RadteraRenal Cortical Scan (Tc-99m DMSA)
NM+ ContrastAbdomen & Pelvis
Indications
- Acute pyelonephritis (cortical defects)
- Renal scarring after UTI / reflux nephropathy
- Differential (split) cortical function
- Evaluation of ectopic/dysplastic kidney, column of Bertin vs mass
Patient prep
- Hydration encouraged
- No fasting required
- Empty bladder before imaging (children)
Contrast
AgentTc-99m DMSA (dimercaptosuccinic acid; cortical-binding agent)
RouteIV
Dose3-5 mCi (111-185 MBq) adult; weight-based for children
TimingImaging 2-4 hours after injection (cortical fixation)
Technique
- LEHR or pinhole collimator, 140 keV
- Planar posterior and posterior oblique views; pinhole magnification (esp. pediatrics)
- SPECT improves detection of scars/defects
- Compute relative (split) function from posterior counts
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Posterior planar | Posterior | 2-4 h post-injection |
| 2 | Posterior obliques (RPO/LPO) | Oblique | Separate kidneys, characterize polar defects |
| 3 | SPECT (optional) | Axial | Improved scar/defect detection |
Key points
- Acute pyelonephritis: wedge-shaped cortical defect without volume loss; scar: defect with cortical thinning/volume loss
- DMSA is the gold standard for renal cortical imaging and split cortical function
- Pinhole/magnified views valuable in children
- Differentiate pseudotumor (column of Bertin) showing normal uptake from true mass (photopenic)
References
• SNMMI/EANM Practice Guideline for Tc-99m DMSA Renal Cortical Scintigraphy
• Radiopaedia: DMSA scan link
• Radiopaedia: DMSA scan link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.