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Quantitative SPECT of Technetium-99m-DMSA Uptake in the Kidneys of Normal Children and in Kidneys with Vesicoureteral Reflux: Detection of Unilateral Kidney Disease

Department of Nuclear Medicine, Rebecca Sieff Government Hospital, Safed
Departments of Nuclear Medicine and Urology, Rambam Medical Center, Haifa
Department of Nuclear Medicine, Nahariya Hospital, Nahariya
The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Correspondence: For correspondence or reprints contact: David Groshar, MD, Dept. of Nuclear Medicine, Rebecca Sieff Government Hospital, 13100 Safed, Israel.

ABSTRACT

Quantitative SPECT was used to evaluate renal functional volume (cc), percent of injected dose/cc (%ID/cc) and renal uptake (%) in 11 children with unilateral vesicoureteral reflux grade 3 or greater, and in 19 normal control children without reflux. Methods: Studies were performed 4–6 hr after intravenous injection of 0.750–2 mCi of ^99mTc-DMSA. Results: Control kidneys (n = 38) had a volume of 99.7 ± 29.5 cc. The %ID/cc was 0.27 ± 0.08, and the uptake in one kidney was 24.8% ± 3.9%. Global renal uptake (right plus left) was 49.6% ± 7.3%. Functional volume of the control kidneys showed an increase with age, and the %ID/cc showed a steeper decrease with age, resulting in a trend of the kidney uptake to decrease with age. Kidneys with reflux had a decreased kidney uptake of 15.7% ± 29.5%, compared to age-and sex-matched controls (t = 4.7, p < 0.001). The contralateral kidneys without reflux had a significantly increased total uptake of 33.4% ± 6.8% as compared to controls (t = 3.44, p < 0.01). Global uptake by the kidneys was 49.2% ± 8.6% and was not statistically different from controls (t = 1.0, ns). Conclusion: Our results suggest that SPECT quantitation of ^99mTc-DMSA uptake in each kidney separately could be used as a noninvasive method to assess impairment and compensation of the function of the individual kidney in children with vesicoureteral reflux.

Key Words: vesicoureteral reflux • unilateral kidney disease • technetium-99m-DMSA • SPECT