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• W2325261165 abstract "You have accessJournal of UrologyImaging/Radiology: Uroradiology IV1 Apr 2016PD14-09 ANALYSIS OF TRACER CLEARANCE AT 40 MIN IN MAG 3 RENAL SCANS IDENTIFIES PATIENTS WITH SYMPTOMATIC UPJ OBSTRUCTION BUT NORMAL T1/2 Friedrich-Carl von Rundstedt, Jason Scovell, Wesley A. Mayer, and Richard E. Link Friedrich-Carl von RundstedtFriedrich-Carl von Rundstedt More articles by this author , Jason ScovellJason Scovell More articles by this author , Wesley A. MayerWesley A. Mayer More articles by this author , and Richard E. LinkRichard E. Link More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1006AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The diagnosis of a ureteropelvic junction (UPJ) obstruction is based on clinical symptoms, radiologic appearance and functional imaging. The clearance of the tracer in a MAG 3 lasix renal scan is indicative for the level of obstruction and universally measured by the T1/2. However patients with the clinical picture of a UPJ obstruction may have a normal T1/2. We aimed to explore alternative measures in the renal scan that can be used as an adjunct to T1/2 to increase the diagnostic accuracy for the detection of UPJ obstruction. METHODS We reviewed the charts of 172 consecutive patients who underwent a laparoscopic or robotic-assisted pyeloplasty for UPJ obstruction between 2005 and 2015. Pre and postoperative MAG3 lasix-washout renal scan images were available for review in 37 patients with primary unilateral UPJ obstruction and two kidneys. We defined P40 as the percentage of maximal tracer count (T max) present at 40 minutes. We generated a reference range using the pre-operative renal scans from the unaffected kidney (mean +/- 2SD) and evaluated its utility as an adjunct or alternative to T1/2. We determined the percentage of patients who had normalization of the P40 value after pyeloplasty. RESULTS Renal scans from 37 symptomatic patients were analyzed. 19 patients presented with a normal T1/2 (mean 9.0 +/- 4.9 min) and 18 with an abnormal T1/2 (36.7 +/- 6.4 min). Using data from the unaffected kidney, we determined that the upper-limit of normal (97.5th percentile) for P40 in our population was 0.244. We validated this range using values from the unaffected kidney on the post-operative renal scan and identified no patients with an abnormal P40 on their unaffected kidney. 73.0% (n=27) of patients had an abnormal P40, whereas only 48.6% (n=18) had abnormal T1/2. All patients with an abnormal T1/2 also had an abnormal P40. In the subset of patients with a normal T1/2 an additional 47.4% (n=9) of patients had an elevated P40 increasing the sensitivity of the renal scan from 48.6% to 73.0%. All patients with an abnormal preoperative T1/2 showed an improvement in P40 after pyeloplasty (0.898 vs. 0.399, p<0.01) and 84.2% (n=16) of patients with a normal preoperative T1/2 had a significantly lower p40 post pyeloplasty (0.235 vs. 0.150, p<0.01). CONCLUSIONS The utilization of P40 markedly increases the sensitivity of a renal scan for the diagnosis of a UPJ obstruction and may be a valuable test to document functional improvement after a pyeloplasty. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e306 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Friedrich-Carl von Rundstedt More articles by this author Jason Scovell More articles by this author Wesley A. Mayer More articles by this author Richard E. Link More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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