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Nuklearmedizin 1993; 32(06): 306-315
DOI: 10.1055/s-0038-1632295
Originalarbeit
Schattauer GmbH

Beurteilungskriterien für die Captopril-Nierenfunktions- szintigraphie mit 99mTc-MAG3

Diagnostic Criteria in 99mTc-MAG3 Renal Function Scintigraphy with Captopril
R. Piepenburg
,
A. Bockisch
,
G. Maier
,
C. Düber
1   Aus der Klinik mit Poliklinik für Nuklearmedizin (Dir.: Prof. Dr. K. Hahn), Klinik für Röntgendiagnostik (Dir.: Prof. Dr. M. Thelen), Johannes-Gutenberg-Universität, Mainz, FRG
,
P. Kann
2   Aus der Klinik mit Poliklinik für Nuklearmedizin (Dir.: Prof. Dr. K. Hahn), III. Medizinische Klinik und Poliklinik, Innere Medizin und Endokrinologie (Dir.: Prof. Dr. J. Beyer) des Klinikums der Johannes-Gutenberg-Universität, Mainz, FRG
,
K. Hahn
› Author Affiliations
Further Information

Publication History

Eingegangen: 18 May 1993

16 July 1993

Publication Date:
03 February 2018 (online)

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Zusammenfassung

Im Rahmen der Diagnostik der renovaskulären Hypertonie hat die Nierenfunktionsszintigraphie unter Einfluß eines ACE-Hemmers als nichtinvasives Verfahren erhebliche Bedeutung erlangt. Unter Einsatz des Radiopharmazeutikums 99mTc-MAG3 wurden bei 54 Nieren mit angiographisch, klinisch und endokrinologisch gesicherter Diagnose folgende szintigraphischen Parameter isoliert auf ihre Aussagekraft zum Nachweis bzw. Ausschluß einer relevanten Nierenarterienstenose untersucht: parenchymaler Nuklidtransport, Harnabflußsituation, Nierengröße und seitengetrennte Funktionsanteile. Als typischer Befund einer dekompensierten Nierenarterienstenose erwies sich eine ausgeprägte parenchymale Nuklidretention in Kombination mit einer deutlich verzögerten Harnaktivitätsanflutung im Nierenhohlraumsystem. Im Vergleich zur rein visuellen Beurteilung der Sequenzszintigramme erbrachte die Miteinbeziehung zusätzlicher, quantitativer Kriterien im eigenen Patientenkollektiv keine diagnostischen Vorteile. Bei 43 Patienten mit klinischen Hinweisen auf eine renovaskuläre Hypertonie ergab sich mit diesen Kriterien eine Sensitivität von 89%, die Spezifität betrug 88%. Bilateral positive Befunde erwiesen sich als unspezifisch; blieben diese unberücksichtigt, erhöhte sich die Spezifität der Untersuchung auf 100%.

Summary

Renal function scintigraphy under ACE inhibition has gained an important role in the diagnosis of renovascular hypertension. Using the radiopharmaceutical 99rTTc-MAG3, 54 kidneys with angiographically verified renal artery status were evaluated with respect to the following scintigraphic parameters: intraparenchymal tracer transport, urine drainage, kidney size, and functional side-to-side ratio. In cases of decompensated renal artery stenosis, the typical scan finding using MAG3 was shown to be a distinct parenchymal nuclide retention in combination with a delayed appearance of the radiotracer in the pelvic system. In our patients, the visual impression of the renal sequential scans was superior to quantitative evaluation methods. Using these criteria in 43 patients with suspected renovascular hypertension, sensitivity and specificity were 89% and 88%, respectively. Bilateral positive findings were nonspecific; when excluding them from the study, specificity increased to 100%.

Schlüsselwörter

Nierenarterienstenose - renovaskuläre Hypertonie - Nierenfunktionsszintigraphie - 99mTc-MAG3 - Captopril

Key words

Renal artery stenosis - renovascular hypertension - renal scintigraphy - 99m Tc- MAG3 - captopril
 

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