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99Tcm-DTPA肾脏动态显像在肾脏占位诊断和治疗中的应用价值研究
引用本文:梁 凯,邵国强,赵美丽,崔 璨,贾瑞鹏,王 峰.99Tcm-DTPA肾脏动态显像在肾脏占位诊断和治疗中的应用价值研究[J].南京医科大学学报,2015(11):1654-1658.
作者姓名:梁 凯  邵国强  赵美丽  崔 璨  贾瑞鹏  王 峰
作者单位:南京医科大学附属南京医院泌尿外科,江苏 南京 210006,南京医科大学附属南京医院核医学科,江苏 南京 210006,南京医科大学附属南京医院超声科,江苏 南京 210006,南京医科大学附属南京医院核医学科,江苏 南京 210006,南京医科大学附属南京医院泌尿外科,江苏 南京 210006,南京医科大学附属南京医院核医学科,江苏 南京 210006
基金项目:国家自然科学基金项目青年基金(30670588);江苏省自然科学基金(BK20130082);南京市医学科技发展资金(QRX11253)
摘    要:目的:初步探讨99Tcm-DTPA肾脏动态显像在肾脏单发占位性病变诊断和治疗中的应用价值?方法:回顾性收集2010年1月—2015年1月61例肾脏占位患者,多数接受增强CT和B超检查,所有患者接受99Tcm-DTPA肾脏动态显像和血生化检查,半定量评价肾脏占位?灌注指数(perfusion index,PI)和肾小球滤过率(glomerular filtration rate,GFR)?32例肾脏恶性肿瘤和2例良性肿瘤患者在术后6个月再次行99mTc-DTPA肾脏动态显像?结果:99Tcm-DTPA肾脏动态显像诊断肾脏恶性肿瘤的灵敏度?准确性分别为37.5%?63.9%,明显低于增强CT;对长径大于4 cm者,肾脏动态显像诊断灵敏度?特异性和准确性分别为66.7%?85.7%和75.0%,如果以占位与健侧肾PI比值(T1/K1)≤1?功能相占位病灶与对侧(或邻近)对称肾组织GFR之比(T2/K2)接近0作为肾恶性肿瘤的诊断标准,其诊断灵敏度提高到83.3%?肾脏动态显像占位对侧肾中重度受损时,结合患肾情况选择保守手术,术后6个月肾PI降低,GFR增加,否则多在术后出现肾功能不全,部分患者需要透析治疗?结论:99Tcm-DTPA肾脏动态显像提供肾脏占位PI和单肾PI?GFR,对肾恶性肿瘤的诊断?手术方式选择和预后评价提供了重要数据支持?

关 键 词:肾脏肿瘤  灌注指数  肾脏动态显像  肾单位保留手术  预后
收稿时间:6/9/2015 12:00:00 AM

Application value of 99Tcm-DTPA renal dynamic imaging for diagnosis and treatment duration of renal mass
Liang Kai,Shao Guoqiang,Zhao Meili,Cui Can,Jia Ruipeng and Wang Feng.Application value of 99Tcm-DTPA renal dynamic imaging for diagnosis and treatment duration of renal mass[J].Acta Universitatis Medicinalis Nanjing,2015(11):1654-1658.
Authors:Liang Kai  Shao Guoqiang  Zhao Meili  Cui Can  Jia Ruipeng and Wang Feng
Institution:Department of Urology,Nanjing Hospital Affiliated to NJMU,Nanjing 210006,China,Department of Nuclear Medicine,Nanjing Hospital Affiliated to NJMU,Nanjing 210006,China,Department of Ultranography,Nanjing Hospital Affiliated to NJMU,Nanjing 210006,China,Department of Nuclear Medicine,Nanjing Hospital Affiliated to NJMU,Nanjing 210006,China,Department of Urology,Nanjing Hospital Affiliated to NJMU,Nanjing 210006,China and Department of Nuclear Medicine,Nanjing Hospital Affiliated to NJMU,Nanjing 210006,China
Abstract:Objective:To investigate the application value of 99Tcm-DTPA renal dynamic imaging in the diagnosis and therapy of renal single mass. Methods:A total of 61 patients with renal mass were retrospectively collected from January 2010 to January 2015. All patients accepted 99Tcm-DTPA renal dynamic imaging and blood biochemical test while CT enhanced imaging and ultrasound examination were performed in most cases. Renal perfusion index (PI)and glomerular filtration rate (GFR)was evaluated by 99Tcm-DTPA renal dynamic imaging. 99Tcm-DTPA renal dynamic imaging was performed in 32 cases with renal malignant mass and 2 cases with benign tumor about 6 months later after operation. Results:The diagnostic sensitivity and accuracy of 99Tcm-DTPA renal dynamic imaging for renal malignant mass was 37.5% and 63.9%,respectively,lower than that of CT enhanced imaging,while the diagnostic sensitivity,specificity and accuracy was 66.7%,85.7% and 75.0%,respectively,when the long diameter of the renal mass was more than 4 cm. If diagnostic criteria were designed as PI ratio of the renal mass to normal contralateral kidney(T1/K1)was no more than 1,and GFR ratio of the renal mass of functional phase to contralateral(or adjacent)symmetrical kidney tissues(T2/K2)was almost 0,the diagnostic sensitivity increased to 83.3%. Nephron-sparing surgery was preferred when moderate-to-serious injury of the contralateral kidney was seen on 99Tcm-DTPA renal dynamic imaging. Six months after operation,the renal PI was decreased and GFR was increased,otherwise,the renal function inadequacy was found,some patients needed dialysis treatment. Conclusion:99Tcm-DTPA renal dynamic imaging,evaluating PI,GFR of the kidney and the renal mass,is useful for the diagnosis,operation guiding and prognosis prediction.
Keywords:renal tumor  perfusion index  renal dynamic imaging  nephron-sparing surgery  prognosis
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