99mTc-DMSA planar imaging versus dual-detector SPECT for the detection of renal cortical scars in patients with CKD-3.

OBJECTIVE

The aim of this study was to compare planar technetium-99m-dimercaptosuccinic acid (Tc-DMSA) cortical scintigraphy with Tc-DMSA single-photon emission computed tomography (SPECT) for the detection of renal cortical scars in patients with chronic kidney disease stage-3 (CKD-3).

PATIENTS AND

METHODS

Data of 40 patients (mean age: 43.7±15.3 years, 29 men, 11 women) who underwent planar Tc-DMSA along with regional Tc-DMSA SPECT for the detection of renal cortical scars were prospectively evaluated. All the patients had CKD-3, with a mean serum creatinine level of 2.23±1.85 g/dl. Planar and SPECT Tc-DMSA images were evaluated by two nuclear medicine readers independently. Each kidney was divided into 12 cortical segments. A cortical segment was recorded as abnormal if it had reduced or absent radiotracer activity. The linear correlation coefficient (r value) for the number of abnormal segments detected between readers was calculated for planar imaging, SPECT, and between the two techniques for both the readers.

RESULTS

For both observers, the average correlation coefficient for SPECT (r=0.87) and planar imaging (r=0.90) was high (P<0.0001). A moderately strong linear correlation was also observed between readers for planar imaging and SPECT (r=0.78 and 0.71, P<0.0001). There was no significant difference in the average number of abnormal segments detected by planar versus SPECT imaging: 2.1 for planar imaging and 2.8 for SPECT (P=0.06, two-tailed). In 15% of patients, SPECT detected cortical defects not appreciated on planar imaging.

CONCLUSION

Tc-DMSA renal cortical imaging using dual-head SPECT offers no statistically significant diagnostic advantage over planar imaging for the detection of cortical defects in patients with CKD-3.