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Quantitation of Renal Parenchymal Retention of Technetium-99m-MAG3 in Renal Transplants

Department of Nuclear Medicine, First Hospital, Sun Yet-Sen University of Medical Sciences, Guangzehou, Guangdong, China
Division of Nuclear Medicine, University of Alabama Hospital, University of Alabama at Birmingham Medical Center and Nuclear Medicine Service, Veterans Affairs Medical Center-Birmingham
Department of Pathology, University of Alabama Hospital, Birmingham, Alabama

Correspondence: For correspondence or reprints contact: Charles D. Russell, MD, PhD, Division of Nuclear Medicine, University of Alabama Hospital, 619-19th Street South, Birmingham, AL 35233-6835.

ABSTRACT

When imaging renal transplants with tubular agents, such as mercaptoacetyltriglycine, marked parenchymal retention is a hallmark of acute rejection (AR) or acute tubular necrosis (ATN). (AR can be distinguished from ATN by the time course on serial studies.) The quantitative relationship of retention to uptake can be measured by dividing the background-corrected renal activity at 20 min by that at 3 min. Methods: The diagnostic value of this ratio (R_20/3) was tested in a series of 555 renograms. Because patients with mild disease have minimal abnormalities, the patients were ranked by their estimated severity of disease (1–4 for abnormal and 0 for normal). Results: R_20/3 was found to correlate strongly with severity of ATN (Spearman's = 0.879, p < 0.001, n = 168) and also with severity of AR ( = 0.888, p < 0.001, n = 267). There were two (3%) false-positive results in 64 normal patients. Conclusion: If 0.8 is taken as the upper limit of normal for R_20/3, then among patients with disease severity 3 or 4, there were no false-negative findings in 104 patients with ATN or in 203 patients with AR. R_20/3, despite its simplicity, is an effective diagnostic parameter.

Key Words: renal parenchymal retention • renal transplant • mercaptoacetyltriglycine

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