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General Clinical Specialties: Renal/Electrolyte/HypertensionNephro-Urology |
1 Joint Program of Nuclear Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts; 2 Children's Hospital, Boston, Massachusetts
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Objectives: To determine whether dose reduction up to 50% is possible in pediatric DMSA renal SPECT when image reconstruction is performed with a 3D OSEM reconstruction with resolution recovery.
Methods: 50 sequential DMSA renal SPECTs were performed at our institution. Studies were acquired on a dual detector gamma camera with each detector achieving a 360° rotation. Images were reconstructed from both detectors using filtered back projection (FBP) and from one detector using OSEM with resolution recovery. The images were reviewed by two nuclear medicine physicians blinded to patient data. Image sets were evaluated for qualitative assessment of renal scarring and image quality and quantitative analysis of renal size and function.
Results: We reviewed 50 studies with 98 kidneys (36 f, 14 m). Mean age was 8.6 ± 6.8 yrs (range 1-24), mean weight was 33 ± 27 kg and mean dose was 1.6 mCi. Image quality was significantly better with OSEM reconstruction (p<0.001, paired t test). Scarring was quantified using a 15 point scale (14.3 ± 1.4 with OSEM,14.4 ± 1.4 with FBP reconstruction). Among 98 kidneys, 19 showed scaring and 75 no scaring on both techniques; in 4 cases FBP showed no scaring and OSEM showed scaring. No kidneys were normal with OSEM and showed scarring with FBP reconstruction. There were no statistically significant differences between the methods in evaluating percent renal function (p=0.97).
Conclusions: DMSA renal SPECT may be obtained with substantial dose reduction when OSEM with resolution recovery is used. This technique may also be superior even at a lower dose in image quality and sensitivity.
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