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Renal uptake in liver scan
Renal U p t a k e in Liver Scan Serafin Tiu, Barbara Klein, Elissa L. Kramer, and Joseph J. Sanger
A
57-YEAR-OLD male with a previous history of congestive heart failure, tuberculosis, and gout was admitted for sudden onset of left-sided weakness. Physical examination revealed bibasilar rales, I + pitting pedal edema, and a grade 2/3 systolic murmur. The liver is mildly enlarged. Chest x-ray films showed cardiomegaly with failure pattern. Laboratory findings included abnormally elevated liver function tests, and elevated hemoglobin and hematocrit levels. A liver-spleen scan was performed following the intravenous (IV) administration of 3 mCi of 99mTc-sulfur colloid. The liver was borderline enlarged, spleen was unremarkable, and there
From the New York University Medical Cente~Bellevue Hospital, New York. Address reprint requests to Serafin Tiu, MD, NYU Medical Cente~Bellevue Hospital, 560 First Ave, New York, N Y 10016. 9 1986 by Grune & Stratton, Inc. 0001-2998/86/l 601-0007505.00/0
was marked uptake in the bone marrow and both kidneys (Fig 1A and B). An echocardiogram revealed bilateral dilatation of the ventricles, an ejection fraction of 45%, and findings consistent with cardiomyopathy. The patient was later uneventfully discharged with diagnosis of transient ischemic attack (TIA) and congestive heart failure. Renal uptake of sulfur colloid agent is seen primarily in patients with kidney transplants undergoing rejection, acute tubular necrosis, or sepsis} ~ This is probably due to entrapment of technetium sulfur colloid in fibrin deposits, or increased phagocytic activity in the renal capillary beds. 4-5 However, the mechanism seen in nontransplanted kidneys is not fully understood. It is suggested that in congestive heart failure, the filtration factor is increased, with the plasma protein becoming concentrated beyond the glomeruli, causing entrapment of technetium sulfur colloid. 6 It is also possible that the phagocytic response is induced by the congestive heart failure in the renal tubular cells]
Fig 1A.
80
Seminars in Nuclear Medicine, Vol XVI, No 1 (January), 1986: pp 80-81
RENAL UPTAKEIN LIVERSCAN
81
Fig 1. (A and B) Posterior view of a liver scan showing uptake in both kidneys.
UNCOMMON
COMMON 1) Transplanted
kidney (acute or chronic
r e j e c t i o n ) 1-3
1) Transplanted kidney (acute tubular necrosis, sepsis) I-3
2) Liver transplant patients 14
2) C o n g e s t i v e h e a r t f a i l u r e 7-1~ 3) T e c h n i c a l : t e c h n e t i u m s u l f u r colloid p r e p a r a t i o n f r o m first d a y g e n e r a t o r , H p r e s e n c e o f s o l u b l e f o r m o f r e d u c e d t e c h n e t i u m ~2'13
RARE
1) Acessory spleen presence in kidney 12
REFERENCES 1. Frick MP, Loken MK, Goldberg ME, et al: Use of 99mTc-sulfur colloid in evaluation of renal transplant complications. J Nucl Med 17:181 183, 1976 2. George EA, Codd JE, Newton WT, et al: Comparative evaluation of renal transplant rejection with radioiodinated fibrinogen, 99mTc-sulfurcolloid, and 67Ga-citrate. J Nucl Med 17:175-180, 1976 3. Kim YC, Massari PU, Brown ML, et al: Clinical significance of 99mTc-sulfur colloid accumulation in renal transplant patients. Radiology 124:745-748, 1977 4. George EA, Henry RE, Newton WT, et al: Mechanism of ~mTc-sulfur colloid accumulation in canine renal allografts during hyperacute rejection. J Nucl Biol Med 19:213-219, 1975 5. Klingensmith WC, Tsan MF, Wagner HN: Factors affecting the uptake of 99mTc-sulfur colloid by the lung and kidney. J Nucl Med 17:681-684, 1976 6. Cannon P J: The kidney in heart failure. N Engl J Med 296:26-32, 1977
7. Shook DR, Shafer RB: Renal uptake of 99mTc-sulfur colloid. Clin Nucl Med 1:223-225, 1975 8. Coleman RE: Renal colloid localization. J Nucl Med 15:367-368, 1974 9. Higgins CB, Taketa RM, Taylor A, et al: Renal uptake 99mTc-sulfur colloid. J Nucl Med 15:564-566, 1974 10. Klingensmith WC, Datu JA, Burduck DC: Renal uptake of 99mTc-sulfur colloid in congestive heart failure. Radiology 127:185-187, 1978 11. Jackson GL: Renal accumulation of 99mTc-SC. Clin Nucl Med 2:176, 1977 12. Kirchner PT (ed): Nuclear Medicine Review Syllabus. New York, Society of Nuclear Medicine, 1980, p 293 13. Fisher SM, Brown RG, Greyson ND: Unbinding of 99mTcby iodinated antiseptics. J Nucl Med 18:1139, 1977 14. Kuni CC, Klingensmith WC: Renal uptake of 99mTcSC in liver transplant patients. Clin Nucl Med 4:335-337, 1979
A
57-YEAR-OLD male with a previous history of congestive heart failure, tuberculosis, and gout was admitted for sudden onset of left-sided weakness. Physical examination revealed bibasilar rales, I + pitting pedal edema, and a grade 2/3 systolic murmur. The liver is mildly enlarged. Chest x-ray films showed cardiomegaly with failure pattern. Laboratory findings included abnormally elevated liver function tests, and elevated hemoglobin and hematocrit levels. A liver-spleen scan was performed following the intravenous (IV) administration of 3 mCi of 99mTc-sulfur colloid. The liver was borderline enlarged, spleen was unremarkable, and there
From the New York University Medical Cente~Bellevue Hospital, New York. Address reprint requests to Serafin Tiu, MD, NYU Medical Cente~Bellevue Hospital, 560 First Ave, New York, N Y 10016. 9 1986 by Grune & Stratton, Inc. 0001-2998/86/l 601-0007505.00/0
was marked uptake in the bone marrow and both kidneys (Fig 1A and B). An echocardiogram revealed bilateral dilatation of the ventricles, an ejection fraction of 45%, and findings consistent with cardiomyopathy. The patient was later uneventfully discharged with diagnosis of transient ischemic attack (TIA) and congestive heart failure. Renal uptake of sulfur colloid agent is seen primarily in patients with kidney transplants undergoing rejection, acute tubular necrosis, or sepsis} ~ This is probably due to entrapment of technetium sulfur colloid in fibrin deposits, or increased phagocytic activity in the renal capillary beds. 4-5 However, the mechanism seen in nontransplanted kidneys is not fully understood. It is suggested that in congestive heart failure, the filtration factor is increased, with the plasma protein becoming concentrated beyond the glomeruli, causing entrapment of technetium sulfur colloid. 6 It is also possible that the phagocytic response is induced by the congestive heart failure in the renal tubular cells]
Fig 1A.
80
Seminars in Nuclear Medicine, Vol XVI, No 1 (January), 1986: pp 80-81
RENAL UPTAKEIN LIVERSCAN
81
Fig 1. (A and B) Posterior view of a liver scan showing uptake in both kidneys.
UNCOMMON
COMMON 1) Transplanted
kidney (acute or chronic
r e j e c t i o n ) 1-3
1) Transplanted kidney (acute tubular necrosis, sepsis) I-3
2) Liver transplant patients 14
2) C o n g e s t i v e h e a r t f a i l u r e 7-1~ 3) T e c h n i c a l : t e c h n e t i u m s u l f u r colloid p r e p a r a t i o n f r o m first d a y g e n e r a t o r , H p r e s e n c e o f s o l u b l e f o r m o f r e d u c e d t e c h n e t i u m ~2'13
RARE
1) Acessory spleen presence in kidney 12
REFERENCES 1. Frick MP, Loken MK, Goldberg ME, et al: Use of 99mTc-sulfur colloid in evaluation of renal transplant complications. J Nucl Med 17:181 183, 1976 2. George EA, Codd JE, Newton WT, et al: Comparative evaluation of renal transplant rejection with radioiodinated fibrinogen, 99mTc-sulfurcolloid, and 67Ga-citrate. J Nucl Med 17:175-180, 1976 3. Kim YC, Massari PU, Brown ML, et al: Clinical significance of 99mTc-sulfur colloid accumulation in renal transplant patients. Radiology 124:745-748, 1977 4. George EA, Henry RE, Newton WT, et al: Mechanism of ~mTc-sulfur colloid accumulation in canine renal allografts during hyperacute rejection. J Nucl Biol Med 19:213-219, 1975 5. Klingensmith WC, Tsan MF, Wagner HN: Factors affecting the uptake of 99mTc-sulfur colloid by the lung and kidney. J Nucl Med 17:681-684, 1976 6. Cannon P J: The kidney in heart failure. N Engl J Med 296:26-32, 1977
7. Shook DR, Shafer RB: Renal uptake of 99mTc-sulfur colloid. Clin Nucl Med 1:223-225, 1975 8. Coleman RE: Renal colloid localization. J Nucl Med 15:367-368, 1974 9. Higgins CB, Taketa RM, Taylor A, et al: Renal uptake 99mTc-sulfur colloid. J Nucl Med 15:564-566, 1974 10. Klingensmith WC, Datu JA, Burduck DC: Renal uptake of 99mTc-sulfur colloid in congestive heart failure. Radiology 127:185-187, 1978 11. Jackson GL: Renal accumulation of 99mTc-SC. Clin Nucl Med 2:176, 1977 12. Kirchner PT (ed): Nuclear Medicine Review Syllabus. New York, Society of Nuclear Medicine, 1980, p 293 13. Fisher SM, Brown RG, Greyson ND: Unbinding of 99mTcby iodinated antiseptics. J Nucl Med 18:1139, 1977 14. Kuni CC, Klingensmith WC: Renal uptake of 99mTcSC in liver transplant patients. Clin Nucl Med 4:335-337, 1979