The value of different washout parameters in the evaluation of renal transplants by technetium-99m-ethylene- l-l-dicysteine

Technetium-99m-ethylene-l-l-dicysteine ((99m)Tc-EC) is an agent with a potential for renal imaging. It is reported that EC uses the same tubular transporter system as ortho-hippurate (OIH) and mercaptoacetyltriglycine (MAG3) and that this agent has good imaging properties and higher renal clearance than MAG3. In this study we used (99m)Tc-EC to compare different washout parameters in renal transplanted patients. Sixty nine scans in 55 patients (38 males, 17 females) were performed with (99m)Tc-EC during the follow-up period after kidney transplantation. After bolus injection of 280MBq (99m)Tc-EC, 60x1sec and 29x1min images were taken in anterior position. Perfusions of transplanted kidneys were examined visually and perfusion indices (PI) were calculated according to Hilson's method. The semiquantitative washout parameters such as 20 and 30min to peak activity ratios and 20 and 30min to 3min activity ratios were calculated. The patients were clinically evaluated by nephrologists experienced in renal transplantation cases and followed-up by serum creatinine and blood urea nitrogen determinants which were checked every postoperative day until stabilized to a optimal level for each patient. Two standard deviations above the mean values derived from all cases with normal functioning transplanted kidneys were calculated for each method. Then, these values served as the threshold to differentiate the pathological cases respectively. Of the 69 total studies performed, we found 34 normal kidneys, 14 rejections, 19 acute tubular necrosis (ATN) and 2 cyclosporin A toxicity cases. The number of abnormal cases detected with 30/3min, 30/max, 20/3min and 20/max indices were 27, 26, 24, and 18, respectively. In conclusion, we strongly recommend in studying renal transplants to consider the activity at the 3(rd) min post injection as a reference point instead of the time to maximum activity for washout index calculation. If, for any reason the time to maximum counts using (99m)Tc-(peak activity) is prefered, then the period of study should not be performed for less than 30min to achieve reliable results.