title: Usefulness of clearance parametric images in detection of regional renal parenchyma dysfunction.
abstract: BACKGROUND
  The aim of the study was to examine whether parametric clearance images (PAR) enhance diagnostic potential of a dynamic renal scintigraphy with detection of local dysfunction of kidneys, on a model of kidneys after treatment with extracorporeal shock wave lithotripsy (ESWL), MATERIAL AND METHODS: Kidneys after ESWL were accepted as a proper model for the implementation of this objective because of the previously proven damaging effect of a shock wave on renal parenchyma and known region of ESWL application. Forty patients (23 males and 17 females) at the age of 37 to 70 years (mean value 54) with untreated earlier single, one-sided nephrolithiasis, currently treated with ESWL, underwent a study. A dynamic renal 99mTc-EC scintigraphy was performed three times: before ESWL, a week and a month after this therapeutic intervention. PAR images generated with use of an in-house developed software were compared with summation (SUM) of images obtained from radiopharmaceutical uptake phase and quantitative global function parameters (GFP) of each kidney, like split function, MTT - mean transit time and PTT - parenchymal transit time.
  
  
  RESULTS
  PAR and SUM images of all 40 kidneys before ESWL were normal. PAR images revealed local or diffused defects a week and a month after therapeutic intervention in statistically significantly larger numbers of kidneys than SUM images (19 vs. 6, p = 0.002 and 16 vs. 5, p = 0.003, respectively). A week after ESWL, when defects in PAR images were observed in about a half of all renal segments (29/57 - 51%) all GFP values were significantly worse than in kidneys without defects. A month after ESWL defects in PAR images could be observed in ab. 1/3 (17/48 - 35%) of segments and were less extensive, whereas GFP values did not differ significantly from values in kidneys without clearance function impairment in the PAR images.
  
  
  CONCLUSIONS
  PAR images enhance diagnostic potential of a dynamic renal scintigraphy with detection of local function defects. These images allow to detect more local renal function defects than SUM images.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kuśmierek
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Bieńkiewicz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Konecki
authors.forename: Marian
authors.initials: M
authors.lastname: Surma
authors.forename: Marek
authors.initials: M
authors.lastname: Sosnowski
authors.affiliation: Department of Quality Control and Radiological Protection, Medical University of Łódź, Poland. anna@csk.umed.lodz.pl.
authors.forename: Anna
authors.initials: A
authors.lastname: Płachcińska
mesh_terms: D000328:Adult; D000368:Aged; D003545:Cysteine / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000000981:diagnostic imaging / Q000628:therapy; D009683:Nuclear Medicine; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging / Q000379:methods / Q000706:statistics & numerical data; D019275:Radiopharmaceuticals
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C073806:technetium Tc 99m-ethylenedicysteine; D003545:Cysteine
keywords: dynamic renal scintigraphy; extracorporeal shock wave lithotripsy; parametric renal clearance images