Non-invasive measurement of renal blood flow with 99mTc DTP A: comparison with radiolabeled microspheres

Abstract

This technique for non-invasive measurement of renal blood flow is based on the principle of fractionation of cardiac output, and applicable with any recirculating gamma activity tracer. It effectively determines the count rate that would be recorded over the kidney if the tracer behaved like radiolabeled microspheres and was completely trapped in the kidney on first pass. After correction for kidney depth, the estimated first pass activity plateau, expressed as a fraction of the injected dose, is equal to the kidney's fraction of cardiac output. The principle of the technique was validated by comparison with renal blood flow based on radiolabeled microspheres. Nine separate comparisons were made in two anaesthetised dogs. A known dose of ^99mTc radiolabeled microspheres (particle size 23-45 μm) was injected into the left ventricle and the count rate over each kidney recorded. A known dose of ^99mTc diethylenetriaminepenta acetic acid (DTPA) was then given as an intravenous bolus and the data recorded dynamically with a gamma camera online to a computer. After subtraction of the stable signal arising from the preceding radiolabeled microspheres, the theoretical first pass activity plateau from the DTPA that would have been recorded if the DTPA, after reaching the systemic circulation, had behaved like radiolabeled microspheres and become completely trapped in the renal vascular bed, was estimated. Using doses based on syringe counts before and after injection the ratio of renal blood flow values given by the two techniques (DTPA:RLMS) was 1.14 (SD 0.22) for the left kidney and 1.1(0.17) for the right. Using doses based on whole body counts, corresponding ratios were 1.05(0.11) and 1.02(0.13). The variations in the ratios were less when based on this dose estimate, probably because of difficulties in accurately measuring the syringe dose of radiolabeled microspheres. Renal blood flow measured with this new technique is at least as accurate as that given by left ventricular injection of radiolabeled microspheres.