How is kidney scintigraphy performed? Dynamic renal scintigraphy: the essence of the study, indications and contraindications What the study shows

Scintigraphy - modern method radiology diagnostics, which is used to evaluate the functioning various organs and fabrics.

Scintigraphy- a method of functional imaging that involves introducing radioactive isotopes into the body and obtaining an image by determining the radiation emitted by them.

Scintigraphy is a procedure performed on a gamma ray scanner - a diagnostic radiological device - after injecting a small amount of radioactive substance.

KIDNEY SCINTIGRAPHY (NEPHROSCINTIGRAPHY) is a diagnostic test that involves injecting a small amount of radioactive medicine (a radioactive tracer) into the body and obtaining images of the kidneys using a gamma camera. The resulting images can help in diagnosis and treatment various diseases kidney

Kidneys is a paired excretory and endocrine organ that regulates the chemical homeostasis of the body through the function of urine formation.

The kidneys are located in the lumbar region on either side of the spine. The right kidney is slightly lower than the left.

There are two types of nephroscintigraphy:

Static nephroscintigraphy. Gives an image of the kidneys and urinary system, allows you to assess the condition of the kidney parenchyma, their size, correct or incorrect position, shape. This radiological examination is additional after analysis x-rays. Its disadvantage is that the resulting scintigram does not record functional changes organs and does not allow you to get full picture diseases.

Dynamic scintigraphy. After administration of the radiopharmaceutical into circulatory system The gamma camera begins to record the state of the urinary system. Pictures are taken at regular intervals. Thus, it is possible to evaluate the passage of urine from the kidneys through the ureters to the bladder. This allows you to obtain a clear image of the kidneys, their parenchyma, the collecting apparatus and evaluate functional disorders using compiled graphs and comparison of some indicators.

Normally, after the administration of a radiopharmaceutical (hippuran), after five minutes, clear photographs of the parenchyma can be taken; after one to two minutes, the contrast of the image decreases, and the drug is evenly distributed in the pyelocaliceal system.

After about fifteen minutes, the radiopharmaceutical is fixed in the bladder. Any slowdown in excretory processes or a decrease in tissue accumulation of hippuran indicates a pathology of the urinary system or kidneys.

DYNAMIC KIDNEY SCINTIGRAPHY (NEPHROSCINTIGRAPHY) is a radiological examination of the kidneys by recording the passage of nephrotropic radiopharmaceuticals through the kidneys.

Dynamic nephroscintigraphy is a method that examines not only functional abnormalities, but also the anatomical features of organs. This branch of medicine, called nuclear medicine, uses in its research the properties of radionuclide pharmaceuticals to be distributed and selectively accumulate in the tissues and cells of the body. Together with the use of ultrasound, MRI, PET/CT, such diagnostics provide a complete picture of the disease and allow the most adequate treatment to be prescribed.

Scintigraphy using a drug that is tropic to kidney tissue is used if the presence of a tumor is suspected genitourinary system.

By observing the process of uptake of radiopharmaceuticals by cells of the urinary system, the radiologist can accurately determine:

The functioning of both kidneys, the functioning of the ureters and bladder.

The nature of the tumor is malignant or benign.

Distinguish congenital abnormalities in the size or shape of the kidney from changes that occur during oncological pathologies.

Condition of the second kidney, if surgery is necessary.

The effectiveness of chemotherapy and other treatments in repeated studies.

Indications for dynamic nephroscintigraphy

Any significant changes or impairment of renal function.

Detected anomalies of organ development.

Second and third stages of hydronephrosis.

Cysts and neoplasms of the kidneys and urinary system (to exclude the malignant nature of the tumor).

Evaluation of the second kidney for renal failure when planning nephrectomy.

Planning organ-conserving surgery on a solitary kidney.

Exclusion or detection of metastases in the kidneys and genitourinary system.

Dynamic nephroscintigraphy is of particular importance when choosing a method of treating kidney cancer. The main indicator when choosing between resection of a kidney affected cancerous tumor, and nephrectomy is to assess the reserve capacity of the contralateral kidney. In this case, dynamic nephroscintigraphy data allows one to visualize not only the size and extent of the tumor, but also to assess the condition of healthy kidney segments. After introducing a radiopharmaceutical into the circulatory system, the gamma camera records the capture of the drug by three segments of the kidney in turn: first the upper, then the middle and, finally, the lower. At the same time normal indicators for each of the segments - 14, 18 and 14 units. respectively.

Due to the high accuracy of this radiological study, it is possible to predict the development of such a complication as renal failure in operated patients. The scintigram obtained as a result of diagnosis complements the laboratory biochemical analysis, as well as creatinine analysis and x-ray diagnostics.

Dynamic nephroscintigraphy gives more accurate results, since the gamma camera covers the entire lumbar area. It is possible to study while moving and sitting.

Contraindications to dynamic renal scintigraphy

All methods based on registration of capture, accumulation and distribution special drugs, labeled radioactive isotopes, are potentially dangerous. Therefore, some patients have limitations for this radiological examination.

These include:

The patients are in serious condition. Dynamic nephroscintigraphy takes from 45 minutes to one and a half hours. This can be tiring for frail patients.

Pregnant women. At intravenous administration radiopharmaceuticals increases the risk of exposure to the fetus. If confirmed or possible pregnancy diagnosis is carried out only by vital signs.

Nursing mothers. Radiopharmaceuticals are short-lived and are eliminated from the body within 24 hours. During this period after diagnosis, you should refuse breastfeeding.

Cancer patients after chemotherapy. Increase possible side effects treatment, therefore a pause of three weeks is necessary before diagnosis.

Cancer patients after radiation therapy. You should wait two to three months after treatment.

Recently operated patients. Excessive accumulation of radiopharmaceuticals is possible at the surgical site, and therefore the examination is carried out after the recovery period.

Despite the existing contraindications, dynamic nephroscintigraphy is a safe and painless method that gives highly accurate results.

Benefits of dynamic renal scintigraphy

High accuracy and sensitivity of the equipment.

Ability to detect metastases.

Safety and effectiveness.

The scintigram obtained during diagnosis displays changes in the kidneys much earlier than similar X-ray examination. If the latter can note changes in an organ already significantly affected by the tumor, then scintigraphy finds abnormal zones in the kidneys a year and a half earlier than conventional studies.

Renal cell cancer is one of the most dangerous oncological diseases. Every year, oncologists register up to 30 thousand cases malignant tumors kidneys or urinary system. In this regard, there is an increasing need early diagnosis cancer. Common diagnostic methods such as x-rays and measurements biochemical parameters make it possible to detect malignant pathologies when more than half of the kidney cells are affected. At the same time, kidney surgery with a tumor size exceeding 4 cm has an unfavorable prognosis even with proper treatment.

Static nephroscintigraphy is a more progressive, but partially biased radiological method, in contrast to highly accurate research using dynamic nephroscintigraphy.

Preparation for dynamic renal scintigraphy

The radiologist will warn the patient about the need to administer the radiopharmaceutical by intravenous injection, which generally does not cause severe pain.

In some cases, you need to additionally drink a special solution to improve the quality of the obtained scintigram. After this, the drug spreads throughout the body within three hours, after which the diagnosis itself is carried out.

Radiopharmaceuticals used during dynamic renal scintigraphy

If a blockade (obstruction) of the kidney is suspected, additional injections are given for examination. diuretic(“Lasix”). When evaluating hypertension, inhibitors such as Enalopril or Captopril are administered simultaneously with the administration of the radiopharmaceutical.

The radiopharmaceuticals used differ depending on the purpose of the study. For example, technetium DTPA is used to study kidney function. If a condition of the ureters or tubules is diagnosed, c99m DMSA or technetium is used. These drugs are safe and short-lived isotopes that do not harm the patient’s body.

Most radiopharmaceuticals are eliminated naturally after destruction, so one of the recommendations for patients is to drink plenty of fluids and maintain personal hygiene after the end of the diagnosis.

Method of performing dynamic renal scintigraphy

Dynamic nephroscintigraphy is performed on an outpatient basis and does not require hospitalization.

The patient is in a separate room, where a rotating gamma camera is directed at him. The diagnostic time can take up to one and a half hours, during which you need to remain motionless and silent. This must be strictly observed to avoid research errors.

The doctor is in another room, but sees and hears the patient, and also gives hints in case he needs to change position. This allows the patient to report unpredictable conditions, such as palpitations, heaviness in the head, or difficulty breathing.

If a child is diagnosed, one of the parents can be nearby, having previously protected themselves with a lead apron.

Upon completion diagnostic study the patient can have a snack and rest, and then return to their usual lifestyle.

Advantage of scintigraphy - this is not only information about the function of the organ, but also obtaining quantitative characteristics the extent of its damage in the earliest stages.

Among the many methods for diagnosing pathologies of the urinary system, kidney nephroscintigraphy stands out. This method is minimally invasive, maximally informative, painless and safe. Moreover, the cost of the procedure is affordable for each patient. Scintigraphy involves examining the kidneys and urinary tract using a radioisotope substance introduced into the body in small doses. Read more about what kidney scintigraphy is and what its advantages are, as well as about the features of the procedure in the material below.

Important: the radiopharmaceutical (RP), introduced into the patient’s body before the procedure, is completely and unchanged excreted along with the urine, without in any way harming the human body.

Detailed Definition

Radioisotope scintigraphy is performed on a special machine called a gamma tomograph. The gamma camera of this device monitors the movement and localization of the injected substance, displaying the results on the monitor. Subsequently, a diagnostic specialist creates an accurate examination scintigram. It is noteworthy that radiopharmaceuticals work in this case as a marker, staining healthy and pathologically damaged kidney tissues in certain shades on the scintigram.

Types of scintigraphic examination

Depending on the diagnostic goal, one of the following types of scintigraphy can be applied to the patient:

Dynamic renal scintigraphy. It is used if the attending physician wants to monitor the function of both the organs themselves and the function of the urinary system. In this case, a radioisotope substance is introduced into the patient’s body and, using a gamma camera, its entire path from the moment it enters the kidneys to the exit into the urethra is monitored. Scintigraphy shows the complete process of urine formation in stages. This diagnosis makes it possible to monitor in detail the functioning of the urinary system.
Static renal scintigraphy. This type of diagnosis is used as an additional one after radiography of the urinary organs. Static scintigraphy evaluates the general condition of each kidney (shape, size, density and functionality of the parenchyma, location of the kidneys relative to the spinal column and other organs). It should be understood that static scintigraphy (SS) does not provide a picture of the functionality of the urinary system.

Indications for scintigraphy

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This method of hardware diagnostics differs from others in a lot of advantages. These are:

Safety for the patient. Thus, the administered radioisotope substance reaches the patient’s kidneys after 30 minutes, and is completely eliminated from the body within 2 days unchanged. At the same time, you can speed up the elimination process by drinking plenty of water. In this case, the entire route of hippuran (a radioisotope substance) is monitored by sensors installed in the area of the kidneys, heart and large vessels.
No need for special patient preparation. The maximum that a patient should do is come to the procedure with an empty stomach. In some cases, a full or, conversely, empty bladder is necessary.
Ability to track kidneys over time. This cannot be done even with standard radiography using a contrast agent.
Objectivity of the data obtained. And this is important in making an accurate diagnosis and prescribing treatment.
No allergy to the administered substance. Hippuran does not in any way affect the central nervous system patient.
The fastest possible processing of received data. Results are available within half an hour after the procedure.

Contraindications for scintigraphy

Despite the fact that this hardware diagnostic method renal functions And possible deviations does not pose a danger to the patient; however, it is undesirable for the following groups of people:

Pregnant and lactating women. In the first case, radiopharmaceuticals may have a slight, but still effect on intrauterine development fetus In the case of nursing women, it is worth remembering that hippuran leaves the body within two days. This means that at this time you will have to wean the baby from the breast.

Important: lactating and pregnant women undergo scintigraphy only for vital signs.

Seriously ill patients. In this case, the patient may simply not be able to stand 40-50 minutes in one position.
Cancer patients. So, it is worth knowing that after a course of chemotherapy, at least 21 days must pass before scintigraphy. And after radiation therapy - at least 90 days.
Patients with metal implants. These include pacemakers, wires implanted into joints, metal plates, etc.
Patients who are intoxicated.

Preparatory activities before scintigraphy

It is worth knowing that in most cases, renoscintigraphy does not require special and thorough preparation. Basically, the patient is asked to come for diagnosis on an empty stomach. In addition, all metal objects will need to be removed from the body, including jewelry in the form of earrings or piercings. Depending on the diagnostic goals, the specialist may ask the patient to empty the bladder or vice versa to fill it. In addition, the doctor may offer the patient to drink a certain liquid, the effect of which is aimed at improving the quality of the procedure and obtaining more accurate images on the monitor.

Scintigraphy technique

Renoscintigraphy is performed exclusively on an outpatient basis in a special clinic with necessary equipment. It is advisable to make an appointment for diagnostics in advance, since the procedure takes from 35 minutes to an hour.

Important: you should know that the dose of the radioisotope drug is selected purely individually according to physical indicators patient (height, weight, etc.). In this case, children and adults are administered different categories of hippuran. As a rule, radiopharmaceuticals are administered intravenously in a volume of 1-2 ml.

After the drug is administered, the patient is placed on a special gamma tomography table, after which the specialists retire to an adjacent room to monitor the scan results. It is worth understanding that movements and conversations during scanning are extremely undesirable. This may distort the resulting image in particular and the results in general. Therefore, it is so important to maintain a motionless body position throughout the entire procedure.

If the patient feels nausea, dizziness, palpitations, etc., the diagnostician should be informed about this using a special button placed in the patient’s hand. In this case, during the examination, the patient will be given additional medications to relieve symptoms. Additional diuretics may also be administered if there are mechanical obstructions in the ureters.

Important: The patient does not require any special treatment or any recovery after renoscintigraphy.

Important information about scintigraphy

It is very important to understand that the use of a radioisotope substance in the diagnosis of renal pathologies does not affect the human body in any way. Its radiation exposure to the body is so small that such diagnostics can be carried out even every day. But at the same time, it is renoscintigraphy that makes it possible to identify malignant and other kidney pathologies at the very beginning of their development (almost 1.5 years earlier than if the pathology was diagnosed by ultrasound or x-ray). However, the most important factor preventing the use of renoscintigraphy everywhere is the lack of expensive equipment in all clinics in the country.

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What is nephroscintigraphy?

Radionuclide nephroscintigraphy is a diagnostic method based on the use of radiological agents that contain a radioactive nuclide. It does not affect the functions of the body, its purpose is to concentrate in the kidney to obtain the most accurate images, which will help the doctor make a correct diagnosis. The procedure for administering the drug is carried out by an experienced urologist, since you need to be able to correctly calculate the dose of the drug for each patient. Thanks to renoscintigraphy, the doctor diagnoses neoplasms of various etiologies and other diseases that require emergency treatment. This type of scintigraphy provides the doctor with information about organ dysfunction a year earlier than other diagnostic methods would reveal it. The early stages of pathology development are assessed, when the patient has no symptoms and characteristic manifestations of the disease.

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Advantages

Diagnostic procedures such as ultrasound, computed tomography and radiography provide information about the structure of organ tissue, and thanks to radionuclide scintigraphy, the doctor receives data on the functioning of the kidneys. Therefore, this method allows us to identify congenital anomalies, renal failure, obstruction of the urinary system, with injuries and damage to the vessels and arteries of the organ. But you need to remember that this type of diagnostic study will reveal a dysfunction of the organ, but will not always provide information about the root cause of the pathology. Scintigraphy is useful for obtaining data on the functioning of various structures of the kidneys, which helps the doctor in making an accurate diagnosis.

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Types of kidney scintigraphy

Dynamic

Dynamic nephroscintigraphy of the kidneys is indicated to monitor the functioning of the organ. During the renoscintigraphy procedure, the doctor monitors the functioning of the organ at all intervals of work. Radionuclide dynamic nephroscintigraphy (DRSG) involves introducing radiological contrast into the organ tissue, which moves through the kidney cells along with the bloodstream. The results of renoscintigraphy at the moment the product enters the urinary tissue are valuable. Dynamic renal scintigraphy provides information about the joint functioning of the kidneys and their work.

If a patient is suspected of having kidney disease, renoscintigraphy (DRSG) is used from any age. To obtain reliable data, it is allowed to take separate samples using specific preparations. To get accurate readings, the patient needs to fill the bladder an hour before diagnosis. To do this, drink up to a liter of liquid, and before the test the bladder is emptied. Dynamic nephroscintigraphy (DNSG) lasts 1.5-2 hours, the duration depends on the state of organ function. Radioisotope dynamic nephroscintigraphy with voiding test is not performed on patients who have impaired urinary control. We are talking about elderly people, young children, patients with abnormalities in the development of the bladder.

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Static

Static renal scintigraphy makes it possible to see pathologies in the structure of the kidneys and dysfunction. This type of study allows you to find out the size of the organ, shape and position, how the blood flow circulates and whether there are any abnormalities in the structure of the organ’s tissues. All these parameters cannot be monitored during ultrasound diagnostics or fluoroscopy. It takes no more than an hour, but it all depends on how serious the patient’s condition is and what pathologies develop.

This type of diagnosis is also used when identifying the disease in children. Thanks to scintigraphy, the doctor sees anatomical feature organ, its location, features of blood flow. The nuance of nephroscintigraphy is that 2 hours must pass after the contrast is administered to the child, then the doctor begins the examination procedure.

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Indications for the procedure

Renal scintigraphy is reasonable to perform if cancer and neoplasms are suspected.

The renoscintigraphy procedure is performed if the development of an oncological neoplasm is suspected.
To determine the etiology of the neoplasm. In this case, the DRSG study is carried out jointly with other diagnostic procedures.
For disorders of the kidneys and bladder.
When the size of the kidneys is not normal and there is a suspicion of the development of a neoplasm.
Before kidney surgery, when the doctor needs to know their condition and characteristics.
After a course of chemotherapy to obtain data on the quality of treatment.
When the doctor suspects pathology and abnormality of the kidneys.
To determine whether metastases have spread to organs.
Before any organ surgery.

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Preparation

In order for the diagnosis of DRSG to give the most accurate result, you need to prepare for it. To do this, the doctor injects a tracer into the patient’s body intravenously. In another case, the patient is advised to drink a contrast agent 3 hours before the procedure. Thanks to the drugs, it is possible to obtain clear and high-quality images in which all pathologies are visualized.

DRG using a radionuclide is indicated for patients in whom the development of obstruction is suspected. In this case, the patient needs to use a diuretic. Scanning of the renal arteries is carried out quickly; the person does not need to be in the hospital; preparatory procedures are sufficient, according to the doctor’s recommendation. During a scintigraphic scan, the patient is not allowed to move or talk, as the images are unclear. At the doctor’s command, the patient needs to change his body position in order to get pictures from different angles.

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How do they do it?

Radioisotope kidney scans are carried out in a specialized department of the hospital, where there is a specialization in nuclear medicine. To take pictures, a person needs to lie down in a device that consists of 2 cameras with gamma radiation. The pre-injected contrast is concentrated in the kidney tissue, thanks to which the doctor studies the functioning of the organs and identifies pathologies. The device scans the kidneys and after a fixed time, the images are visualized on the monitor screen. The radiodrug does not cause negative consequences. In order for it to be eliminated from the body faster, the patient needs to drink a lot of fluids.

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Survey results

The scintigraphic examination data is analyzed by a urologist, who may additionally prescribe an ultrasound or MRI.

The results of the DRSG study are interpreted by a urologist. Using images, he will see the condition of the kidneys, their functioning, the presence of pathologies and changes in the structure of the organs. If the scintigraphy image shows pathology, the patient is prescribed additional ultrasound examination, MRI diagnostics and CT scan of the kidneys. Scintigraphy results will show the following pathologies:

the function of urine outflow during inflammatory processes in the kidney and bladder;
renal failure and causes;
stones and neoplasms in the kidneys, bladder and urinary tract;
malignant tumor in an organ;
pathologies of the renal arteries, in which blood flow in the organ is impaired.

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Possible complications

Scanning and the use of contrast agents are safe and do not harm the body. The patient may develop complications such as increased blood pressure, frequent desire to go to the toilet. In order for the contrast to leave the body faster, you need to drink clean water V large quantities, then the drug is excreted in the urine and the symptoms go away.

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Restrictions and contraindications

Kidney scintigraphy is contraindicated for patients in serious condition, since the procedure lasts up to 2 hours, it will be difficult for a person to withstand such a time. Diagnostics is contraindicated during pregnancy and during feeding, because the contrast has radiation properties. But in case of urgent need, after scintigraphy and administration of the drug, you will need to stop breastfeeding for a day.

It is contraindicated to undergo a scan after a course of chemotherapy and radiation exposure. Nephroscintigraphy is contraindicated in patients who have undergone major surgery, since when contrast is administered, a lot of fluid will accumulate in the kidneys, and this is dangerous. Scintigraphy should not be used in patients who have developed an allergic reaction to a radionuclide. Under other circumstances, the diagnostic procedure does not pose any danger or discomfort.

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Types of nephroscintigraphy

Kidney scintigraphy has three types - static, dynamic, high-speed.

Their goals are slightly different:

Dynamic scintigraphy. This is a type of scintigraphy that allows you to evaluate kidney function in detail. The radiopharm drug enters the renal tissue through the bloodstream, then moves through the vessels into the ureters and bladder. Dynamic kidney scintigraphy analyzes the functions of each kidney separately, as well as the work of the organ in the “ensemble” in relation to each other.

Static scintigraphy. Gives a clear image of the kidneys, allows you to accurately determine the shape and topography of the kidneys, size, and shows the presence of pathologies. Static nephroscintigraphy is performed in a direct projection, and is more revealing than x-rays and ultrasound.

Static scintigraphy is usually not used in isolation, but only in combination with other types of examination.

High-speed (circuloscintigraphy) of the kidneys is carried out for the purpose of a detailed study of renal blood flow, the rate of which varies greatly in pathologies.

About drugs

Patients are usually very concerned about the question: what danger does kidney scintigraphy pose to the body? Are there consequences and side effects for the introduction of a radioisotope? Let's explain.

Each kidney scintigraphy, depending on the indications, is performed with different drugs:

For dynamic scingraphy, the drug hippuran is used.
The static radioisotope procedure is performed using neohydrin.
Perotechnetate is used for circuloscintigraphy.

The dose of each drug is calculated by the doctor strictly individually. Body weight plays a decisive role here, because the radioisotope load is calculated per kilogram of weight.

We won't go into details nuclear physics and characteristics of drugs from this point of view. Let’s just say that they do not have a toxic effect on the body. After the procedure, they are completely eliminated from the body in an absolutely natural way (with urine and feces).

The radiation dose that the body receives is negligible, so harm from the pharmaceutical drug is excluded.

Each of the listed drugs “works” according to the indicator principle. It contains a vector molecule that is absorbed by kidney tissue and an isotope (radioactive marker). It is the isotope that projects gamma rays onto a gamma camera, which shows the result on the monitor.

Important points

If the doctor suspects a patient has vesicoureteral reflux, he makes a note in the referral that the patient needs a study with a voiding test. This is what doctors call indirect radionuclide cystography.

Isotope diagnostics with a voiding test is excluded only for people who are not able to independently control the process of urination. Young children can also be included in this category.

In addition to voiding, there are other types of tests: physiological, pharmacological, stress test.

We think you have received enough theoretical information. Now let's move closer to the practical part.

Where is the research conducted?

A study such as scintigraphy is done both on an outpatient basis and in hospitals. The office where isotope diagnostics is carried out is usually located on the lower or basement floor of the institution. The office staff undergoes special additional training. Their responsibilities include not only conducting scintigraphy, but also interpreting the results.

Indications for the study

Renal scintigraphy has the following indications:

Renal function assessment and urinary tract after surgery.
Vesicoureteral reflux.
Anomalies of organ development.
State of the organ before chemotherapy.
Oncological processes of the kidneys.
Pyelonephritis, strictures and other renal pathologies.
Arterial hypertension.

Contraindications

The main contraindications are during pregnancy and breastfeeding. Also, before the study, the doctor analyzes the condition of the patients - severe, decompensated chronic diseases– these are also relative contraindications to the procedure. Not because there will be consequences in terms of well-being, but because the examination process can last quite a long time - from half an hour to 1.5 hours, which not every patient can do.

Preparation for the procedure

If we consider the concept of preparation broadly, then it is not required. The patient is not forced to fast or cleanse the intestines before scintigraphy. But there are several rules that must be followed:

It is necessary to eat before scintigraphy and drink 2 glasses of water.

Of course, the water should be still. Under no circumstances should you replace the water strong tea or coffee. Such preparation may distort the results.

Before examinations, you can eat everything, with the exception of marinades, smoked meats, and spicy foods. But for patients with chronic kidney pathologies, such a diet is the usual norm.

If kidney diagnostics are carried out with a pharmacological test, hypertensive patients stop taking diuretics within 24 hours. And it is advisable to stop taking ACE inhibitors within a week. This is done so that the results can be assessed without errors. Stopping antihypertensives for such a long period can lead to crises, so it is better to do scintigraphy with a pharmaceutical test in the hospital.

Decoding the results

You can rack your brains as much as you like over the mysterious pictures of your kidneys and incomprehensible diagrams, but only a specialist can figure out what is normal and what is pathology.

IN general outline we will explain what can be determined from scintigraphy results.
You can accurately see the position, shape, size of the organ.
You can evaluate functional abilities: blood flow, excretory function.
You can determine the presence and absence of pathologies.
If scintigraphy is done for trauma or kidney damage, additional diagnostic procedures may be required.

The results are assessed by a radiologist. Related diagnostic procedures are PET CT and SPECT.

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The essence of diagnosis, goals and advantages

Radionuclide diagnostics is a study of the functioning internal organs and human tissues, based on registration of radioactive radiation pharmacological drug. It is characterized by high sensitivity, a wide and accurate range of data obtained during the study. This makes it possible to detect diseases already at initial stages, when other methods are still uninformative. Its role in monitoring the effectiveness of drug or surgical treatment is also very important.

Radioisotope research kidney test involves the introduction of a special substance into the blood that allows one to examine the structure of the kidneys.

The essence of the method is to analyze the information obtained after the introduction of a special radioactive substance into the blood, which is distributed throughout the body depending on the functioning of its organs and systems. The radiation is detected using special equipment. The administered drug tends to accumulate quickly and is quickly eliminated from the body, without causing any harm to the patient. Based on the characteristics and speed of movement of radiopharmaceuticals with the blood, as well as their heterogeneous concentration in organs and tissues, one can judge the presence of a particular disease. The most commonly used isotopes of iodine. At the accumulation stage, they make it possible to “see” the functional and structural state of the kidneys, and the rate of excretion characterizes the state of the urinary tract.

The simplicity of the process, minimal risk to the patient and the lack of specialized preparation for the procedure make it a very popular and effective diagnostic tool. It is also important that radionuclide compounds can be used in patients with hypersensitivity to radiopaque agents. And the main advantage of such methods was the opportunity to study physiological functions in parallel with the determination of topographic and anatomical parameters.

The scintigraphy method was developed a long time ago. The first experiments date back to the beginning of the twentieth century.

But wide medical use Radionuclide diagnostics was developed only in the second half of the 20th century, when special equipment was designed.

Do not confuse scintigraphy and scanning, these are two completely different methods research.

What is the essence of the method?

The uniqueness of the study lies in the possibility of diagnosing a functioning organ and all its tissues. The basis of the method is the use of a radiopharmaceutical (RP). Without it, research is impossible. This chemical substance with certain characteristics.

The widespread misinformation about these drugs is due to illiteracy and the lack of reliable data about its properties. Apart from slight radioactivity, it is harmless and is characterized by a large number of positive features.

When introduced into the body, the drug does not cause any allergic reactions and common drug effects. The amount of substance introduced into the body is very small.

When using radiopharmaceuticals, the injected drug affects only a specific organ under study.

Administration of the drug with a small dose of radiation is not likely to cause adverse effects. All the talk about the danger of overexposure is caused by people who are absolutely far from understanding the processes taking place.

In fact, it's very effective method determining violations in the structure of an organ or its basic functions.

If we compare the possibilities, then with scintigraphy, pathology can be visible 12 months earlier than it would be visible with other diagnostic methods.

What is being done is the assessment of the early stages of changes in organ function and the identification of their violations. But if only it were that simple.

The scintigraphy method has become widespread throughout the world. In America, about 17 million studies are conducted annually, in Europe about 12 million.

In the USA, the number of diagnostic equipment exceeds 12 thousand. In Russia there are a little more than 200 of them, and most of them are obsolete equipment.

In this regard, the number of studies does not reach a million. The situation with radionuclide diagnostics is becoming catastrophic. Plus constant interruptions in the supply of radiopharmaceuticals.

Features when examining the kidneys

When examining the kidneys using scintigraphy, they use a simple and accurate way to study their functions and anatomy.

Nephroscintigraphy far exceeds all other examinations in terms of efficiency and accuracy.

Not only all kidney functions are assessed, but also possible structural changes and abnormalities in the blood supply. It makes it possible to examine the condition of the entire urinary system.

The study is carried out using a drug such as hippuran, the concentration depends on the age of the patient.

Children are prescribed type 125I, as for adults, 131I is used for them. There are no side effects from this drug, even when re-tested after a day, two or a month.

The required effective amount of the administered drug is from 1 to 2 milliliters. It is more convenient to carry out diagnostics in the back area. This is explained by the fact that there the kidneys are closest to the surface of the body.

It is better to carry out diagnostics while lying down, this makes it easier for the patient long time do not change the position of the scanned area. It is optimal if the device is no more than 2 centimeters from the body. The patient does not need to take any preliminary actions.

But it is better to empty your bladder before the test. To be effective, the study begins no earlier than one minute after administration of the drug, but it may take longer for the drug to fully spread.

Varieties of techniques

There are several types of renal scintigraphy. The most common are three types:

Renoscintigraphy– dynamic and most used method with wide practical significance.
Nephroscintigraphy– both dynamic and static examination of the kidneys is possible.
There is a third type of high-speed scintigraphy that is not widely used - Circuloscintigraphy to study the blood circulation of the area under study and the kidneys.

Purpose of the examination

The main purpose is to determine renal function, but it can be caused by a wide variety of urological or nephrological indications.

The most common are:

kidney injuries;
congenital diseases;
kidney transplant;
hypertension and other diseases.

The range of indications for prescribing a study is much wider. This is explained by the high efficiency of the study.

You can see all the failures and disturbances: the speed of blood flow in the kidneys, notice the difference in the work of the left and right kidney, see the scars from the transferred inflammatory processes and much more.

Its main advantage is accuracy, harmlessness and absolute painlessness.

Stage one - preparation

A scintigraphic examination does not require preparation; it is usually performed on an empty stomach.

But depending on the area being examined and the type of procedure, a full or empty bladder may be required.

A prerequisite is the removal of metal objects from the examination area. Sometimes, during a kidney test, it is necessary to empty the bladder, but this is done in rare cases.

Registration for the study is made in advance, and the attending physician must inform the patient of all necessary information about the progress of the upcoming examination.

Progress of the procedure

The patient is given the required dose of radiopharmaceuticals intravenously. The drug must spread throughout the body and reach the organ being tested.

As soon as the drug has reached a given area, a special gamma camera detects the radiation emanating from the radiopharmaceutical in the human body and transmits the information to a scintigraphic complex connected to a computer.

The image obtained during kidney examination is made up of several static curves by adding them dynamically.

An experienced doctor determines the position in which the object of study is exactly within the coverage area of the gamma camera. For more detailed studies, additional medications may be required.

If you need to change your body position, this is done under the guidance of a doctor. It is advisable to remain still, so the picture of the research will be much more accurate.

The examination time lasts from half an hour or more, it all depends on the goals set for the doctor for diagnosis.

After the procedure, special treatment measures are absolutely unnecessary and not required. This applies to handling personal items and washing them. The radioactive drug is eliminated from the body independently, naturally.

Results and transcript

After the scintigraphic examination, the patient is given the results. To prepare them you will have to wait in the corridor for about 20 minutes.

The result consists of photographs of the organ being examined and a conclusion from the doctor who conducted the study.

The description indicates the date of the study, the course of the procedure, the drugs used and the doctor’s signature. The images reflect the actual condition of the kidneys, size and shape, as well as the condition of the circulatory organs.

The photograph or scintigram shows the distribution of the radioactive substance in the kidneys. If changes or deviations in the functioning of organs are detected, this must be indicated in the results of the study.

It is difficult for a non-specialist to understand the terminology used in the description; it is better to consult a doctor.

This you need to know - restrictions and contraindications

No complications arise during scintigraphy, but there are a number of contraindications and limitations. This procedure is not performed on patients in serious condition, this is due to the need to maintain a certain position of the study area and immobility during the procedure.

But it is difficult to demand this from a patient in serious condition. It is not advisable to conduct research during pregnancy, but in special cases diagnosis is carried out.

The method is not performed on patients who:

have undergone chemotherapy;
underwent a course of radiation therapy.

Immediately after surgical intervention Scintigraphy is not performed on the organ being examined due to the strong accumulation of fluid in the operated area.

Not easy to find, not cheap to make

Not all facilities have the equipment to conduct such studies. medical institutions. This is due to their cost, as well as the lack of qualified personnel with sufficient experience.

The equipment is installed in medical institutes, oncology centers, diagnostic centers, large regional hospitals. In small populated areas they may not be there.

The most opportunities to do static and dynamic nephroscintigraphy of the kidneys are:

The cost of the study depends on the type of study, which organs and areas are to be diagnosed. Average price in Russia within from 2400 to 4500 rubles, but it may vary depending on regions.

The method using radioisotope scanning is different from all existing ones. It allows you to identify the disease long before the appearance of kidney problems, when other studies have not yet shown any changes.

Distrust of kidney scintigraphy is due to ignorance of the processes themselves and lack of practice, although there is quite enough information about them. As for the drug, it is produced from short-lived isotopes.

The amount of radiation exposure does not exceed five percent of the permissible dose; this is a negligible figure. In 6 hours, the radiopharmaceutical completely disintegrates without having any effect on the body.

When a person has impaired kidney function, it is important to identify the cause of the failure using diagnostic methods. Kidney scintigraphy helps determine the disease by different stages development, which allows the doctor to choose required course treatment according to the current situation. What are the different types of examinations, how to properly prepare for them, and what complications may arise in a patient after the diagnostic procedure?

Kidney scintigraphy allows you to obtain data on the condition of the organ at the earliest stages of the onset of the disease.

What is nephroscintigraphy?

Radionuclide nephroscintigraphy is a diagnostic method based on the use of radiological agents that contain a radioactive nuclide. It does not affect the functions of the body, its purpose is to concentrate in the kidney to obtain the most accurate images, which will help the doctor make a correct diagnosis. The procedure for administering the drug is carried out by an experienced urologist, since you need to be able to correctly calculate the dose of the drug for each patient. Thanks to renoscintigraphy, the doctor diagnoses neoplasms of various etiologies and other diseases that require urgent treatment. This type of scintigraphy provides the doctor with information about organ dysfunction a year earlier than other diagnostic methods would reveal it. The early stages of pathology development are assessed, when the patient has no symptoms and characteristic manifestations of the disease.

Advantages

Diagnostic procedures such as ultrasound, computed tomography and radiography provide information about the structure of organ tissue, and thanks to radionuclide scintigraphy, the doctor receives data on the functioning of the kidneys. Therefore, this method makes it possible to identify congenital anomalies, renal failure, obstruction of the urinary system, in case of injuries and damage to the vessels and arteries of the organ. But you need to remember that this type of diagnostic study will reveal a dysfunction of the organ, but will not always provide information about the root cause of the pathology. Scintigraphy is useful for obtaining data on the functioning of various structures of the kidneys, which helps the doctor in making an accurate diagnosis.

Types of kidney scintigraphy

Dynamic

Static

This type of diagnosis is also used when identifying the disease in children. Thanks to scintigraphy, the doctor sees the anatomical feature of the organ, its location, and blood flow characteristics. The nuance of nephroscintigraphy is that 2 hours must pass after the contrast is administered to the child, then the doctor begins the examination procedure.

Indications for the procedure

Renal scintigraphy is reasonable to perform if cancer and neoplasms are suspected.

The renoscintigraphy procedure is performed if the development of an oncological neoplasm is suspected.
To determine the etiology of the neoplasm. In this case, the DRSG study is carried out in conjunction with other diagnostic procedures.
For disorders of the kidneys and bladder.
When the size of the kidneys is not normal and there is a suspicion of the development of a neoplasm.
Before kidney surgery, when the doctor needs to know their condition and characteristics.
After a course of chemotherapy to obtain data on the quality of treatment.
When the doctor suspects pathology and abnormality of the kidneys.
To determine whether metastases have spread to organs.
Before any organ surgery.

Preparation

Types of nephroscintigraphy
Recommendations for conducting research

Kidney scintigraphy is one of the methods of radiation diagnostics, which is used when it is necessary to assess the functioning of organ tissues. Dynamic renal scintigraphy is a functional imaging technique in which special radioactive isotopes are injected into the patient's body. After this, a study is carried out, using emitted radiation, the data that is necessary for the examination and conclusion is displayed on the screen.

The kidney is a paired organ that performs the function of chemical homeostasis through the formation of urine and its excretion. Scintigraphy for diagnosing kidney disease is a procedure performed using special equipment called a gamma tomograph. This is a radiologically safe device. It is used only after a special substance is introduced into the body. The radioactive label is a special medical drug, which is used quite often for examination. The result obtained helps to determine the form of the disease and select the appropriate treatment.

Static scintigraphy of the kidneys can be of several types - this is the static examination itself and the dynamic one. Static scintigraphy allows for assessment general condition parenchyma, size, position of the kidney. The examination is usually carried out after an x-ray. Among the disadvantages of such diagnostics, it should be noted that functional changes are not recorded, i.e. A complete map of the disease is not obtained, which is why this examination is carried out only together with others.

During a dynamic study, a special radioactive substance is injected into the patient, and images for the study are taken at certain intervals.

The procedure can take up to 1.5 hours. This study is not prescribed for seriously ill patients. But it is the most complete, allowing you to get an accurate picture of the work of the organ and determine what problems there are. Often this procedure is prescribed for cancer patients, as it is more complete.

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Kidney scanning is used in the following cases:

If there is a suspicion of the development of tumor processes in the kidneys and other organs of the genitourinary system.
If necessary, determine the nature of the tumor. Prescribed along with other diagnostic methods.
If necessary, check the performance of not only the kidneys, but also the bladder and ureters.
If there are deviations in the size and shape of the kidneys, there is oncological pathology various types.
Before surgery, if one or two kidneys need to be assessed.
After chemotherapy, when it is necessary to obtain an assessment of the quality of treatment.
A kidney scan is performed if developmental anomalies are detected, there are organ dysfunctions, or changes.
The study is effective at stages 2 and 3 of hydronephrosis.
If neoplasms are diagnosed, it is necessary to exclude their malignant nature.
To assess the condition of the kidney if renal failure is suspected and nephrectomy is planned.
Before anyone surgical intervention on the kidneys.
If it is necessary to determine the presence of metastases.

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Contraindications for use

Diagnosis of kidney disease is not always applied. There are a number of contraindications for which the study is not carried out:

If the patient is in serious condition, the study is not carried out (the time for such a procedure takes from 45 minutes to 1.5 hours; a seriously ill patient will not always be able to maintain a lying position without moving).
Not used during pregnancy, carried out only for health reasons early stages.
For nursing mothers, such an examination is also not used, but if there is an urgent need, then within 24 hours after it you should stop breastfeeding, since it takes time (24 hours) for the drug to be completely eliminated.
Not suitable for patients who have just completed chemotherapy.
Not applicable to patients who have undergone radiation therapy.
Nephroscintigraphy is not used when the patient has just undergone surgery, since there may be too much fluid accumulation in the area of the operated organ.
If there is an individual intolerance to the drug used for diagnosis.

In general, nephroscintigraphy is a safe and completely painless procedure.

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Preparation and method

Diagnosis of kidney diseases requires preparation, for which the patient is given a special drug-label. This is done through intravenous injections, no unpleasant or very painful sensations this procedure does not cause. For some types of diagnostics, the doctor may give a solution that you need to drink, this makes the scintigraphy better. You need to drink the solution 3 hours before the kidneys are diagnosed, this is exactly the time required for the solution to completely distribute in the body and reach the kidneys. The solution itself is absolutely safe, it does not affect your well-being in any way, so you should not be afraid.

Radionuclide diagnostics, which are carried out when obstruction is suspected, may require the administration of a special diuretic drug. Inhibitors may be required and used to evaluate hypertension. Today, duplex scanning of the renal arteries is performed on an outpatient basis; the diagnosis does not require an inpatient stay. The patient is in a special room with a gamma camera, the diagnosis itself lasts approximately 1.5 hours. The patient must remain silent and lie still during the examination. This makes it possible to avoid errors in determining the result.

During the diagnosis of kidney disease, the doctor will be in the next room, he can clearly see the patient, and, if necessary, can give him orders to change position. If the procedure is performed on a child, the parents will remain with the child to monitor the position of the body. A lead apron for adults must be used. After the kidney scan is completed, the patient can return to ordinary activities, no negative consequences, no pain is felt.

Nephroscintigraphy is a diagnostic process that makes it possible to determine kidney function. This procedure is prescribed by a doctor when it is necessary to obtain characteristics of the organ’s activity. The results obtained make it possible to see the beginning of the problem even at early stage, which is very important for proper treatment.