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

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

• LITERATUR

• 1 Arlart I, Rosenthal J, Adam WE, Bargon G, Franz HE. Predictive value of radionuclide methods in the diagnosis of unilateral renovascular hypertension. Cardiovasc Radiol 1979; 02: 115-25.
• 2 Blaufox MD. Cost-effectiveness of nuclear medicine procedures in renovascular hypertension. Semin Nucl Med 1989; 19: 116-21.
• 3 Brandau W, Bubeck B, Berger J, Georgi P. Excretion characteristics of Tc-99m-MAG₃ in patients. In: Schmidt HAE, Buraggi GL. (Hrsg). Trends and possibilities in nuclear medicine. Stuttgart, New York: Schattauer; 1988
• 4 Bubeck B, Brandau W, Eisenhut M, Weidenhammer K, Georgi P. The tubular extraction rate (TER) of ^99mTc-MAG₃: a new quantitative parameter of renal function. NucCompact 1987; 18: 260-7.
• 5 Bubeck B, Brandau W, Weber E, Kälble T, Parekh N, Georgi P. Pharmacokinetics of Technetium-99m-MAG₃ in Humans. J Nucl Med 1990; 31: 1285-93.
• 6 Carmichael DJS, Snell ME, Mathias CJ, Peart S. Detection and investigation of renal artery stenosis. Lancet I 1986; 667-70.
• 7 Cuocolo A, Esposito S, Volpe M, Celentano L, Brunetti A, Salvatore M. Renal artery stenosis detection by combined Gates’ technique and captopril test in hypertensive patients. J Nucl Med 1989; 30: 51-6.
• 8 Degenhardt S, Friedrich H, Wambach G, Fischer JH, Gross-Fengels W, Linden A, Neufang KF, Hümmerich W. Der Stellenwert des Captopriltests in der Hypertoniediagnostik. Klin Wochenschr 1989; 67: 1077-84.
• 9 Distier A, Spies K-P, Fobbe F. Diagnostik der renovaskulären Hypertonie. Dt Ärztebl 1992; 89 A₁. 923-31.
• 10 Dondi M, Fanti S, de Fabritiis A, Zuccalà A, Gaggi R, Mirelli M, Stella A, Marengo M, Losinno F, Monetti N. Prognostic value of captopril renal scintigraphy in renovascular hypertension. J Nucl Med 1992; 33: 2040-4.
• 11 Dondi M, Franchi R, Levorato M, Zuccala A, Gaggi R, Mirelli M, Stella A, Marchetta F, Losinno F, Monetti N. Evaluation of hypertensive patients by means of captopril enhanced renal scintigraphy with technetium-99m DTPA. J Nucl Med 1989; 30: 615-21.
• 12 Dondi M, Monetti N, Fanti S, Marchetta F, Corbelli C, Zagni P, De Fabritis A, Losinno F, Levorato M, Zuccala A. Use of technetium-99m-MAG₃ for renal scintigraphy after angiotensin-converting enzyme inhibition. J Nucl Med 1991; 32: 424-8.
• 13 Dubovsky EV, Russell CD, Japanwalla M, Mangipudy M. Bilateral response to captopril is nonspecific. Eur J Nucl Med 1991; 18: 575 (Abstract).
• 14 Fine EJ, Sarkar S. Differential diagnosis and management of renovascular hypertension through nuclear medicine techniques. Semin Nucl Med 1989; 19: 101-15.
• 15 Fommei E, Ghione S, Palla L, Mosca F, Ferrari M, Palombo C, Giaconi S, Gazzetti P, Donato L. Renal scintigraphic captopril test in the diagnosis of renovascular hypertension. Hypertension 1987; 10: 212-20.
• 16 Fritzberg AR, Kasina S, Eshima D, Johnson DL. Synthesis and biological evaluation of technetium-99m MAG₃ as a hippuran replacement. J Nucl Med 1986; 27: 111-6.
• 17 Geyskes GG, Oei HY, Puylaert CBAJ, Dorhout EJMees. Renovascular hypertension identified by captopril-induced changes in the renogram. Hypertension 1987; 09: 451-8.
• 18 Gosse P, Dupas JY, Reynaud P, Jullien E, Dallocchio M. Captopril test in the detection of renovascular hypertension in a population with low prevalence of the disease. A prospective study. Am J Hypertens 1989; 02: 191-3.
• 19 Hricik DE, Browning PJ, Kopelman R, Goorno WE, Madias NE, Dzau VJ. Captopril-induced functional renal insufficiency in patients with bilateral renal-artery stenoses or renal-artery stenosis in a solitary kidney. New Engl J Med 1983; 308: 373-6.
• 20 Jafri RA, Britton KE, Nimmon CC, Solanki K, Al-Nahhas A, Bomanji J, Fettich J, Hawkins LA. Technetium-99m MAG₃, a comparison with iodine-123 and iodine-131 orthoiodohippurate, in patients with renal disorders. J Nucl Med 1988; 29: 147-58.
• 21 de Jong PE, de Zeeuw D. Renale Wirkungen der Konversionsenzymhemmer. Dtsch Med Wschr 1991; 116: 743-62.
• 22 Jonker G-J, de Zeeuw D, Huisman RM, Piers DB, Beekhuis H, van der Hem GK. Angiotensin converting enzyme inhibition improves diagnostic procedures for renovascular hypertension in dogs. Hypertension 1988; 12: 411-9.
• 23 Kopecky RT, McAfee JG, Thomas FD, Anderson GH, Hellwig B, Roskopf M, Patchin D. Enalaprilat-enhanced renography in a rat model of renovascular hypertension. J Nucl Med 1990; 31: 501-7.
• 24 Kremer TKHovinga, Beukhof JR, van Luyk WHJ, Piers DA, Donker AJM. Reversible diminished renal ^99mTc-DMSA uptake during converting-enzyme inhibition in a patient with renal artery stenosis. Eur J Nucl Med 1984; 09: 144-6.
• 25 Kremer TKHovinga, de Jong PE, Piers DA, Beekhuis H, van der Hem GK, de Zeeuw D. Diagnostic use of angiotensin converting enzyme inhibitors in radioisotope evaluation of unilateral renal artery stenosis. J Nucl Med 1989; 30: 605-14.
• 26 Kutkuhn B, Kaup FG, Torscllo G, Grabensee B. Captopril-stimulierte Plasma-Renin- Aktivität in der Diagnostik der renovaskulären Hypertonie. Dtsch Med Wschr 1988; 113: 719.
• 27 Kutkuhn B, Szabo Z, Torsello G, Grabensee B. Endokrine und nuklearmedizinische Diagnostik der renovaskulären Hypertonie. Dtsch Med Wschr 1989; 114: 1828-32.
• 28 Lamki L, Spence JC, MacDonald AC, Roulston M. Differential glomerular filtration rate in diagnosis of renovascular hypertension and follow-up of balloon angioplasty. Clin Nucl Med 1986; 11: 188-93.
• 29 Lee H-B, Blaufox MD. Renal functional changes after converting enzyme inhibition or nitroprusside in hypertensive rats. Contr Nephrol 1987; 56: 87-94.
• 30 Lee H-B, Blaufox MD. Technetium-99m MAG₃ clearances after captopril in experimental renovascular hypertension. J Nucl Med 1989; 30: 666-71.
• 31 Lepage R, Lemieux RJ, Cartier P, Charlebois N, McNamara D. Pre post captopril Tc-99m MAG₃ renography: correlation with renal angiography and plasma renin activity. J Nucl Med 1991; 31: 934.
• 32 McAfee JG, Kopecky RT, Thomas GD, Hellwig B, Roskopf M. Comparison of different radioactive agents for the detection of renovascular hypertension with captopril in a rat model. J Nucl Med 1988; 29: 509-15.
• 33 Muller FB, Sealey JE, Case DB, Atlas SA, Pickering TG, Pecker MS, Preibisz JJ, Laragh JH. The captopril test for identifying renovascular disease in hypertensive patients. Am J Med 1986; 80: 633-44.
• 34 Nally JV, Gupta BK, Clarke HS, Higgins JT, Potvin WJ, Gross ML. Captopril renography for the detection of renovascular hypertension. Cleve Clin J Med 1988; 55: 311-8.
• 35 Nitzsche E, Grosser G, Rump C, Strauß E, Meyer E, Keller E, Moser E. Captopril- Nierenfunktionsszintigraphie (C-NFSZ) bei der Abklärung der arteriellen Hypertonie. Radiologe 1991; 31: 141-6.
• 36 Oei HY, Geyskes GG, Dorhout EJMees, Puylaert CBAJ. The significance of captopril renography in renovascular hypertension. Contr Nephrol 1987; 56: 95-103.
• 37 Peters AM, Brown J, Crossman D, Brady AJ, Hemingway AP, Roddie ME, Allison DJ. Noninvasive measurement of renal blood flow with technetium-99m-DTPA in the evaluation of patients with suspected renovascular hypertension. J Nucl Med 1990; 31: 1980-5.
• 38 Pickering TG. Renovascular hypertension: etiology and pathology. Semin Nucl Med 1989; 19: 79-88.
• 39 Rödler HD, Kaul A, Hine G. Internal radiation dose in diagnostic nuclear medicine. Berlin: Hoffmann; 1978
• 40 Russell CD, Yester MV, Dubovsky EV. Measurement of renal parenchymal transit time of ^99mTc-MAG₃ using factor analysis. Nucl-Med 1990; 29: 170-6.
• 41 Sfakianakis GN, Bourgoignie JJ, Jaffe D, Kyriakides G, Perez-Stable E, Duncan RC. Single-dose captopril scintigraphy in the diagnosis of renovascular hypertension. J Nucl Med 1987; 28: 1383-92.
• 42 Tack C, Sos TA. Radiologic diagnosis of renovascular hypertension and percutaneous transluminal renal angioplasty. Semin Nucl Med 1989; 19: 89-100.
• 43 Taylor A, Eshima D, Fritzberg AR, Christian PE, Kasina S. Comparison of iodine- 131 OIH and technetium-99m MAG₃ renal imaging in volunteers. J Nucl Med 1986; 27: 795-803.
• 44 Taylor A, Eshima D, Christian PE, Wooten WW, Hansen L, McElvany K. Technetium- 99m MAG₃ kit formulation: preliminary results in normal volunteers and patients with renal failure. J Nucl Med 1988; 29: 616-22.
• 45 Thornbury JR, Stanley JC, Fryback DG. Hypertensive urograms: a nondiscriminatory test for renovascular hypertension. AJR 1982; 139: 19-24.
• 46 Thorstad BL, Russell CD, Dubovsky EV, Keller FS, Luke RG. Abnormal captopril renogram with a technetium-99m-labeled hippuran analog. J Nucl Med 1988; 29: 1730-7.
• 47 Wenting GJ, Tan-Tjiong HL, Derkx FHM, de Bruyn JHB, Man in ’t Veld AJ, Schalekamp MADH. Split renal function after captopril in unilateral renal artery stenosis. Brit Med J 1984; 288: 886-90.