Effect of administered activity on precision in the assessment of renal function using gamma camera renography

Estimates of glomerular filtration rate from MR renography and tracer kinetic models

PURPOSE

To compare six methods for calculating the single-kidney glomerular filtration rate (GFR) from T(1)-weighted magnetic resonance (MR) renography (MRR) against reference radionuclide measurements.

MATERIALS AND METHODS

In 10 patients, GFR was determined using six published methods: the Baumann-Rudin model (BR), the Patlak-Rutland method (PR), the two-compartment model without bolus dispersion (2C) and with dispersion (2CD), the three-compartment model (3CD), and the distributed parameter model (3C-IRF). Reference single-kidney GFRs were measured by radionuclide renography. The coefficient of variation of GFR (CV) was determined for each method by Monte Carlo analyses for one healthy and one dysfunctional kidney at a noise level (sigma(n)) of 2%, 5%, and 10%.

RESULTS

GFR estimates in patients varied from 6% overestimation (BR) to 50% underestimation (PR and 2CD applied to cortical data). Correlations with reference GFRs ranged from R = 0.74 (2CD, cortical data) to R = 0.85 (BR). In simulations, the lowest CV was produced by 3C-IRF in healthy kidney (1.7sigma(n)) and by PR in diseased kidney ((2.2-2.4)sigma(n)). In both kidneys the highest CV was obtained with 2CD ((5.9-8.2)sigma(n)) and with 3CD in diseased kidney (8.9sigma(n) at sigma(n) = 10%).

CONCLUSION

GFR estimates depend on the renal model and type of data used. Two- and three-compartment models produce comparable GFR correlations.

Activity optimization method in SPECT: A comparison with ROC analysis

A discriminant method for optimizing activity in nuclear medicine studies is validated by comparison with ROC (received operating characteristic)-curves. The method is tested in 21 single photon emission computerized tomography (SPECT), performed with a cardiac phantom. Three different lesions (L(1), L(2) and L(3)) were placed in the myocardium-wall by pairs for each SPECT. Three activities (84, 37 or 18.5 MBq) of 99mTc were used as background. Linear discriminant analysis was used to select the parameters that characterize image quality among the measured variables in the images [(Background-to-Lesion (B/L(i)) and Signal-to-Noise (S(i)/N) ratios)]. Two clusters with different image quality (P=0.021) were obtained. The ratios B/L(1), B/L(2) and B/L(3) are the parameters used to construct the function with 100% of cases correctly classified into the clusters. The value of 37 MBq was the lowest tested activity for which good results for the B/L(i) ratios were obtained. The result coincides with the applied ROC-analysis (r=0.89).

Reference values for 99mTc-MAG3 renography determined in healthy, potential renal donors

BACKGROUND

Reference values for 99mTc-MAG3 renography were determined and the influence of sex and age (< 50/ > or = 50 years) was elucidated.

METHODS

Sixty-eight potential renal donors were evaluated by renography among other tests. Through examination of their records 41 healthy subjects with a normal renal arteriography were included in this study and the reference values of the functional distribution (the split function, SF), the time to peak renal parenchymal activity (Tmax) and the residual activity (RA) were calculated.

RESULTS

For Tmax there was no significant influence of sex or age. Mean RA increased significantly with age (20.5 vs. 23.2%, P = 0.03), but no difference was found between sexes. Mean SF (right kidney) was significantly higher among males.

CONCLUSIONS

When a diuresis of at least 2 ml min-1 is demanded we found the following normal ranges: SF > 41%, Tmax < 4.3 min and RA < 33.7%.

Consensus report on quality control of quantitative measurements of renal function obtained from the renogram: International Consensus Committee from the Scientific Committee of Radionuclides in Nephrourology

Among all the physiological indices that can be quantified using renography, measurement of renal function is the most basic. These measurements are used to make critical clinical management decisions and, as such, their reliability needs to be quality assured. This article seeks to address each aspect of the renography procedure, with particular emphasis on the effect on measurement of relative renal function. Estimation of individual kidney function is mentioned, but only briefly. A consensus approach was adopted, overseen, and directed by a chairman appointed by the Scientific Committee of the International Radionuclides in Nephro-Urology Group. The chairman selected the panel of experts from eight different countries based on their practical experience in the field. Where evidence exists to support the various recommendations it is given. Otherwise, the stated guidance represents the considered opinion of a body of experts, based on long experience and unpublished data. Some necessary compromises were made to account for the fact that renography is seldom performed solely with the purpose of measuring relative renal function. The technicalities of renography have always been a source of debate in nuclear medicine, which is reflected by the fact that a consensus could simply not be reached on a small number of issues. The structure of the report ensures that these are clearly indicated. This should serve to highlight gaps in our current knowledge, thus helping to direct future research. It is envisaged that the recommendations will be revised on a 2-year cycle to ensure that they remain up to date. An "open" process will be used to encourage participation and ownership. It is hoped that promotion of these guidelines, suitably complemented by audit processes, will raise standards in the practice of gamma camera renography.