Mustafa Seham, Elgazzar Abdelhamid
Department of Biomedical Sciences, College of Nursing, The Public Authority for Applied Education & Training, Shuwaikh, Kuwait.
Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
EJNMMI Radiopharm Chem. 2025 Mar 31;10(1):15. doi: 10.1186/s41181-024-00325-4.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, are globally recognized as the primary choice for alleviating kidney pain and ureteric colic. This study examines the effects of long-term diclofenac administration on renography using two radiopharmaceuticals: 99mTc-mercaptoacetyltriglycine (99mTc-MAG3), which is excreted almost exclusively by the renal tubules, and 99mTc-diethylenetriamine pentaacetic acid (99mTc-DTPA), which is predominantly excreted by glomerular filtration.
Diclofenac administration caused a rightward shift in renograms, indicating delayed renal uptake and clearance for both tracers. For 99mTc-MAG3, the average time to peak activity (Tmax) increased from 2.88 ± 0.3 min (control) to 4.2 ± 0.3 min (treated), while time from peak to 50% activity (T½) rose from 4.16 ± 0.1 min to 5.48 ± 0.5 min. For 99mTc-DTPA, Tmax increased from 4.3 ± 0.4 min to 12.9 ± 2.0 min, and T½ extended from 13.35 ± 1.5 min to 29.75 ± 2.0 min (n = 12; *p < 0.05 for all comparisons). Delayed tracer arrival in the bladder was particularly pronounced with 99mTc-DTPA.
Chronic diclofenac exposure significantly delays Tmax and T½ for both tracers, with a greater impact observed using 99mTc-DTPA. These findings highlight 99mTc-MAG3 as the preferred radiopharmaceutical for renography in settings involving long-term NSAID administration, ensuring accurate and reliable interpretation and minimizing variability associated with radiopharmaceutical selection.
双氯芬酸等非甾体抗炎药在全球范围内被公认为缓解肾绞痛和输尿管绞痛的首选药物。本研究使用两种放射性药物研究长期给予双氯芬酸对肾图的影响：99m锝-巯基乙酰三甘氨酸（99mTc-MAG3），几乎完全由肾小管排泄；以及99m锝-二乙三胺五乙酸（99mTc-DTPA），主要通过肾小球滤过排泄。
给予双氯芬酸导致肾图向右移位，表明两种示踪剂的肾脏摄取和清除延迟。对于99mTc-MAG3，平均达峰时间（Tmax）从2.88±0.3分钟（对照组）增加到4.2±0.3分钟（治疗组），而从峰值到50%活性的时间（T½）从4.16±0.1分钟增加到5.48±0.5分钟。对于99mTc-DTPA，Tmax从4.3±0.4分钟增加到12.9±2.0分钟，T½从13.35±1.5分钟延长到29.75±2.0分钟（n = 12；所有比较*p < 0.05）。使用99mTc-DTPA时，示踪剂到达膀胱的延迟尤为明显。
长期接触双氯芬酸显著延迟了两种示踪剂的Tmax和T½，使用99mTc-DTPA时观察到的影响更大。这些发现突出了99mTc-MAG3作为长期使用非甾体抗炎药情况下肾图检查的首选放射性药物，可确保准确可靠的解读，并最大限度减少与放射性药物选择相关的变异性。
