Renal Transplant Complications Detected by SPECT/CT Fused Imaging

"SPECT and CT fused images provide both functional and anatomical information about the kidney, which provides better diagnostic capability and greater confidence to our physicians,” said Shashi Khandekar, administrator of the nuclear medicine department, Cleveland Clinic (Cleveland, OH, USA). "We are becoming more technologically savvy and we strongly feel that as more and more clinicians use hybrid SPECT/CT imaging, technologists also need to be prepared and acquire all of the necessary qualifications for this technology.”

The study combined SPECT and CT imaging techniques to provide an in-depth portrait of the biologic processes of renal function. Conventionally, physicians have used two-dimensional planar imaging to evaluate post-renal transplant complications, which include urinary leak, infection, and transplant nonviability or kidney failure. However, a recent retrospective study conducted by the Cleveland Clinic revealed that three-dimensional (3D) SPECT/CT hybrid imaging is suitable for imaging these and other disease states. Employing SPECT/CT imaging may even answer clinical questions that could otherwise have led to additional imaging studies, invasive biopsies, and delayed treatment for the patient.

The retrospective study involved 12 renal transplant cases in which 10 patients were suspected of having a urinary leak, 1 patient showed evidence of kidney failure and 1 patient was thought to have a transplant-associated infection. After traditional planar imaging, all patients were scanned using noncircular SPECT imaging and low dose noncontrast CT imaging using a hybrid SPECT/CT system.

The use of SPECT/CT with Tc99m-MAG3, an imaging agent taken up by the kidneys and used to assess renal function, helped clinicians positively detect urinary leaks for seven of the 10 patients when fused imaging revealed fluid outside the anatomic confines of the patients' urinary system. The molecular imaging technique was also able to successfully identify kidney failure using the same agent, and infection was detected in one patient injected with In-111 labeled WBC (white blood cell), an agent that helps image leukocyte activity associated with the body's immune response.

The study's findings were presented at the Society of Nuclear Medicines (SNM) 57th annual meeting, June 5-9, 2010, in Salt Lake City, UT, USA.

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