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Dynamic Renal Transplant Imaging with Tc-99m DTPA (Sn) Supplemented by a Transplant Perfusion Index in the Management of Renal Transplants

Guy's Hospital, London, England

Correspondence: For reprints contact: A. J. W. Hilson, Dept. of Nuclear Medicine, Guy's Hospital, London SE1 9RT, England.

ABSTRACT

We have performed 955 studies on 152 patients with 167 renal transplants. Images were recorded following bolus injection of 12–15 mCi Tc-99m DTPA (Sn). The data were stored on a computer and analyzed by generation of region-of-interest curves from (a) the iliac artery distal to the transplant, (b) the kidney, and (c) a background area. A perfusion index was adopted:

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In 276 studies the patient clearly had acute tubular necrosis (ATN), rejection, or a normal kidney on retrospective analysis. The normal perfusion index has a value below 150, and it increases with falling perfusion, such as is seen in rejection and in renal-artery stenosis. The use of this index in addition to sequential images and changes in the region-of-interest curves usually allows separation of rejection from ATN and, particularly, rejection from normals. When serial studies are performed, the separation of rejecting from nonrejecting transplants is excellent, although renal-artery stenosis may cause similar changes in perfusion.