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Optimal Scintigraphic Evaluation of a Hydronephrotic Horseshoe Kidney

Nuclear Medicine Section, Department of Radiology, Boston University Medical Center, Boston, Massachusetts

View larger version (58K): [in this window] [in a new window]   FIGURE 1.  Axial cranial (A) to caudal (B) CT images demonstrate horseshoe kidney with dilated, hydronephrotic left collecting system.

View larger version (55K): [in this window] [in a new window]   FIGURE 2.  Study 1. (A) Dynamic prefurosemide posterior image at 28 min demonstrates asymmetric radiotracer accumulation and retention in left proximal collecting system. (B) Dynamic postfurosemide posterior image at 28 min demonstrates continued marked radiotracer retention.

View larger version (95K): [in this window] [in a new window]   FIGURE 3.  Study 2. (A and B) Dynamic prefurosemide anterior and posterior images at 28 min demonstrate findings similar to those of study 1. (C and D) Static pregravity anterior (C) and posterior (D) images were obtained. After 15 min of ambulation, patient voided. Subsequent static postgravity anterior (E) and posterior (F) images visually appear similar to pregravity images; however, computer region-of-interest activity measurements demonstrated additional 24% radiotracer clearance.

View larger version (71K): [in this window] [in a new window]   FIGURE 4.  Study 2. Two different dynamic postfurosemide anterior and posterior images at 28 min after ambulation demonstrate nearly complete emptying of left renal collecting system. Half-time for emptying was 9 min. Incidentally noted was vicarious hepatobiliary excretion of radiotracer into small bowel.