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Diffuse 123I-MIBG renal uptake in a patient with severe renal artery stenosis: a consequence of adrenergic activation
Captación renal difusa de 123I-MIBG en un paciente con estenosis severa de la arteria renal: una consecuencia de la activación adrenérgica
Valentina Scolozzia,
, Germano Perottia, Giovanni Gambarob, Giuseppe Celic, Alessandro Giordanod
Corresponding author
a Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
b Nefrology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
c Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
d Nuclear Medicine Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Nuclear Medicine Unit, Fondazione Policlinico Universitario A. 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Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Captación renal difusa de <span class="elsevierStyleSup">123</span>I-MIBG en un paciente con estenosis severa de la arteria renal: una consecuencia de la activación adrenérgica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1750 "Ancho" => 2333 "Tamanyo" => 225829 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">123</span>I-MIBG scintigraphy was performed with planar anterior/posterior acquisitions of abdomen, 4 and 24<span class="elsevierStyleHsp" style=""></span>h after the intravenous injection of 370<span class="elsevierStyleHsp" style=""></span>MBq of radiopharmaceutical. Early images showed abnormal and diffuse <span class="elsevierStyleSup">123</span>I-MIBG uptake in both renal parenchyma (white arrows), compatible with physiological urinary excretion of the tracer. Delayed images showed increased activity in left kidney (black arrow), probably due to an increased sympathetic activity, whereas the right kidney was not visualized. No focal uptake in the left adrenal gland or other abnormalities were identified.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 48-year-old woman was referred to our center for severe hypertension resistant to therapy and ultrasound suspicion of left renal artery stenosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">99m</span>TC-diethylenetriaminepentaacetic acid (DTPA) angioscintigraphy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed a functionally excluded left kidney, consistent with left renal artery stenosis, confirmed by subsequent CT angiogram of abdomen (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). <span class="elsevierStyleSup">123</span>I-metaiodobenzylguanidine (MIBG) scintigraphy was also performed because of a clinical suspicion of pheochromocytoma (globular aspect of left adrenal gland at CT and borderline level of urinary metanephrines). The scan showed diffuse and increased uptake in the whole left kidney parenchyma at 4 and 24<span class="elsevierStyleHsp" style=""></span>h, but no focal uptake in the left adrenal gland (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">123</span>I-MIBG scintigraphy is usually performed for the evaluation of neuroendocrine tumors such us pheochromocytomas and paragangliomas, due to the specific uptake in sympathetic-adrenal cells,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> with an extremely low percentage of false-positive results. Focal renal <span class="elsevierStyleSup">123</span>I-MIBG accumulation has already been reported in acute pyelonephritis (in the renal parenchyma)<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> and in obstruction (in the renal pelvis). Conversely, diffuse renal <span class="elsevierStyleSup">123</span>I-MIBG uptake is uncommon and has been previously attributed to compromised renal blood flow, as in cases of renal artery stenosis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> In our patient, the diffuse activity of the renal parenchyma, in the images acquired at 4<span class="elsevierStyleHsp" style=""></span>h, is attributable to physiological urinary excretion of the tracer, being evident in both kidneys. Nevertheless, the diffuse uptake of the left kidney at 24<span class="elsevierStyleHsp" style=""></span>h may be probably due to increased sympathetic activity, already described in patients with resistant hypertension and renal artery stenosis. Indeed, the activation of the sympathetic nervous system determines exacerbation of hypertension by enhancing renin release, decreasing renal blood flow, and increasing tubular sodium retention. In these cases, renal denervation is sometimes used to resolve hypertension and associated comorbidities.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Scolozzi V, Perotti G, Gambaro G, Celi G, Giordano A. Captación renal difusa de <span class="elsevierStyleSup">123</span>I-MIBG en un paciente con estenosis de la arteria renal grave: una consecuencia de la activación Adrenérgica. Rev Esp Med Nucl Imagen Mol. 2019;38:247–249.</p>" ] ] "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" => 2673 "Ancho" => 2833 "Tamanyo" => 326341 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">99m</span>TC-DTPA renal angioscintigraphy did not show abnormalities in right kidney: morphology and size were normal; perfusion, uptake and excretion of the radiopharmaceutical were regular with a normal renogram curve. The left kidney showed an extremely low <span class="elsevierStyleSup">99m</span>TC-DTPA uptake, with poor visualization during the entire dynamic acquisition and a renogram characterized by typical “plateau”. The relative percentage of radiopharmaceutical uptake was 92% for the right kidney and 8% for the left kidney. These findings were suggestive of functionally excluded left kidney, in agreement with the suspicion of left renal artery stenosis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 616 "Ancho" => 800 "Tamanyo" => 62075 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT-angiogram of abdomen confirmed the presence of a severe stenosis at the beginning of the left renal artery with a non-calcified wall plaque (arrow); the ipsilateral kidney was small with low cortical thickness.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1750 "Ancho" => 2333 "Tamanyo" => 225829 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">123</span>I-MIBG scintigraphy was performed with planar anterior/posterior acquisitions of abdomen, 4 and 24<span class="elsevierStyleHsp" style=""></span>h after the intravenous injection of 370<span class="elsevierStyleHsp" style=""></span>MBq of radiopharmaceutical. Early images showed abnormal and diffuse <span class="elsevierStyleSup">123</span>I-MIBG uptake in both renal parenchyma (white arrows), compatible with physiological urinary excretion of the tracer. Delayed images showed increased activity in left kidney (black arrow), probably due to an increased sympathetic activity, whereas the right kidney was not visualized. No focal uptake in the left adrenal gland or other abnormalities were identified.</p>" ] ] ] "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" => "The evolution in the use of MIBG scintigraphy in pheochromocytomas and paragangliomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Rufini" 1 => "G. Treglia" 2 => "G. 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