• Journal of the Korean Society of Radiology
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• v.9 no.4
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• pp.235-238
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• 2015

The aims of this study were to evaluate the difference of renal uptake rate in $^{99m}Tc-DMSA$ scan on pediatrics by including the bladder. Phantom and Clinical studies were performed. In the phantom study, we put $^{99m}TcO_4{^-}$ (300uCi, 11 MBq) in 3cups filled with distilled water at the rate 1:1:0, 1:1:0.5, 1:1:1, 1:1:2 and were placed Lt kidney, Rt kidney and bladder position on the table. To acquire the image, we used Symbia-E gamma camera from Siemens with preset count method(400,000 counts). In quantitative analysis, the counts of drawing ROIs on the phantom were analyzed. In clinical studies, we analyzed the 20 pediatrics who were examined by $^{99m}Tc-DMSA$ scan. At first, the images were acquired with both kidney and bladder. Secondly we acquired images after shielding the bladder. And the data were compared using a pared t-test by SPSS(ver.22.0). As a result of renal phantom's experiment, we compared with average of uptake rate(%), 1:1:0 was Lt 43.32%, Rt 45.97%, 1:1:0.5 was Lt 35.79%, Rt 36.89%, 1:1:1 was Lt 29.68%, Rt 31.45% and 1:1:2 was Lt 22.89%, Rt 24.32%. There was no correlation between the zoom and uptake rate. The results of patient were that excluded bladder was $29.83{\pm}8.81%$(Lt), $24.29{\pm}6.66%$(Rt) and included bladder was $26.65{\pm}8.03%$(Lt, $21.78{\pm}6.24%$(Rt). This is deemed statistically significant (p<0.05). Renal uptake rate was undervalued because the counts of bladder were included in the total counts.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.1
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• pp.43-47
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• 2013

Purpose: A duplicated ureter is congenital renal malformations with ureter in two. Patients with duplicated ureter are in force to $^{99m}Tc-DMSA$ scan at surgery before and after. In existing examination, at produce result after $^{99m}Tc-DMSA$ scan, didn't compare to upper pole and lower pole with malformed kidney and compared to only relative uptake ratio. Therefore, this study will examine about utility of set a partial region of interest and to functional recovery of renal cell through change of upper pole uptake ratio of malformed kidney by setting each partial region of interest in upper pole and lower pole of malformed kidney in $^{99m}Tc-DMSA$ examination in surgery before and after. Materials and Methods: Pediatric patients with malformed kidney of incomplete duplicated ureter, 15 patients were enrolled in this study. Scanning were scan 3 to 4 hours after injection of $^{99m}Tc-DMSA$ 1.5 ~ 1.9 MBq/kg. Region of interest were each set in normal kidney, upper pole and lower pole with malformed kidney. Region of interest were set with same condition and method to images of surgery before and after that radio technologist 1 person, resident of nuclear medicine 1 person and doctor of urology together. Therefore, this study were compared to uptake ratio (A: B: C) that normal kidney (A), lower pole of malformed kidney (B) and upper pole of malformed kidney (C) about uptake ratio changes of malformed kidney in follow-up examination of surgery before and after. Results: When compared to 15 patients, uptake ratios were increased 7 persons and decreased 8 persons. Among increased 7 persons, it were periods of follow-up examination that 2 persons were 14 months, 4 persons were 12 months and 1 person was 8 months after surgery. Among decreased 8 persons, it were periods of follow-up examination that 4 persons were 12 months 3 persons were 6 months and 1 persons were 4 months after surgery. Conclusion: Existing study could not see the exact uptake ratio changes of malformed kidney because using only the overall Left-Right kidney uptake ratios. But a setting partial region of interest was able to see exactly what changes in the uptake of each upper pole and lower pole of malformed kidney. Because recovery of renal parenchymal cells is difficult in an evaluation of short period of time, follow-up examination should be made in long period of time. How to set up partial region of interest be thought that it would be useful.

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.327-332
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• 1992

$^{99m}Tc-dimercaptosuccinic$ acid (DMSA) 주사후 일정시간에 측정한 절대적 신섭취량은 기능이 살아있는 신피질량과 관계있다. 소아의 신기능은 출생후 계속 성숙되어 생후 약 $1\sim2$년에 성인의 기능에 도달하는데 DMSA섭취도 성인과는 다른 양상을 보일 것으로 기대되며 신질환에서 절대적 신섭취율의 평가는 연령을 고려해야 할 것이다. 저자들은 DMSA 스캔을 시행한 소아 환자를 대상으로 스캔상 피질 결손이 없으며 양측신의 섭취율이 비슷하고 혈중 크레아티닌치가 정상인 경우를 대조군으로 하여 연령별 DMSA의 절대적 신섭취율을 구하였고 방광요관역류를 가진 환아를 대상으로 DMSA스캔을 시행하고 신섭취율을 조사하였다. 1) 대조군은 모두 65명으로 좌우측 신섭취율의 유의한 차이는 없었으며 연령에 따라 2세경에 플라토에 도달하였는데 한쪽 신장의 평균섭취율은 3개월 미만이 $14.5{\pm}3.1%$ ID, 3개월에서 6개월 미만이 $17.2{\pm}2.1%$ID, 6개월에서 1년 미만이 $18.4{\pm}1.3%$ID, 1년에서 1년6개월 미만이 $19.3{\pm}1.1%$ID, 1년 6개월에서 2년 미만이 $21.9{\pm}2.0%$ID, 2세이상 15세이하가 $20.1{\pm}0.6%$ID였으며 전체 평균섭취율은 $19.4{\pm}0.5%$ID (injected dose, $mean{\pm}S.E.$)였다. 2) 방광요관역류를 가진 환아는 55명 (일측성 56명, 양측성 29명)으로 109신장을 대상으로 하였다. 방광요관역류의 정도와 피질결손의 수와는 대체로 비례관계가 있었으나 방광요관역류가 없으면서 피질결손이 있는 경우가 25신장중 2예 (8%)였으며, 방광요관역류가 있는 84신장중 27예 (32.1%), 이중에서 방광요관역류가 3도 이상인 62신장중 13예 (21%)에서는 피질결손이 없었다. 3) 이환신의 DMSA 섭취율을 연령에 따른 대조군의 섭취율에 대한 비(섭취율비)로 나타내면 한쪽에 역류가 있을 때 이환신의 경우 $0.55{\pm}0.06$, 정상신의 경우 $1.34{\pm}0.05$이었으며, 양쪽에 역류가 있을 때는 평균 $0.82{\pm}0.08$ $(mean{\pm}S.E.)$ 이었다. 4) 피질결손이 있는 신장의 절대 DMSA 신섭취율은 감소되어 있었고 상대측 신장의 섭취율은 피질 결손이 있더라도 대상적인 증가의 경향을 보였다. 이상의 결과로 소아에서 DMSA 절대적 신섭취율의 연령에 따른 변화를 알 수 있었으며 방광요관역류의 정도와 피질결손의 정도가 반드시 비례하지만은 않아서 시간경과에 따른 추후 검사가 필요하리라 생각된다. 또한 방광요관역류가 있는 환아에서 DMSA 섭취율로 신기능을 평가할 때, 특히 영유아에서 연령에 따른 고려가 있어야 할 것으로 보인다.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.27-33
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• 2012

Purpose: Most of diagnosis in the pediatric hydronephrosis patients have been performed $^{99m}Tc$-DMSA renal scan. Then the region of interest (ROI) is set for comparative analysis of uptake ratio in left-right kidney after acquiring the image. But if the equipment set an automatic ROI, the ROI could include expanded renal pelvis due to hydronephrosis and the uptake ratio of left-right kidney will be incorrect result. Therefore this study compared both ROIs including expanded renal pelvis and excluding renal pelvis through experiment using normal kidney phantom and expanded renal pelvis phantom and suggested setting method of improved ROI. In addition, this study have been helped by readout doctor for investigate distinction radiopharmaceutical uptake between renal cortex and remained urine by expanded renal pelvis. Materials and Methods: The both of renal phantoms were filled with water and shacked with $^{99m}TcO_4$ 111 MBq. In order to describe the expanded renal pelvis, the five latex balloon were all filled with 10 mL water and each of balloon was mixed with $^{99m}TcO_4$ 18.5, 37, 55.5, 74, 92.5 MBq. And we made phantom with fixed $^{99m}TcO_4$activity of 37 MBq and mixed water 5, 10, 15, 20, 25 mL in each balloon. The left kidney was fixed its shape and the right kidney was modified like as hydronephrosis kidney by attached the latex balloons. And the acquiring counts were 2 million. After acquisition, we compared the image of ROI with Expanded renal pelvis and the image of ROI without renal pelvis for analyzing difference in the uptake ratio of left-right kidney and for reproducibility, set the ROI 5 times in the same images. Patients were injected $^{99m}Tc$-DMSA 1.5~1.9 MBq/kg and scanned 3 to 4 hours after injection. The each of 3 skillful radio technologists performed the comparing estimation by setting ROI. To determine statistical significance between two data, SPSS (ver. 17) Wilcoxon Signed Ranks Test was used. Results: As a result of renal phantom's experiment, we compared with average of counts Background (BKG) ratios in the setting of ROI including expanded renal pelvis and setting of excluding expanded renal pelvis. Therefore, they can obtain changed counts and changed ratios. Patient also can obtain same results. In addition, the radiopharmaceutical uptake in expanded renal pelvis was come out the remained urine that couldn't descend to ureter by the help of readout doctor. Conclusion: As above results, the case of setting ROI including expanded renal pelvis was more abnormally increasing uptake ratio than the case of setting ROI excluding expanded renal pelvis in analysis the uptake ratio in left-right kidney of hydronephrosis. Because of the work convenience and prompted analysis, the automatic ROI is generally used. But in case of the hydronephrosis study, we should set the manual ROI without expanded renal pelvis for an accurate observation of the uptake ratio of left-right kidney since the radiopharmaceutical uptake in expanded renal pelvis is the remained urine.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.2
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• pp.25-30
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• 2013

Purpose: To evaluate kidney function, renal relative uptake is very important and is affected by kidney and the setting of background region of interest (ROI). In particular, in the case of patients with hydronephrosis to the naked eyes, such as size, position and shape etc. can be difficult to identify. So according to ROI to be set by user, the results are many differences. This study assumes the ROI of a constant kidney. According to the change of background ROI by analyzing renal relative uptake affect how the results are intended to study. Materials and Methods: From January 2012 to February 2013, we analyzed 27 patients with hydronephrosis who were examined MAG3 test in nuclear medicine department of Samsung medical center. After patients were received intravenous injection of $^{99m}Tc-MAG3$ 185 MBq (5 mCi) data were obtained. While we reconstructed images of patients, we've changed background ROI in the process of setting up ROI. First, in the process of renal processing, automatic ROI which set automatically and background ROI which needed to set manually were compared. Second, we set the ROI position separated by above, lateral and bottom of kidney. Third, background setting time were compared with 1-2 min and 2-3 min. Results: The relative uptake occurred in 3.7%p of the errors on average in Automatic & Manual ROI study. And comparison of background ROI position study, located in the lower position was more accurate results. Above, lateral, bottom each of the values 74.6%, 67.6% and 62.0% showed respectively. The standard value was 59.9%. finally, split function range test doesn't show significant difference. Conclusion: The study shows that relative uptake of kidney is affected in the background ROI. Therefore, it should be set by considering various dependent factors.

• Journal of radiological science and technology
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• v.36 no.4
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• pp.299-304
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• 2013

Whole body bone scan has been used to confirm bone metastasis and follow-up study with radio isotope. However, if the factors related to $^{99m}Tc$ uptake and waiting time for study are inappropriate, it would be image of low quality. The purpose of present study was to investigate correlation between the evaluation index of renal function and uptake of radiopharmaceuticals. The population for this retrospective study consisted of 387 patients who underwent whole body bone scan between June 2012 and December 2012. As a result of quantitative and qualitative analysis, we were able to confirm that GFR of less than normal range and creatinine levels in blood of more than average are more likely to be under the mean uptake rate. As a result of analysis on the indicator affecting soft-tissue and bone uptake, the correlation of all elements was somewhat low. Also there are no statistically significances due to the other parameters we did not deal with. Therefore, further research on additional factors is needed for exact study and improvement of the image quality.

• The Korean Journal of Nuclear Medicine Technology
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• v.19 no.1
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• pp.37-43
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• 2015

Purpose $^{99m}Tc-DMSA$ renal scintigraphy serves as location, size and shape of kidney, so it has been used for diagnosis and passage observation after the operation or treatment. There are 3 methods of calculating the relative renal uptake ratio such as geometric mean of the counts from the anterior and posterior views, arithmetical mean from the only posterior view and posterior view which applied the renal depths. In this study, we seek to correlation between the change of total relative uptake ratio according to different inspection methods of obtaining the renal count rate. Materials and Methods The phantom experiments proceeded 5 times depending on each renal depth with the kidney phantom and tissue equivalent materials. In the clinical research, we investigated 36 adult patients who had visited our hospital from february to october, 2014 and received $^{99m}Tc-DMSA$ renal scan. The equipment was used as a gamma camera named INFINIA (General Electric Healthcare, milwaukee, USA) and we drew the region of interests through semiautomatic method by using Xeleris Ver. 2.1220 of GE. In addition, we obtained the lateral view of kidney to measure the renal depth of each patient. Then the results were compared with 3 methods of calculating relative renal uptake ratio. Results The phantom studies show when the difference between the left ant right kidney depth were less than 1 cm, there were no statistically significant difference among values calculated through anterior and posterior views and only posterior view (P>0.05), while the excess of 1cm, the results showed a statistically significant change in the value (P<0.05). In case of clinical research, the correlation between total relative uptake ratio by obtaining both sides of image and posterior view applied the kidney depth (r=0.999) was higher than by obtaining only posterior view and applying the kidney depth to one side image (r=0.988). Conclusion This study has found that, the difference of calculating total relative uptake ratio compared with obtaining anterior and posterior views and only posterior view. In order to reduce the error, we recommend the method of obtaining anterior and posterior views and is considered to be useful, particularly the patients have similar uptake ratio of left and right kidney and difficulties of measurements of kidney depth.

• Proceedings of the KSCN Conference
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• 2004.05a
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• pp.408.1-408
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• 2004

본 연구는 한국(서울)에 살고 있는 331명의 어린이와 미국(뉴저지)으로 이주한 262명의 한국어린이, 총 593명을 대상으로 어린이 비만 발생에 있어서 환경요인의 영향을 살펴보고자 하였다. 연구대상 아동의 신장, 체중, 허리둘레 및 엉덩이둘레 및 부모의 신장과 체중을 측정하였다. 또한, 설문지를 이용하여, 아동의 식생활태도와 식습관, 식품섭취 빈도를 조사하였다. 비만 발생율을 살펴보면 남아의 경우, 미국 거주 아동이 12.6%로 한국 거주 아동의 8.0% 보다 유의하게 높았고, 여아의 경우도 미국 거주 아동의 비만 발생율이 8.2%로 한국 거주 아동의 5.1%보다 유의하게 높았다.(중략)

• The Korean Journal of Nuclear Medicine
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• v.37 no.4
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• pp.245-253
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• 2003

Puorpose: The purpose of this study was to evaluate the usefulness of $^{99m}Tc$ DMSA scintigraphy on the dignosis of a renal scar in children with urinary tract infections. Materials and Methods: Eighty three patients were included in this study, who were diagnosed as the urinary tract infection on the basis of symptom, urinalysis and urine culture. $^{99m}Tc$ DMSA scintigraphy and voiding cystoureterography were peformed within 7days before the treatment in all patients. We classified the scintigraphic findings as follow s : 1 ; a large hypoactive upper or lower pole. 2 ; a small hypoactive area. 3 ; single defect resulting in localized deformity of the outlines. 4 ; deformed outlines in a small or normal sized kidney. 5 ; multiple defects. 6 ; diffuse hypoactive kidney without regional impairment. Follow-up scintigraphy was done at least 6 months after the initial study. When the abnormality on the initial scintigraphy was not completely resolved on the follow-up scan, the lesion was defined as containing a scar. Results: One hundred and fifteen renal units of 166 units(69.3%) showed abnormal findings on the DMSA scintigraphy. 65 units(56.5%) was diagnosed as containing renal scars on follow-up scintigraphies. Incidences of renal scar among renal units showing pattern 3, 4 and 5 on the initial scan was 75%, 78% and 78%, respectively. Whereas many of renal units showing 1, 2 and 6 pattern were recovered(65%, 76%, 50%). Sensitivity, specificity and accuracy of pattern-based DMSA scintigraphic findings on the diagnosis of renal scar was 76.9%, 85.1% and 81.9%, respectively. VUR was significantly associated with the renal scar when the initial DMSA shows unrecoverable findings(pattern 3, 4, 5). Odds ratio of the renal scar in a kidney showing unrecoverable initial scintigraphic findings was 19.1. Odds ratio in a kidney with mild or moderate-to-severe VUR was 3.5 and 14.4 respectively. Conclusion: In the urinary tract infection, renal scar was significantly developed in a kidney showing unrecoverable findings on the initial DMSA scan and VUR on voiding cystoureterography.

• 대한핵의학회:학술대회논문집
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• 1991.05a
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• pp.146.1-146.1
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• 1991