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Advisor(s)
Abstract(s)
O renograma com 99mTc-MAG3 permite a avaliação funcional do sistema urinĂĄrio em utentes adultos e pediĂĄtricos. O protocolo para a realização do renograma tem vindo a padronizar-se, de acordo com recomendaçÔes internacionais. As guidelines mais recentes recomendam que, nos renogramas, a avaliação seja efetuada atravĂ©s de dois indicadores: a função renal relativa (FRR) e a excreção renal do traçador. Assim, surgiu a Atividade Residual Normalizada (NORA â Normalized Residual Activity), que Ă© indicada para a avaliação de drenagem, e representa a quantidade de atividade que permanece no rim num dado instante comparativamente com a presente no segundo minuto do estudo. Pode ser calculada no final do estudo dinĂąmico (NORA20), em imagens adquiridas apĂłs a micção, precocemente apĂłs o estudo dinĂąmico (NORAPMi) e mais tardiamente (NORAPMt).
O objetivo desta dissertação visou estabelecer valores de referĂȘncia da NORA por grupo etĂĄrio, tipo de rim (normais, dilatados e obstruĂdos) e diferentes momentos de cĂĄlculo. TambĂ©m se pretendeu estudar a influĂȘncia da visualização da vesĂcula biliar no cĂĄlculo deste parĂąmetro, e avaliar as diferenças entre NORAPMi e NORAPMt bem como o seu impacto no diagnĂłstico de obstrução.
Para a concretização destes objetivos, realizaram-se renogramas com 99mTc-MAG3 em utentes com justificação clĂnica para o exame, e calculou-se, atravĂ©s de um software desenvolvido para o processamento de renogramas, os valores de NORA20, NORAPMi e NORAPMt.
O estudo desenvolvido permitiu obter valores de referĂȘncia para utentes pediĂĄtricos e adultos. Sugere ainda que a visualização da vesĂcula biliar nĂŁo interfere no cĂĄlculo da NORA. A NORAPMi e NORAPMt diferem entre si, exceto em rins obstruĂdos. PorĂ©m, a distinção entre rins dilatados e obstruĂdos atravĂ©s da anĂĄlise da drenagem, apenas Ă© possĂvel atravĂ©s da NORAPMt, o que acentua a importĂąncia de aquisição de imagem de pĂłs-micção entre os 50 e 60 minutos apĂłs o inĂcio do estudo dinĂąmico.
The 99mTc-MAG3 renogram allows functional evaluation of the urinary system in paediatric and adult patients. The protocol for performing this exam must be standardized, according to international recommendations. The most recent guidelines advise that the evaluation be performed through two indicators: relative renal function (RRF) and renal tracer excretion. Thus, Normalized Residual Activity (NORA) has emerged, it is the one indicated to evaluate drainage, and represents the renal counts that are still remaining in the kidney at any moment, divided by the renal counts present in the second minute of the study. It can be calculated at the end of the dynamic study (NORA20) and at postmicturition images, obtained early after the dynamic study (NORAPMi) and later (NORAPMt). The purpose of this project was to determine NORA reference values by age group, kidney condition (normal, dilated and obstructed) and different moments of calculation. It was also intended to study the influence of gallbladder on parameter calculation, and evaluate the differences between NORAPMi and NORAPMt and their impact on obstruction diagnosis. To achieve these objectives, 99mTc-MAG3 renograms were performed in patients with clinical justification for this exam, and NORA20, NORAPMi and NORAPMt values were calculated using a software developed for renograms processing. This project allowed us to obtain reference values for paediatric and adult patients. It also suggests that visualization of gallbladder does not interfere with NORA calculation. NORAPMi and NORAPMt differ from each other except for obstructed kidneys. Moreover, the distinction between dilated and obstructed kidneys through drainage analysis is only possible with NORAPMt, so in these cases it is very important to acquire a post-micturition image between 50 and 60 minutes after the beginning of the dynamic study.
The 99mTc-MAG3 renogram allows functional evaluation of the urinary system in paediatric and adult patients. The protocol for performing this exam must be standardized, according to international recommendations. The most recent guidelines advise that the evaluation be performed through two indicators: relative renal function (RRF) and renal tracer excretion. Thus, Normalized Residual Activity (NORA) has emerged, it is the one indicated to evaluate drainage, and represents the renal counts that are still remaining in the kidney at any moment, divided by the renal counts present in the second minute of the study. It can be calculated at the end of the dynamic study (NORA20) and at postmicturition images, obtained early after the dynamic study (NORAPMi) and later (NORAPMt). The purpose of this project was to determine NORA reference values by age group, kidney condition (normal, dilated and obstructed) and different moments of calculation. It was also intended to study the influence of gallbladder on parameter calculation, and evaluate the differences between NORAPMi and NORAPMt and their impact on obstruction diagnosis. To achieve these objectives, 99mTc-MAG3 renograms were performed in patients with clinical justification for this exam, and NORA20, NORAPMi and NORAPMt values were calculated using a software developed for renograms processing. This project allowed us to obtain reference values for paediatric and adult patients. It also suggests that visualization of gallbladder does not interfere with NORA calculation. NORAPMi and NORAPMt differ from each other except for obstructed kidneys. Moreover, the distinction between dilated and obstructed kidneys through drainage analysis is only possible with NORAPMt, so in these cases it is very important to acquire a post-micturition image between 50 and 60 minutes after the beginning of the dynamic study.
Description
Trabalho final de mestrado para obtenção do grau de mestre em Engenharia Biomédica
Keywords
Renograma Renogram Drenagem Drainage Rim Kidney VesĂcula biliar Gallbladder Atividade residual normalizada Normalized residual activity NORA
Pedagogical Context
Citation
BENTO, Bianca Correia - Valores de referĂȘncia para cĂĄlculos da atividade residual normalizada em renogramas com 99mTc-MAG3. Lisboa: Instituto Superior de Engenharia de Lisboa - Escola Superior de Tecnologia da SaĂșde de Lisboa, 2018. Dissertação de mestrado.
Publisher
Instituto Superior de Engenharia de Lisboa - Escola Superior de Tecnologia da SaĂșde de Lisboa