Mahfooz Akhtar ( Atomic Energy Medical Centre, Mayo Hospital, Lahore. )
Maqbool Shahid ( Atomic Energy Medical Centre, Mayo Hospital, Lahore. )
A patient having a tumour in the right para-aortic region (proved to be a non-Hodgkin Lymphoma on biopsy) was for the first time detected by a non-invasive, isotope study with TC99m MMSA for renal blood flow. The lesion was outlined due to displacement of aorta and involvement of the upper pole of the right kidney as seen 15 seconds after the I.V. injection of MMSA (JPMA 35:51, 1985).
The technique of taking sequential pictures over the kidneys after giving an intravenous injection of pertechnetate was first used in 1.966 to find out the state of renal blood flow in the transplanted kidney1. The technique has the advantage of giving more or less similar information noninvasively as obtained by aortography which is an invasive technique and is also contraindicted in cases of renal function impairment. Later on the pertechnetate was substituted for Tc99m -Glucoheptonate which gives the same information as pertechnetate about the transit through the renal tissue and at the same time gives a static image of the kidney at the conclusion of the study2.
This technique was later on used for detecting extent of renal injuries3 and differentiating between vascular and avascular focal defect in the kidney4.
At the Atomic Energy Medical Centre, Mayo Hospital, we have used Tc99m-Monomer. captosuccinic acid (MMSA) both for the renal flow study and renal imaging.5 The advantage is that both these tests are performed by a single injection of radiopharmaceutical. MMSA is excreted by the kidney tubules and is an ideal substance for renal imaging. The patient is positioned under the Gamma Camera in prone position with a pillow under his abdomen and the detector focused to view both the kidneys and the area around. After an injection of Tc99m MMSA (5 mci) immediate sequential pictures are taken at the intervals of 5 seconds for one minute obtaining 12 frames, and a static picture is taken after about 15 minutes to complete the study.
The most important point to be stressed in the report is, the non-invasiveness of the technique like most of the other isotope procedures.
1. Rosenthal, L. Radionucide angiography as a method for detecting relative difference in renal flow. J. Canad.Ass. RadioL, 1968; 19 8.
2. Rosenthal, L. Radiotechnetium renogr7 hy in Renovascular Hypertention, Radionuclid adies of Germitoimmunary. New York, Grune and Stratton, 1974.
3. Mordecai, et al. Traumatic Injuries of the Renal Vasculature and Parenchyme. Radionuclide studies of the Germitoirninunary system. New York Grune and Stratton, 1974.
4. Jose, 0. Marales. Space occupying Lesions of the Kidney. Radionuclide studies of the Germitoimmunary system. New York, Grune and Stratton, 1974.
5. Faiz-ur-Rehman, et al. Technetium-99m-Sn-Mono mercaptosuccinic Acid (MMSA)A potential Radiopharmaceutical for Renal Studies. J. Nucl. Med., 1982; 23 72.