Clinical Usefulness of 99mTc-DMSA Renal SPECT Using High Sensitivity-All Purpose Collimator for Pediatric Patients

고감도 범용성 콜리메이터를 이용한 소아 환자 99mTc-DMSA 신장 SPECT의 유용성

  • 김진의 (동신대학교 방사선학과) ;
  • 김정수 (동남보건대학교 방사선과) ;
  • 한재복 (동신대학교 방사선학과) ;
  • 최남길 (동신대학교 방사선학과)
  • Received : 2015.08.19
  • Accepted : 2015.10.23
  • Published : 2016.03.28


$^{99m}Tc$-DMSA planar scan that can analyze the functions of kidney quantitatively provides less information on a lesion than tomography scanning. Therefore, this study applied a high sensitivity all-purpose collimator that is sensitive to photonic signals to $^{99m}Tc$-DMSA and carried out a clinical scan with single photon emission computed tomography (SPECT). And diagnostic accuracy and time requirement of were analyzed to know the clinical usefulness of the applied scanning method. 10 subjects were intravenously injected with radiopharmaceutical product (1.0-1.2 MBq/kg) and scanned by a gamma camera with planar scanner (high resolution (HR)-mode, $256{\times}256$, 50 kcts/view, 4 image) and SPECT (HR / high sensitive (HS)-mode, $128{\times}128$, step and shoot, $180^{\circ}$, variable sec/angle, total 64 frame, OSEM reconstruction), respectively. The collected data was compared with an analysis program. The results showed that HS-mode SPECT detected total counts 1.8-5.6 times more than planar scan. Relative renal function evaluated based on the counts was not significantly different by two scanning methods (p=0.96) and it turned out that test time was shortened by 39% when HS-mode SPECT was used. Therefore, SPECT using HR, HS-mode collimator could analyze renal function more quantitatively than using planar scan and the former could diagnose the location information of a lesion more accurately than the latter as well as shortened test time requirement, which demonstrated the clinical usefulness of $^{99m}Tc$-DMSA renal SPECT using high sensitivity all purpose collimator.


$^{99m}Tc$-DMSA;SPECT;All Purpose Collimator;Total Relative Uptake Ratio


  1. J. Kawamura, S. Hosokawa, O. Yoshida, T. Fujita, Y. Ishii, and K. Torizuka, "Validity of $^{99m}Tc$-dimercaptosuccinic acid renal uptake for an assessment of individual kidney function," J Urol. Vol.119, pp.305-309, 1978.
  2. I. Gordon, "Urinary tract infection in paediatrics: the role of diagnostic imaging," Br J Radiol, Vol.63, pp.507-511, 1990.
  3. M. J. Daly and R. E. Henly, "Defining renal anatomy and function with $^{99m}Technetium$ dimercaptosuccinic acid : clinical and renographic correlation," J Urol, Vol.126, pp.5-9, 1980.
  4. H. A. Ziessman, J. P. O' Malley, and J. H. Thrall, "Genitourinary system," In: Ziessman HA, editor, nuclear medicine: the requisites, 4th ed. philadelphia: elsevier mosby, pp.168-203, 2014.
  5. J. C. Craig, D. M. Wheeler, I. Irwig, and R. B. Howman-Giles, "How accurate is dimercaptosuccinic acid scintigraphy for the diagnosis of acute pyelonephritis? A meta-analysis of experimental studies," J Nucl Med, Vol.41, pp.986-993, 2000.
  6. G. Montini, K. Tullus, and I. Hewitt, "Febrile urinary tract infections in children," N Engl J Med, Vol.365, pp.239-250, 2011.
  7. A. Piepsz, "Cortical scintigraphy and urinary tract infection in children," Nephrol Dial Transplant, Vol.17, pp.560-562, 2002.
  8. P. A. Merguerian, M. A. Jamal, S. K. Agarwal, G. A. McLorie, D. J. Bagli, B. Shuckett, D. L. Gilday, and A. E. Khoury, "Utility of SPECT DMSA renal scanning in the evaluation of children with primary vesicoureteral reflux," Urology, Vol.53, No.5, pp.1024-1028, 1999.
  9. K. E. Applegate, L. P. Connolly, R. T. Davis, D. Zurakowski, and S. T. Treves, "A prospective comparison of high-resolution planar, pinhole, and triple-detector SPECT for the detection of renal cortical defects," Clin Nucl Med, Vol.22, pp.673-678, 1997.
  10. H. R. Saleh Farghaly and M. H. Mohamed Sayed, "Technetium-99m dimercaptosuccinic acid scan in evaluation of renal cortical scarring: Is it mandatory to do single photon emission computerized tomography?," Indian J Nucl Med, Vol.30, No.1, pp.26-30, 2015.
  11. B. Mouratidis, J. M. Ash, and D. L. Gilday, "Comparison of planar and SPECT $^{99m}Tc-DMSA$ scintigraphy for the detection of renal cortical defects in children," Nucl Med Commun, Vol.14, pp.82-86, 1993.
  12. M. Brenner, D. Bonta, H. Eslamy, and H. A. Ziessman, "Comparison of $^{99m}Tc-DMSA$ dual-head SPECT versus high-resolution parallel-hole planar imaging for the detection of renal cortical defects," AJR Am J Roentgenol, Vol.193, No.2, pp.333-337, 2009.
  13. Y. C. Wu, P. S. Wu, N. T. Chiu, B. F. Lee, W. J. Yao, and Y. Y. Chiou, "Comparison of $^{99m}Tc-DMSA$ renal SPECT and ultrasonography for diagnosis of acute pyelonephritis in children," Ann Nucl Med Sci., Vol.16, No.3, pp.111-116, 2003.
  14. A. M. Gordon, A. Hossein, M. C. Bernard, M. A. Judith, and L. G. David, "$^{99m}Technetium$-dimercapto-succinic acid renal scanning and excretory urography in diagnosis of renal scars in children," J Urol., Vol.142, pp.790-792, 1989.
  15. Amy Piepsz, Paula Colarinha, Isky Gordon, Klaus Hahn, Pierre Olivier, Isabel Roca, Rune Sixt, and Jeannette van Velzen, "Guideline on $^{99m}Tc-DMSA$ scintigraphy in children," Eur J Nucl Med., Vol.28, No.3, pp.37-41, 2001.
  16. Guzzi, GianPaolo and Caterina A. M. La Porta, "Molecular mechanisms triggered by mercury," Toxicology, Vol.244, No.1, pp.1-12, 2008.
  17. E. D. Williams, "Renal single photon emission computed tomography : should we do it?," Semin Nucl Med., Vol.22, pp.112-121, 1992.
  18. A. F. Yapar, M. Aydin, M. Reyhan, Z. Yapar, and A. Sukan, "The conditions for which the geometric mean method revealed a more accurate calculation of relative renal function in $^{99m}Tc-DMSA$ scintigraphy," Nucl Med Commun, Vol.26, No.2, pp.141-146, 2005.
  19. M. Lyra and A. Ploussi, "Filtering in SPECT image reconstruction," Int J Biomed Imaging, pp.693-795, 2011.
  20. D. Groshar, B. Moskovitz, E. Issaq, and O. Nativ, "Quantitative SPECT of DMSA uptake by the kidneys: Assessment of reproducibility," Kidney Int., Vol.52, pp.817-820, 1997.
  21. T. C. Yen, W. P. Chen, S. L. Chang, R. S. Liu, S. H. Yeh, and C. Y. Lin, "Technetium-99m-DMSA renal SPECT in diagnosing and monitoring pediatric acute pyelonephritis," J Nucl Med., Vol.37, No.8, pp.1349-1353, 1996.
  22. M. A. Tarkington, R. D. Fildes, K. Levin, H. Ziessman, B. Harkness, and M. D. Gibbons, "High resolution single photon emission computerized tomography (SPECT) $^{99m}technetium$-dimercapto- succinic acid renal imaging: a state of the art technique," J Urol. Vol.144, pp.598-600, 1990.
  23. M. D. Blaufox, "Procedures of choice in renal nuclear medicine," J Nucl Med., Vol.32, pp.1301-1309, 1991.
  24. M. Majd, H. G. Rushton, R. Chandra, M. P. Andrich, C. P. Tardif, and F. Rashti, "Technetium 99m-DMSA renal cortical scintigraphy for the detection of experimental acute pyelonephritis in piglets: comparison of planar (pinhole) and SPECT imaging," J Nucl Med., Vol.37, pp.1731-1734, 1996.
  25. 최재원, 차성원, 조병수, 김덕윤, "소아 요로감염증에서 99mTc-DMSA SPECT의 진단적 유용성," 소아과, Vol.40, No.11, pp.1559-1566, 1997.
  26. D. Groshar, A. Frankel, O. M. Embon, and D. Front, "Renal function and technetium-99m-dimercapto-succinic acid uptake in single kidney," J Nucl Med., Vol.32, pp.766-768, 1991.
  27. D. Groshar, A. Frankel, G. Iosilevsky, O. Israel, B. Moskovitz, D. R. Levin, and D. Front, "Quantitation of renal uptake of technetium-99m DMSA using SPECT," J Nucl Med., Vol.30, pp.246-250, 1989.
  28. Massoud Majd, Anna R. Nussbaum Blask, Bruce M. Markle, Eglal Shalaby-Rana, Hans G. Pohl, J. S. Park, Roma Chandra, Khodayar Rais-Bahrami, Nayan Pandya, Kantilal M. Patel, and H. Gil Rushton, "Acute pyelonephritis: comparison of diagnosis with $^{99m}Tc-DMSA$ SPECT, spiral CT, MR imaging, and power doppler US in an experimental pig model," Radiology, Vol.218, No.1, pp.101-108, 2001.
  29. T. C. Yen, W. P. Chen, S. L. Chang, Y. C. Huang, C. P. Hsieh, S. H. Yeh, and C. Y. Lin, "A comparative study of evaluating renal scars by $^{99m}Tc-DMSA$ planar and SPECT renal scans, intravenous urography, and ultrasonography," Ann Nucl Med., Vol.8, pp.47-152, 1994.
  30. M. A. Tarkington, R. D. Fildes, and K. Levin, "High resolution single photon emission computerized tomography (SPECT) $^{99m}Technetium$-dimercapto-succinic acid renal imaging : a state of art technique," J Urol., Vol.144, pp.598-600, 1990.
  31. J. R. Buscombe, J. W. Andrew, L. H. Margaret, E. T. Caroline, G. Gill, and J. E. Peter, "Dose three- dimensional display of SPECT data improve the accuracy of techneteum-99m DMSA imaging of the kidneys?," J Nucl Med Technol., Vol.23, pp.122-127, 1995.
  32. J. G. Giblin, K. P. O' connor, R. D. Fildes, B. Harkness, K. Levin, J. T. Newsome, I. Sesterhenn, and M. D. Gibbons, "The diagnosis of acute pyelonephritis in the piglet using single photon emission computerized tomography dimercaptosuccinic acid scintigraphy : a pathological correlation," J Urol., Vol.150, pp.59-762, 1993.