title: Quantitative (99m)Tc DTPA renal transplant scintigraphic parameters: assessment of interobserver agreement and correlation with graft pathologies.
abstract: Various (99m)Tc DTPA scintigraphic quantitative parameters for renal graft function assessment have been recommended, but none is universally accepted. In this study, 439 dynamic renal transplant scintigraphies (DRTS) were retrospectively analysed. In the first set of studies, four observers analysed the 47 random DRTS and interobserver agreement of eleven derived parameters was assessed. In the other set of studies, 181 instances of DRTS, performed on 127 recipients with renal biopsies within five days of each other were selected for correlation with pathology. Hilson's Perfusion index (HI), ΔP, P:Pl, P:U & T10 were selected for this analysis. The pathologies were categorized into renal vascular compromise (RVC; n = 20), acute tubular necrosis (ATN; n = 40), vascular rejection (VR; n = 34), interstitial rejection (IR; n = 33), normal (NOR; n = 36) and unclassified pathologies (n = 18). A majority of the parameters showed good Intraclass correlation (ICC). HI differentiated well between grafts with RVC and the remainder of the study cohort, (p < 0.0001; AUC = 0.84); at a cut-off > 278, it had 84% sensitivity and 78% specificity (Likelihood ratio = 3.8). At < 278, it had 98% 'negative' predictive value for RVC. HI also showed reasonable association with VR (p = 0.02; AUC = 0.62) and IR (p = 0.009; AUC = 0.65). However, significant overlap of HI values between various subgroups was noted. Other parameters had good ICC but were not effective in differentiating graft pathologies. Of the measured parameters, only HI proved to be useful for the pathological assessment, particularly in the identification of vascular compromise. This parameter, however, has lower specificity in differentiating the other pathologies.
authors.affiliation: Department of Nuclear Medicine and PET, John Hunter Hospital Newcastle, New South Wales, Australia.
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Gupta
authors.affiliation: Department of Nuclear Medicine and PET, John Hunter Hospital Newcastle, New South Wales, Australia.
authors.forename: Guy
authors.initials: G
authors.lastname: Lewis
authors.affiliation: Department of Nuclear Medicine and PET, John Hunter Hospital Newcastle, New South Wales, Australia.
authors.forename: Kerry M
authors.initials: KM
authors.lastname: Rogers
authors.affiliation: Department of Medicine, John Hunter Hospital Newcastle, New South Wales, Australia ; Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, University of Newcastle Newcastle, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.affiliation: Department of Nuclear Medicine and PET, John Hunter Hospital Newcastle, New South Wales, Australia.
authors.forename: Kirk
authors.initials: K
authors.lastname: Rostron
authors.affiliation: Department of Nuclear Medicine and PET, John Hunter Hospital Newcastle, New South Wales, Australia.
authors.forename: Leanne
authors.initials: L
authors.lastname: O'Neill
authors.affiliation: Department of Nuclear Medicine and PET, John Hunter Hospital Newcastle, New South Wales, Australia.
authors.forename: Annah
authors.initials: A
authors.lastname: Skillen
authors.affiliation: Department of Nuclear Medicine and PET, John Hunter Hospital Newcastle, New South Wales, Australia.
authors.forename: Suresh
authors.initials: S
authors.lastname: Viswanathan
keywords: Acute tubular necrosis; Hilson’s index; interobserver agreement; quantitative renal transplant DTPA scintigraphy; rejection; renal artery stenosis; renal graft