巯甲丙脯酸肾显像与肾血管性高血压

RVH（肾血管性高血压）是一种低发性，档治性疾病。要求具备较高灵敏度和特异性的检查方法方能获得准确的诊断结果。常规核素肾显像存在较高的假阳性和假阴性率，不宜成为检测RVH的适应方法，而巯甲丙脯酸肾显像诊断和评价RVH的价值已得到公认，并成为肾动脉造影前的一种常规过筛试验。     

肾动态显像对肾血管性高血压的诊断价值

目的　探讨肾动态显像对肾血管性高血压 (RVH)的诊断价值。方法　对 5 2例临床上确诊冠心病合并高血压并怀疑RVH的患者进行肾动态显像 ,测定肾功能参数 :2 0min清除率 ,左 右肾血流放射性比值 ,左右肾高峰时间 ,肾小球滤过率 (GFR) ,有效肾血浆流量 (ERPF)。均行肾动脉造影。结果　 5 2例患者中确诊RVH 2 8例 ,肾动态显像灵敏度为 82 14 % ,特异性为 75 0 0 %。RVH组与肾动脉正常组相比 ,肾动态显像的各项参数差异有显著性 (P <0 0 1)。结论　肾动态显像检查有助于RVH的诊断。     

卡托普利介入99mTc-双半胱氨酸肾动态显像对肾血管性高血压患者的价值

目的研究卡托普利介入^99mTc-双半胱氨酸（^99mTc-EC）肾动态显像对高血压患者的肾血管性原因的诊断准确性,并评价其对肾血管性高血压（RVH）患者血管成型术后肾功能改善的预测价值。方法55例临床疑似RVH的患者,口服卡托普利50mg,60min后进行^99mTc-EC肾动态显像,结果异常患者次日再进行基线水平肾动态显像。按照显像结果将RVH的诊断分为高度可能组、不确定组和低度可能组。结果高度可能组的22例患者中20例有肾动脉狭窄（RAS）;不确定组10例中的5例有RAS;低度可能组23例均证实没有RAS。如果将不确定诊断组和低度可能组归为阴性,诊断RAS的灵敏度为80%,特异度为93.3%,阳性预测值为90.9%,阴性预测值为84.8%;如果将高度可能组和不确定诊断组归为阳性,则灵敏度、特异度、阳性预测值和阴性预测值分别为100%、77.7%、78.7%、100%。22例RVH患者进行介入治疗,高度可能组的18例患者中16例治疗有效,不确定组中3例无效、1例有效。结论卡托普利介入^99mTc-EC肾动态显像是诊断RVH的有效手段,同时能预测患者血管成形术治疗效果。     

99Tcm-DMSA肾皮质显像诊断小儿肾发育不良

目的 探讨^99Tc^m—二巯基丁二酸(DMSA)肾皮质显像诊断小儿肾发育不良的价值。方法 疑为肾发育不良患儿29例，行常规^99Tc^m—DMSA肾皮质显像和腹部B超检查。图像分析：将发育不良肾分为0～4级。结果 ^99Tc^m—DMSA肾皮质显像示29例患儿中24例为单侧肾发育不良，其中11例1级，7例2级，6例3级，余5例患肾未显影为0级，结合其他：检查诊断为肾发育不良。患肾分肾功能为0～24．9％(平均6．3％)。29例患儿中24例患肾肾皮质显像诊断为肾发育不良，5例患肾未显影，由其他影像学方法确诊，诊断灵敏度为82．76％。29例中19例经手术治疗，病理检查证实为肾发育不良。结论 ^99Tc^m—DMSA肾皮质显像诊断肾发育不良灵敏度高、可靠，可确定发育不良肾部位和判断肾功能。     

氯沙坦肾显像对肾血管性高血压的诊断价值

目的　探讨氯沙坦肾显像对肾血管性高血压的诊断价值。方法　 4 6例疑为肾血管性高血压患者 ,基础肾显像后均进行开博通和氯沙坦肾显像 ,并于肾显像后 7d内行肾动脉造影检查。结果　开博通肾显像和氯沙坦肾显像对肾血管性高血压诊断的灵敏度分别为 6 0 .0 %和 84 .0 % ,特异性分别为 95 .5 %和 97.0 % ,准确性分别为 85 .8%和 93.4 % ,阳性预测值分别为 83.3%和 91.3% ,阴性预测值分别为 86 .4 %和 94 .2 % ,两组比较 ,灵敏度和准确性差异有显著性 (P <0 .0 5 ) ,余指标差异无显著性。结论　氯沙坦肾显像对肾血管性高血压诊断的灵敏度和准确性明显高于开博通肾显像     

核素肾皮质显像在急性肾盂肾炎中的作用

急性肾盂肾炎是一种常见的泌尿系疾病,可引起不可逆性肾实质损害——肾疤痕形成,并导致一系列并发症,如高血压、慢性肾功能衰竭等。若对其进行早期诊断和积极治疗,可避免上述异常的出现。核素肾皮质显像是一种良好的显像方法,它可用于急性肾盂肾炎的早期诊断和疗效评价。     

肾脏核素显像在重复肾畸形诊疗中的应用

重复肾畸形是一种常见的先天性泌尿系统疾病,其诊断多依赖于静脉肾盂造影、超声、CT和MRI等常规影像学手段,这些检查方法各有优缺点。肾脏核素显像检查便利、重复性好、辐射剂量低且安全可靠,可同时对肾脏形态和功能进行评估,在重复肾畸形的诊断、临床决策的制定、疗效评估和预后分析等方面具有很大优势。现今,SPECT/CT已迅速普及,肾脏核素显像可以与其他影像学检查优势互补,成为重复肾畸形诊断和治疗评价的重要手段。笔者对肾脏核素显像在重复肾畸形诊疗中的应用进行综述。     

核素肾皮质显像在急性肾盂肾炎中的作用

急性肾盂肾炎是一种常见的泌尿系疾病，可引起不可逆性肾实质损害——肾疤痕形成，并导致一系列并发症，如高血压、慢性肾功能衰竭等。若对其进行早期诊断和积极治疗，可避免上述异常的出现。核素肾皮质显像是一种良好的显像方法，它可用于急性肾盂肾炎的早期诊断和疗效评价。     

^99mTc-硫胶体监测移植肾后急性排异的再评价

目的重新评估99mTc-硫胶体(99mTc-SC)显像在移植肾急性排异方面的临床价值;分析误诊原因;改进方法,以提高诊断的准确性.材料和方法对140例移植肾患者的99mTc-SC显像进行回顾性分析;为避免骨髓影像的干扰,在常规方法的基础上建立镜相法,并对其中20例显像作镜相法和常规法的对比研究.结果99mTc-SC显像(常规法)诊断急性排异的灵敏性84.8%,特异性80.0%,准确性82.1%;使用OKT3的患者的假阳性的发生率明显高于对照组.结论虽然OKT3增加了假阳性的发生率,但99mTc-SC显像仍是目前鉴别诊断移植肾急性排异和急性肾小管坏死的最佳方法;镜相法尚无法替代常规法,但可作为常规法的有效辅助手段.     

超声造影对肾细胞癌的诊断价值

目的探讨超声造影对肾细胞癌的诊断价值。方法对经病理证实的89例肾细胞癌患者进行回顾分析研究,用常规超声和SonoVue超声造影剂分别显示假包膜和肿块内的囊腔、出血及坏死灶,并进行显示率的对比分析。结果常规超声显示出假包膜的有32例(32/89,35.9%),超声造影显示出假包膜有59例(59/89,66.3%);常规超声显示出瘤体内的囊腔、出血和坏死灶有43例(43/89,48.3%),超声造影显示出有68例(68/89,76.4%),两者对肾细胞癌的假包膜和肿块内的囊腔、出血及坏死灶的显示率差异有显著统计学意义(P<0.01)。结论超声造影较常规超声能更清楚显示肾细胞癌的假包膜和瘤体内的囊腔、出血和坏死灶,为超声诊断肾细胞癌提供更多的信息。超声造影对肾细胞癌的明确诊断具有十分重要的临床价值。     

Differential diagnosis and management of renovascular hypertension through nuclear medicine techniques

Identification of patients with renovascular hypertension (RVH) among the larger group of patients with essential hypertension has been aided by a wide variety of in vitro and in vivo nuclear medicine procedures. The most valuable in vitro procedure remains the radioimmunoassay (RIA) for renin activity obtained from individual renal vein catheterization studies. Lateralizing renin activity provides valuable prognostic information about the likelihood for surgical cure of RVH. Older in vivo procedures for the diagnosis of RVH included rectilinear scanning and probe renography, which suffered from poor resolution and specificity, respectively. These tests have been replaced by computer-interfaced gamma camera scintirenography using 131I- or 123I-labeled orthoiodohippurate (OIH), or scintiangiography using 99mTc-DTPA. False-positive (FP) results for RVH persist due to a wide variety of relatively common conditions that can cause asymmetric renal size and function, including outflow obstruction and parenchymal renal disease. Newer approaches promise to improve the specificity of nuclear medicine procedures for identification of RVH. In particular, the number of FP exams appears to improve when scintirenography is performed before and after the administration of oral angiotensin converting enzyme (ACE) inhibitors, using either 99mTc-DTPA or OIH. The incentive for improved diagnostic testing has increased with the availability of percutaneous transluminal angioplasty (PCTA) for treatment of renal artery stenosis (RAS). Follow up of PCTA with scintirenography is of great value in assessing its effect on renal function and in evaluating the subsequent clinical course of the patient.     

Diuretic renography and angiotensin converting enzyme inhibitor renography

Renovascular hypertension and renal outlet obstruction are two clinical conditions well evaluated by nuclear medicine techniques. They both require a specific intervention to challenge a specific aspect of renal functional reserve. Diuretic renography is the oldest common example in nuclear medicine where functional change in the kidney is provoked for diagnostic purposes. The kidney's tubular functional reserve, in this instance, is challenged to induce diuresis and increase urine flow. This intervention permits diuretic renography to retain an essential role in the evaluation of hydroureteronephrosis. Captopril renography is a more recent example of a similar principle and depends on a reactive renin-angiotensin system to identify a kidney responsible for RVH. In both renal outlet obstruction and RVH, an anatomic abnormality is also identified (hydronephrosis and RAS, respectively) at some point in the diagnostic workup. The final diagnosis in each instance, however, depends on evidence for a functional disorder, provoked and measured during the radionuclide interventional examination. These serve as excellent examples of the power of functional imaging to identify specific medical disorders.     

Cost-effectiveness of nuclear medicine procedures in renovascular hypertension

The role of nuclear medicine in the differential diagnosis of renovascular hypertension (RVH) has been a highly controversial one. The reason for this rests with the lack of specificity of this test in screening for RVH. Although renography is very sensitive in detecting unilateral renal disease, it is nonspecific and an unacceptable number of false-positives occur. Recently the introduction of captopril renography has provided a new stimulus for reevaluation of this test in the differential diagnosis of renovascular disease. In spite of prevailing opinion, a careful review of the relative cost of renography and digital subtraction angiography (DSA) demonstrates that there is a role for renography in this differential diagnosis at all stages of investigation. Routine renography, when interposed between DSA studies, significantly reduces the cost per case of RVH found. If captopril renography proves as specific as is theoretically possible, the cost reductions achieved can be even greater. There is a significant and cost-efficient role for renography in the differential diagnosis of RVH. In addition to its reduction of cost in case finding, renography also avoids the risk of contrast media administration in a significant number of patients by reducing the population for screening to those at very high risk of disease.     

Excess prevalence of supraaortic artery lesions in renovascular hypertension: An arteriographic study

Purpose High renin or renovascular hypertension (RVH) has been associated with a higher risk of stroke than low-to-normal renin hypertension. Our present purpose was to investigate the angiographic prevalence and distribution of lesions of the supraaortic arteries in a series of consecutive patients with RVH compared with control patients with low-to-normal renin primary hypertension (PH).Methods Thirty-two consecutive hypertensives (21 females, 11 males, aged 23–72 years) were investigated by renal and aortic arch digital subtraction arteriography (DSA). None of them had any history or symptoms of cerebrovascular disease. In each, the presence and severity of lesions at 17 different segments of the supraaortic arteries were evaluated and a score for supraaortic lesions was then calculated based on the number and severity of lesions. RVH was diagnosed in 16 patients with renal artery stenoses and normalization of blood pressure after percutaneous transluminal renal angioplasty (PTRA) (n=12) or surgery (n=4). The cause of renal artery obstruction was fibrodysplasia in 5 patients (31%) and atherosclerosis in 11 (69%). PH was diagnosed in 16 patients based on a normal renal DSA and exclusion of all other possible causes of hypertension.Results The RVH and PH groups were similar with respect to age, sex, body mass index, diabetes, smoking habits, serum triglycerides, cholesterol, and blood pressure values, and differed only in plasma renin activity (6.0±1.7 ng AngI/ml/h in RVH vs. 1.4±0.3 in PH, mean±SEM, p=0.008). The score for supraaortic arterial lesions was significantly higher in RVH than in PH (181±32 vs. 17±9, p=0.001). This difference was also evident when the five patients with fibrodysplasia were compared with five age- and sex-matched PH patients. The sites most frequently involved were the carotid artery bulb and the internal carotid artery sinus. At each affected site the score was higher for RVH than for PH.Conclusion For the same demographic features and risk profile, RVH was associated with a higher prevalence and severity of supraaortic artery lesions than PH.     

Interobserver reproducibility in the interpretation of captopril renograms from patients suspected of having renovascular hypertension

This work was undertaken to identify, in hypertensive patients suspected of having renovascular hypertension (RVH), scintigraphic images and curves whose interpretation could be difficult. The baseline and postcaptopril Tc-99m MAG 3 images and curves from 10 patients clinically suspected of having RVH were retrospectively selected to have a wide sample of images and curves. The data and a multiple-choice questionnaire were presented as a PowerPoint file, which was sent electronically to Belgian nuclear medicine physicians; they had to answer if the images and curves were or were not suggestive of the diagnosis of RVH or if it was impossible to answer. There was near-complete interobserver agreement for normal baseline and postcaptopril data, for unilateral postcaptopril delayed transit and/or impaired uptake. Agreement was not as good for bilateral and symmetrical changes, for mild changes, or in cases of impaired function. This study shows that the analysis by the Internet of interobserver agreement is an easy and rapid method allowing one to identify difficult to interpret pre- and postcaptopril renographic data.     

Predictive value of radionuclide methods in the diagnosis of unilateral renovascular hypertension

The validity of noninvasive (iodine-131 iodohippurate renogram, iodine-131 ortho-iodohippurate clearance, indium-113m EDTA-technetium-99m DTPA sequential renal scan) and invasive (xenon-133 washout) radionuclide screening tests was evaluated in the diagnosis of 105 patients with unilateral renovascular hypertension (RVH) and in 45 patients with essential hypertension (EH). In RVH positive findings on the stenosed side were noted in 73% of renograms, 73% of o-iodohippurate-clearance tests (n=22), 81% of sequential renal scans, and 90% of xenon-washout studies (n=67). In a subgroup of 55 retrospectively selected patients with normal or improved blood pressure following renovascular surgery, the preoperative findings had been positive on the stenosed side in 78% of renograms, 75% of o-iodohippurate-clearance tests (n=20), 85% of sequential renal scans, and 93% of xenon-washout studies (n=23). The sequential renal scan appears to be a sufficiently reliable method in noninvasive screening for unilateral RVH, although invasive xenon-washout studies show a higher percentage of hemodynamic alterations in the stenosed kidney. O-iodohippurate clearance tests, and in particular xenon-washout studies, can reveal arteriosclerotic lesions in the contralateral, non-stenosed kidney, which may be of importance when the decision for renovascular surgery is pending.     

久居高原健康居民重返平原后心电图变化的观察

目的:研究久居高原居民重返平原后心电图(ECG)的变化,了解其脱离高原环境后右心室占优势的情况是否得到扭转.方法:对240名久居高原(海拔2261m～4200m)健康居民(年龄50岁～84岁)重返平原后进行了ECG检查,主要测定了右心室电压,并对右心室肥厚(RVH)作出诊断.同时与197名平原同龄人进行了对比.结果:返...     

Renovascular hypertension: nuclear medicine techniques.

Angiotensin converting enzyme inhibition (ACEI) renography is the only imaging examination that tests directly for the presence of renovascular hypertension (RVH); other imaging examinations test for the presence of renal artery stenosis (RAS). The goals of ACEI renography are two-fold: 1) to detect those patients with hypertension who have renal artery stenosis as the cause of their hypertension and who would benefit from revascularization, and 2) to determine which hypertensive patients do not have renovascular hypertension and obviate the expense and risk of angiography and, potentially, revascularization. This review summarizes general components of renal scintigraphy (pretest voiding, hydration, patient position, relative uptake, time to peak height of the renogram curve, 20 min/max ratio, postvoid images, quality control) as well as those components specific to ACEI renography (choice of radiopharmaceutical, choice of ACE inhibitor, angiotensin II receptor blockers, diuretics, parenchymal mean transit time, monitoring of blood pressure, 1 versus 2 day protocols and omission of the baseline study). ACEI renography is highly accurate in patients with suspected RVH who have normal or near normal renal function. In this patient population, the sensitivity and specificity of ACEI renography for renovascular hypertension exceed 90%; angiography as an initial approach is not cost effective. Data from 10 studies evaluating cure or improvement in blood pressure in 291 patients undergoing revascularization showed the mean positive predictive value of ACEI renography to be 92%. When azotemic patients present with suspected RVH, as many as 50% of patients may have an intermediate probability ACEI renogram and the sensitivity of detecting RVH falls to approximately 80% even when intermediate and high probability tests are combined.