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Fig. 3A —40-year-old man referred for mercaptoacetyl-triglycine (MAG3)
scanning because of suspected obstruction. QuantEM (developed at Emory
University, licensed to GE Healthcare) review of baseline scan shows no
infiltration. Camera-based MAG3 clearance is normal. Left kidney shows rapid
uptake and washout of tracer in sequential 2-minute images (center).
Relative uptake of left kidney is 56%, whole-kidney half-time
(T
) is 10.8 minutes, and postvoid to maximum count ratio
(postvoid/max) is normal (B) excluding obstruction. Relative function
of right kidney was 46%, and right kidney showed dilatation of renal pelvis,
which can be appreciated on 2-minute image as well as on enlarged 2- to
3-minute image (B). T for whole-kidney region of
interest (ROI) was prolonged at 20.3 minutes and 20-minute-to-maximum-count
ratio (20/max) was elevated at 0.58. However, visually pelvis empties after
voiding and postvoid/max was 0.20 (B). Although postvoid/max count
ratio is slightly elevated (0.16 is the upper limit of normal
[15]), experts' and clinical
decisions were that furosemide was not indicated. CARTAN agreed with experts,
but RENEX concluded that furosemide was needed to exclude obstruction of right
kidney (see Discussion). Tmax = time to maximum count ratio, 20/max =
20-minute-to-maximum-count ratio, k = kilo.
