Technetium.99m-polyphosphate is probably the current agent of choice for bone imaging, and satisfactory renal imaging can be obtained during whole.body bone scanning because the kidneys excrete s9mTc.polypho5ph@ge. in our ex perience, renal images noted during bone scan ning with somTc@polyphosphate are of diagnostic quality. Technetium-99m-polyphosphate has recently been introduced as a bone scanning agent (1—3), and it is probably the current agent of choice for bone imag ing. The localization of DamTc@polyphosphate in the skeletal system is similar to other bone-seeking radio nuclides, and 43—53% of the administered dose was localized in the skeleton of normal rabbits (2). The mode of excretion is through the urinary tract, thus affording excellent images of the kidneys at the time of bone scanning. Recently patients undergoing DDmTc@polyphosphate bone scanning at our institution were noted to have abnormal renal images. These abnormalities were confirmed, thus suggesting that renal lesions may be accurately imaged during bone scanning with this agent. METHODS Technetium-99m-polyphosphate is prepared from a sterile, pyrogen-free kit manufactured by Diagnos tic Isotopes Inc. and New England Nuclear Co. The procedure involves adding °°@‘Tc-pertechnetatesolu tion to a prernixed vial of polyphosphate and stan nous chloride and then mixing for 1—2mm. Scanning is started 3 hr after the intravenous injection of 10 mCi of OOmTc..polyphosphate on an Ohio-Nuclear Model 84 dual 5-in. scanner with S : 1 minification using maximum speed of 750 cm/mm. Whole-trunk or total-body scanning including kidneys and bladder in both anterior and posterior projections is com pleted in approximately 30—45mm. RESULTS Nine out of 52 patients who underwent oDmTc@ polyphosphate bone scanning showed abnormal renal findings that were proven to be accurate on subse quent intravenous pyelograms. Abnormal renal find Received Nov. 7, 1972; revision accepted Feb. 8, 1973. For reprints contact: Chan H. Park, Div. of Nuclear Mcd icine, Dept. of Radiation Therapy and Nuclear Medicine, Thomas Jefferson University Hospital, 1 lth and Walnut Sts., Philadelphia, Pa. 19107. FIG. 1. Normalrenal image.Posteriorscanshowsnormal kidneys in size, shape, position, and contour. Arrow points to radioactivity in Texas urosheath. R@ 534 JOURNAL OF NUCLEAR MEDICINE jnin/C0NCIBE COMMUNICATION RELIABILITY OF RENAL IMAGING OBTAINED INCIDENTALLY IN @lmTc@POLYPHOSPHATEBONE SCANNING Chan H. Park, Leonard M. Glassman,Nobel 1. Thompson,and Julio S. Mata Thomas Jefferson University Hospital, Philadelphia, Pennsylvania ingsincludedisplacementof the kidney(2) , unilater ally poor functioning kidney (2), nonfunctioning kidney ( 1 ) , hydronephorosis, hydroureter (2) , renal cyst ( 1 ) , and hypernephroma ( 1). The following cases are representative examples. Normal renal image. Figure 1 is a posterior scan on an 18-year-old boy who was having pain in his back and urinary incontinence. Bone scan is normal and both kidneys are normal in size, shape, and po sition. Poor functioning kidney. JB is a 44-year-old man who had a bone scan because of pain in his back and right hip. In September 1969, he had a cystectomy and bilateral ureteroileostomy for car cinoma of the urinary bladder. The scan showed a R 1 p FIG. 2. Poorlyfunctioningkidney.Anteriorscanrevealsradio. activity in ileal conduit in right pelvis and in collecting bag in region of right hip. Posterior scan shows poor visualization of left kidney and intravenous pyelogram confirms poorly functioning left kidney. FIG. 3. Hydronephrosisand hydroureter.Posteriorscanre veals no bone metastasis but hydronephrosis and hydroureter on left with poor renal function on right is apparent. Subsequent in. travenous pyelogram documents hydronephrosis and hydroureter secondary to two stones obstructing ureterocele (arrow) and poor visualization of right kidney. 535Volume 14, Number 7 I@@ :*:@!I @-4: I F1G.4. Surgicallyprovenbenignrenalcyst.Posteriorscan shows discrete defect in upper pole of left kidney and increased uptake in region of left hip secondaryto arthritis. Nephrotomogram of left kidney confirmscyst (arrows) in upper pole. poorly functioning left kidney and metastatic lesions in the pedicle of the L5 on the right side, right sacral wing, and the right proximal femur (Fig. 2). Hydronephrosis and hydroureter. OK is a 60- year-old woman who had a past history of an en dometrial sarcoma and a bone scan was done because of pain in the upper thoracic region. She did not have any genitounnary complaints and the blood urea nitrogen was normal at the time of bone scanning. The scan failed to reveal bony metastasis but left hydronephrosis and hydroureter were found (Fig. 3) . A subsequent intravenous pyelogram the follow ing week showed the same finding secondary to two stones obstructing an ureterocele. Space-taking lesions. TS is a 74-year-old woman who had a bone scan because of pain in the left hip and thigh. A mass lesion was noted in the upper pole of the left kidney (Fig. 4) and a renal cyst was found at surgery. Increased uptake in the region of the left hip is due to arthritis. A similar mass lesion in the upper pole of the right kidney on a 36- year-old man was subsequently proven to be a hypernephroma at surgery. DISCUSSION Renal excretion occurs probably as a simple phos phate and the cumulative renal excretion up to 3 hr on rabbits ranged between 45—50% (1 ) . Usually, renal radioactivity would not interfere with the skeletal imaging of the lumbar spine. However, it is very difficult to interpret the pelvic areas when the urinary bladder is filled with urine containing large amounts of radioactivity. To avoid this problem, the PARK, GLASSMAN, THOMPSON, AND MATA patient voids just before the scan and the scanning is started from bottom to top. Radiation dose to the kidneys is 890 mrads per 10 mCi 99@'Tc-polyphosphate assuming 50% of an injected dose in the kidneys and renal disappearance by physical decay alone (4). To decrease radiation dose to the kidneys and bladder, hydration, and fre quent voiding are recommended to the patient. ACKNOWLEDGMENTS We thank Joan Franco for technical assistance, and Mary Ellen Martin and Jane Russel for preparation of the manu script. REFERENCES 1. SUBRAMANIAN G, MCAFEE JO: A new complex of 99mTcfor skeletal imaging. Radiology 99: 192—196,1971 2. SUBRAMANIAN0, MCAFEE JO, BELL EG, et al: mmTc labeled polyphosphate as a skeletal imaging agent. Radi o/ogy102:701—704,1972 3. BLAIR RJ, BELL EG, SUBRAMANIAN0, et al: Evalua tion of @mTc-polyphosphateimaging for non-neoplastic skeletal disease. I Nuc/ Med 13: 414, 1972 4. LIEBERMANE: Personal communication, 1972 ‘9- October 31 through November 3, 1973 Holiday Inn—Rivermont Memphis, Tennessee The ScientificProgramCommitteewelcomesthe submissionof original contributionsin Nuclear Medi cine from membersand non-membersof the Society of Nuclear Medicine for considerationfor the Scientific Session. Program: A. Scientific Session: Selected papers of all aspects of Nuclear Medicine. B. ContinuingEducationSeries: Practical Aspects of Nuclear Medicine Instrumentation. Guidelines: 1. Absfractshouldcontaina statementofpurpose,methodsused,resultsandconclusions. 2. Not to exceed 300 words. 3. Give title of paper and name of author(s) as you wish them to appear on the program. Un derline the name of the author who will presentthe paper. 4. Accepted abstracts will be published in the Southern Medical Journal. 5. Send abstract and four copies to: EDWARDV. STAAB,M.D. Nuclear Medicine Division Vanderbilt University Hospital Nashville, Tennessee 37232Deadline: August 6, 1973 536 JOURNAL OF NUCLEAR MEDICINE SOUTHEASTERNCHAPTER THE SOCIETYOF NUCLEARMEDICINE FOURTEENTHANNUAL MEETING ANNOUNCEMENTAND CALL FOR EXTRACTS