Advantages of multi-target scintigraphy in the diagnosis of kidney cancer

Abstract

Background. There has been a recent increase in the incidence of kidney cancer, which is explained not only by the improvement in the diagnosis of neoplasms but also by a true increase in the incidence of renal cell cancer. This led to the need for in-depth study and solution of the following problem: to prove the benefits of multi-target scintigraphy for the assessment of the functional capacity of kidneys in establishing the diagnosis of kidney cancer and early detection of secondary lesion of the skeleton during the primary full examination of the patient, as well as in monitoring of the disease. Purpose. For the first time to prove diagnostic significance of a multi-target scintigraphic examination with a radiopharmaceutical drug with renal and osteotropic kinetics, in the form of a sequential combination of dynamic renal scintigraphy and osteoscintigraphy (as one diagnostic examination) in the early detection of secondary lesion of the bones of the skeleton and simultaneous determination of the functional capacity of kidneys in the pre-treatment period and in monitoring of the course of kidney cancer. Materials and methods. Dynamic renal scintigraphy and subsequent (within the next 3 hours) osteoscintigraphy with 99mTc-methylenediphosphonic   acid (99mТс-MDP) (activity of 370–740 MBq) were performed on the SPECT-1 gamma camera «AMCRIS-H Limited» (Ukrainian-American enterprise) with computer software «Spect Work» (Ukraine) at the premises of the Department of Radiology and Radiation Medicine of Bogomolets National Medical University in the Department of Radionuclide Diagnostics of communal non-commercial enterprise «Kyiv City Clinical Hospital No.18». 20 patients with a morphologically established diagnosis of kidney cancer, aged from 38 to 68 years, were examined before the full diagnosis was established according to TNMx. As a control group, 8 patients with ultrasonography-confirmed cystic lesions of the kidneys were examined. Results. Using a radiopharmaceutical drug with renal and osteotropic kinetics in the form of a simultaneous sequential combination of dynamic renal scintigraphy and osteoscintigraphy (as one diagnostic examination) allowed us to assess the degree of deterioration of the filtering and excretory capacity of the kidneys regardless of the origin of the expansive process. The results of dynamic renal scintigraphy with 99mТс-MDP made it possible to assess functional capacity of the kidneys no worse than specific renal imaging agents in subsequently given possibility to determine secondary lesion of the bones of the skeleton in osteoscintigraphy. We established indicators of development of renal compensation process and subsequent decompensation process of the contralateral kidney. It was especially noticeable when analyzing the asymmetry of the fixation of the radiopharmaceutical in the functioning kidney parenchyma, depending on the degree of the disease progression. 20 patients with kidney cancer underwent osteoscintigraphy for the complete diagnosis to be established according to TNM. The following changes were detected: the presence of heterogeneous focal (17,8% of the cases) and multifocal (7,1% of the cases) distribution of the radiopharmaceutical. Conclusions. Performing a multi-target scintigraphy with 99mТс-MDP (phosphates) in malignant process in the kidney allows the functional capacity of the kidneys and the presence of the secondary lesion of the bones to be assessed in one exami- nation. Besides reducing radiation burden on the patient (one examination instead of two), it is also economically beneficial.