Renal Perfusion with Tc-99m DTPA???Simple Noninvasive Determination of Extraction Fraction and Plasma Flow

A simple, noninvasive method for the determination of extraction fraction and renal plasma flow in Tc-99m DTPA studies is presented. This method could be performed in conjunction with the measurement of glomerular filtration rate, providing additional information about renal plasma flow. Graphic analysis of the Patlak plot was employed for the determination of the unidirectional influx rate constant (ku) of Tc-99m DTPA from the blood to the kidney and the initial nonspecific distribution volume (Vn) in the kidney. The first pass extraction fraction was estimated from Ku and Vn, assuming a bolus input to the kidney. The glomerular filtration rate was measured by renal counting corrected for depth and dose. Using the estimated extraction fraction (EF) and glomerular filtration rate (GFR), the renal plasma flow (RPF) was calculated using the formula of RPF = GFR/EF. In a total of 76 kidneys in 38 patients (including 9 patients with normal renal function and without evidence of nephrourologic disease), the value of renal plasma flow showed good correlation with that of effective renal plasma flow measured by renal counting with I-131 orthoiodohippuran. There was a characteristic tendency for the extraction fraction to show a larger value as the renal plasma flow decreased. These results indicate that this method is valid for renal plasma flow estimation and the determinations of extraction fraction and renal plasma flow in Tc-99m DTPA studies is helpful as an adjunct to the measurement of glomerular filtration rate in order to adequately assess the pathophysiologic changes of renal disorders.