Technetium-99m Succimer in Nuclear Medicine: NephroSan for Scintigraphic Evaluation of Renal Function

Technetium-99m succimer, also known as technetium Tc-99m dimercaptosuccinic acid (DMSA), commercially known as NephroSan, represents a remarkable advancement in the field of medical imaging, particularly in scintigraphic evaluation. This radiopharmaceutical has become increasingly important in diagnosing and monitoring renal parenchymal function and various other medical conditions. This essay explores the properties of technetium-99m succimer, its mechanism of action, clinical applications, advantages, and limitations in scintigraphic imaging.

Properties and Mechanism of Action

Technetium-99m (Tc-99m) is a metastable nuclear isomer of technetium-99, which is widely used in diagnostic radiology due to its ideal physical properties. It has a short half-life of approximately 6 hours, which minimises radiation exposure, and it emits gamma rays at an energy level (140 keV) that is effectively captured by gamma cameras. When technetium-99m is conjugated to succimer (dimercaptosuccinic acid, DMSA), it forms Tc-99m succimer, which is specifically used for renal imaging.

Succimer, the chelating agent, binds to Tc-99m, allowing it to be taken up by the renal parenchyma after intravenous administration. The uptake mechanism is believed to be related to the compound’s affinity for renal tubular cells, where it binds to the sulfhydryl groups. The localisation of Tc-99m succimer in the kidneys permits high-resolution imaging of renal parenchymal tissue.

Clinical Applications

The primary use of Tc-99m succimer scintigraphy is in the evaluation of renal cortical scarring, differential renal function, and the detection of acute pyelonephritis. It is beneficial in pediatric patients, where congenital anomalies and urinary tract infections can affect renal function. The technique is also employed to assess the renal parenchyma in conditions such as lupus nephritis renal artery stenosis, and in the follow-up of renal transplant patients.

Tc-99m succimer is advantageous in renal cortical imaging because it provides detailed anatomical images. The high-resolution images produced enable physicians to detect even small areas of scarring or dysplasia. Furthermore, the quantification of differential renal function is invaluable in the planning of surgical interventions, such as in the case of severe vesicoureteral reflux or obstructive uropathies.

Beyond its renal applications, Tc-99m succimer has been investigated for its utility in imaging other organs and conditions. For instance, studies have looked into its role in characterising certain types of tumours, such as medullary thyroid cancer, given its uptake in specific tissues.

Advantages in Scintigraphy

Scintigraphy with Tc-99m succimer has several advantages; for example, the high specificity of the radiopharmaceutical for renal parenchymal tissue results in clear, detailed images that are crucial for accurate diagnosis. The procedure is minimally invasive, involving only an intravenous injection, and the short half-life of Tc-99m reduces radiation exposure to the patient.

Furthermore, the ability of Tc-99m succimer to quantify differential renal function can guide therapeutic decisions and offers a non-invasive alternative to more invasive diagnostic procedures like renal biopsy or urography. Additionally, the procedure is well-tolerated by patients, including children, which is particularly important given the pediatric applications of the imaging agent.

Limitations and Considerations

Despite its advantages, Tc-99m succimer scintigraphy is not without limitations. The need for specialised equipment, such as a gamma camera and a radiopharmacy facility to prepare the radiopharmaceutical, can restrict its availability. Additionally, while the radiation dose is relatively low, it is still a concern, especially for children and pregnant women.

In cases where there is poor renal function, the uptake of Tc-99m succimer may be insufficient to provide clear images. In such instances, alternative imaging agents or modalities may be required. Patient hydration and diuresis can also affect the uptake and distribution of the radiopharmaceutical, potentially complicating the interpretation of images.


Technetium-99m succimer scintigraphy is a valuable tool in the diagnostic imaging arsenal, especially for evaluating renal parenchymal conditions. Its unique properties allow for high-resolution imaging and functional assessment of the kidneys, which facilitates early diagnosis and management of renal diseases. While its use has certain limitations, its benefits in clinical practice, particularly in terms of its diagnostic accuracy and safety profile, make it a preferred method for renal imaging in many cases.

As with any medical procedure, the use of Tc-99m succimer must be reasonable, balancing the potential risks against the diagnostic and therapeutic benefits. Continued research and technological advancements are likely to enhance the applications of this radiopharmaceutical further, potentially expanding its utility in diagnosing and managing other medical conditions beyond renal pathology.

In the context of pediatric patients, Tc-99m succimer scintigraphy is especially significant. Children are susceptible to ionising radiation’s effects; thus, the low radiation dose associated with Tc-99m makes it a preferable choice in pediatric imaging. Additionally, its non-invasive nature circumvents the need for sedation or anaesthesia, which are often required for MRI or CT scans in this patient group. This aspect not only reduces the risk associated with sedation but also alleviates the psychological stress for both the child and the parents.

Another field where Tc-99m succimer demonstrates potential is in the evaluation of hypertensive patients. The ability to assess renal function and detect renovascular hypertension through scintigraphic imaging is of considerable clinical value. In patients with high blood pressure, identifying a renal component can be crucial in tailoring the appropriate intervention, whether medical or surgical.

You are here: home » technetium-99m succimer
We use cookies to personalise content and ads, to provide social media features and to analyse our traffic. We also share information about your use of our site with our social media, advertising and analytics partners. View more
Cookies settings
Privacy & Cookie policy
Privacy & Cookies policy
Cookie name Active
This privacy and cookies policy sets out how Open Medscience uses and protects any information that you give Open Medscience when you use this website ( Open Medscience is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this website, you can be assured that it will only be used according to this privacy statement. Open Medscience may change this policy from time to time by updating this page. You should check this page from time to time to ensure that you are happy with any changes. This policy is effective from 19 July 2022.

How we use cookies

A cookie is a small file that asks permission to be placed on your computer's hard drive. Once you agree, the file is added and the cookie helps analyse web traffic or lets you know when you visit a particular site. Cookies allow web applications to respond to you as an individual. The web application can tailor its operations to your needs, likes and dislikes by gathering and remembering information about your preferences. We use traffic log cookies to identify which pages are being used. This helps us analyse data about web page traffic and improve our website in order to tailor it to customer needs. We only use this information for statistical analysis purposes and then the data is removed from the system. Overall, cookies help us provide you with a better website, by enabling us to monitor which pages you find useful and which you do not. A cookie in no way gives us access to your computer or any information about you, other than the data you choose to share with us. You can choose to accept or decline cookies. Most web browsers automatically accept cookies, but you can usually modify your browser setting to decline cookies if you prefer. This may prevent you from taking full advantage of the website. Our website ( may contain links to other websites of interest. However, once you have used these links to leave our site, you should note that we do not have any control over that other website. Therefore, we cannot be responsible for the protection and privacy of any information which you provide whilst visiting such sites and such sites are not governed by this privacy statement. You should exercise caution and look at the privacy statement applicable to the website in question. You are here: home » technetium-99m succimer
Save settings
Cookies settings
Scroll to Top