ "en" => "2mm lithiasis in the right ureter (Arrow), which explains the ascending scintigraphic curve of the right kidney." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACR Appropriateness Criteria® acute onset flank pain—suspicion of stone disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Coursey" 1 => "D.D. Casalino" 2 => "E.M. Remer" 3 => "R.S. Arellano" 4 => "J.T. Bishoff" 5 => "M. Dighe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RUQ.0b013e3182625974" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Q" "fecha" => "2012" "volumen" => "28" "paginaInicial" => "227" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22902840" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is there an advantage in performing a combined examination: diuretic renal scintigraphy and low dose computed tomography compared to the separate use of these methods in urolithiasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Hadzhiyska" 1 => "I. Kostadinova" 2 => "A. Demirev" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1967/s0024499100200" "Revista" => array:6 [ "tituloSerie" => "Hell J Nucl Med" "fecha" => "2015" "volumen" => "18" "paginaInicial" => "90" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26187205" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal scintigraphy in the acute care setting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Sfakianaki" 1 => "G.N. Sfakianakis" 2 => "M. Georgiou" 3 => "B. Hsiao" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Semin Nucl Med" "fecha" => "2013" "volumen" => "43" "paginaInicial" => "114" "paginaFinal" => "128" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003800000002/v1_201903020621/S2253808918300533/v1_201903020621/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003800000002/v1_201903020621/S2253808918300533/v1_201903020621/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918300533?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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Vol. 38. Issue 2.

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