Case Author(s): Anton J. Johnson, M.D., Ph.D. and Henry D. Royal, M.D. , 1/29/97 . Rating: #D2, #Q5

Diagnosis: Renal cell carcinoma

Brief history:

49 year old male with back pain.


Renal Scintigraphy

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Full history/Diagnosis is available below

Diagnosis: Renal cell carcinoma

Full history:

49 year old male with recently diagnosed renal cell carcinoma involving his right kidney. Renal scintigraphy was requested to evaluate left renal function. The patient has known metastatic disease to bone.


7.8 mCi Tc-99m MAG3 i.v.


The posterior abdominal radionuclide angiogram demonstrates increased blood flow to the upper pole of the right kidney corresponding to the site of the patient's known tumor. There is otherwise prompt, symmetrical perfusion to the remainder of the right and left kidneys. Two additional sites of increased blood flow and blood pool are seen outside of the kidneys -- one at about the level of the L2 vertebral body and the other at about L4 or L5. Both of these regions correspond to sites of known metastatic disease to bone. Sequential one minute images show decreased function in the upper pole of the right kidney. The mid and lower pole of the right and entire left kidney demonstrate normal uptake and excretion.


Renal cell carcinoma (RCC) is the most common malignant tumor of renal origin. It has a peak incidence in the sixth decade, occurs twice as commonly in males, and has a tendency to metastasize to lungs, bone, and liver. Although it commonly presents with painless hematuria, RCC can present with symptoms related to metastatic disease (as in this case). The vast majority of RCC tumors are hypervascular on contrast enhanced CT and conventional angiography. The findings on renal scintigraphy frequently include increased flow on the radionuclide angiogram and decreased activity on the delayed images. The flow findings are variable, however, and lack of increased flow should not be used as an argument against RCC. Fortunately, front line imaging modalities such as CT, US, and MRI are much better than renal scintigraphy at characterizing renal tumors. The value of renal scintigraphy in the workup of renal mass lesions comes from its ability to provide functional information prior to surgical intervention.

References: Datz FL: Gamuts in Nuclear Medicine, 3rd ed. St. Louis, Mosby, 1995, p333. Datz FL: Handbook of Nuclear Medicine, 2nd ed. St. Louis, Mosby, 1993, p168. Dunnick NR, et al: Textbook of Uroradiology, Baltimore, Williams & Wilkins, p113. Sandler MP, et al: Diagnostic Nuclear Medicine, 3rd ed. Baltimore, Williams & Wilkins, pp1201-1202.

View followup image(ct). Single axial image from a CT study shows a large right renal mass as well as a metastatic focus in the posterior right twelfth rib near its vertebral articulation. The anterior midline structure with central low attenuation is normal stomach.

Differential Diagnosis List

The differential diagnosis for a hypervascular lesion in the region of the kidney includes renal cell carcinoma, abscess, arteriovenous malformation, gastric activity simulating a mass, renal metastasis, pheochromocytoma simulating a renal mass, angiomyolipoma, and prominent spleen in a normal patient.

ACR Codes and Keywords:

References and General Discussion of Renal Scintigraphy (Anatomic field:Skeletal System, Category:Neoplasm, Neoplastic-like condition)

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Case number: rs014

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