99mTc-MAG-3 OBSTRUCTIVE UROPATHY
Female, 18 year old with dilation of left excretory system. Upper row, 5 perfusion images during the first min of injection. Second row with 5 images corresponding to the effective plasma renal flow (EPRF) of uptake and excretion, during 30 min. Diuretic was injected at min 15. Third row with perfusion time activity curves and fourth row with time activity curves from EPRF. R= right and L= left.
Right kidney is normal at perfusion, EPRF with complete response to diuretic and fast renogram washout. The left kidney is enlarged, with severe pelvocalyceal dilation, which shows photopenic at start and fills in at the delay images (yellow arrows) with flat curve (yellow arrow), not responding to diuretic and consistent with marked obstruction at the pyeloureteral junction.
According to Vittori et al., adding the administration of the diuretic in seated position at 10 min after tracer injection, improves the accuracy of the renogram.
Reference:
1 Sfakianakis GN et al A renal protocol for all ages and all indications: mercapto-acetyl-triglycine (MAG3) with simultaneous injection of furosemide (MAG3-F0): a 17-year experience.Semin Nucl Med. 2009 May;39(3):156-73.
2
Vittori M, D'Addessi A, Pinto F, Tartaglione G, Bassi P. (99m)Tc-MAG3 diuretic
renography in assessment of obstructive uropathy. The new test F+10SP: a step
ahead in the differential diagnosis. Urologia. 2011 Jul-Sep;78(3):221-6.