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。     

肾闪烁显像诊断急性肾盂肾炎的价值

用９９ｍＴｃ－ＤＭＳＡ肾皮质显像诊断急性肾盂肾炎的敏感性明显优于静脉肾盂造影和超声图像检查方法。但是，对照研究的临床诊断和实验室检测值的准确性和可靠性将直接影响诊断的真实敏感性。因此，要了解肾闪烁显像对急性肾盂肾炎诊断的真实敏感性，不应以临床诊断和实验室的参数值作对照，而应将组织病理学的诊断结果与闪烁显像图形的结果进行对照。采用动物模型，以病理学诊断为参考标准，其ＤＭＳＡ对急性肾盂肾炎诊断的敏感性和特异性分别为９１％和９９％，且两种诊断结果的一致性为９７％。     

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,可治性疾病。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的适当方法,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。     

肾急性炎症性病变的CT诊断

作者回顾分析２１例肾急性炎症性病变的临床和ＣＴ表现，包括急性肾盂肾炎１４例、肾脓肿５例、炎性假瘤和化脓性肾盂肾炎各１例。结果表明，肾的各类急性炎症性病变具有一定的较特征性的ＣＴ表现。ＣＴ能准确地显示病变的程度和范围，为临床上及时诊断和治疗提供依据。     

每分钟尿细胞排泄率在肾盂肾炎诊断中的价值

急性慢性肾盂肾炎 (肾小管间质性肾炎 )是严重危害人的健康的常见疾病 ,早期诊断及治疗可预防并发症 ,提高生存率。肾盂肾炎的诊断常依靠尿液有形成分的定量计数 ,临床上常用的有Ａｄｄｉｓ尿沉渣计数、1小时尿细胞排泄率及每分钟尿细胞排泄率等。我们以每分钟尿细胞排泄率试验对肾盂肾炎进行了观察 ,证明这种方法对早期诊断、治疗效果及预后判断有一定参考价值 ,适合在基层医疗单位推广使用。现报道如下。1　材料与方法1.1　标本来源　选我院确诊为急、慢性肾盂肾炎患者 5 0例 ,其中急性肾盂肾炎 2 4例 ,慢性肾盂肾炎 2 6例 ,男 3例 ,女 47…     

99Tcm-DMSA肾显像在小儿泌尿道感染中的应用

目的 探讨^99Tc^m-二巯基丁二酸（DMSA）肾显像对鉴别小儿上、下尿路感染（UTI）、判断肾瘢痕和指导临床治疗的价值。方法 对近5年来临床诊断UTI252例患儿^99Tc^m-DMSA肾显像结果进行分析。其中男94例，女158例，年龄1个月-14岁。肾显像采用常规方法，并计算分肾功能。显像结果分为正常[诊断为下尿路感染（LUTI）]和异常[诊断为上尿路感染（UUTI）或肾瘢痕]。结果 252例UTI患儿，110例显像正常，诊断为LUTI；142例显像结果异常，诊断为UUTI，其中116例为急性肾盂肾炎（APN），26例为肾瘢痕。LUTI者分肾功能为46％－54％。UUIT者单肾受累患者中，其受累肾脏分肾功能均低于45％（13％－44％）。UUTI患儿中有17例经正规抗感染治疗后再次显像，其中13例APN患儿，12例6个月后随访，显像结果均转正常或明显好转，1例4个月后随访无明显变化；4例肾瘢痕形成者6个月后复查无明显变化。结论 ^99Tc^m-DMSA肾显像鉴别小儿UTI无创伤，简便易行，可靠，尤适用于儿童。     

肾动态显像测定GFR对泌尿系肿瘤患者肾功能判定的临床价值

99mTc-DTPA肾动态显像应用于肾脏早期占位性病变的诊断,显像剂99mTc-DTPA(95%)以上被肾小球滤过而不被重吸收,因而采用99mTc-DTPA肾动态显像测定的肾小球滤过率(GFR)可直接反映实际GFR值。本文将肾动态显像测定GFR对泌尿系肿瘤患者肾功能判定的情况报告如     

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。     

肾感染性疾患的影像诊断

肾感染性疾患的影像诊断长期以来不够重视 ,因之对它的研究及临床总结也处于进展较缓慢的状况。直至近年高分辨率ＣＴ及ＭＲ问世 ,以及肾脏病理学的深入理解 ,始较迅速地将其推动向前发展。1　急性肾盂肾炎此为一种中青年女性及儿童易患的疾病 ,多由尿路上行性革兰氏阴性菌感染 ,不及时诊断及治疗可导致严重肾功能衰竭。当致病菌进入肾乳头部在肾实质内可释放破坏酶及自由基 ,小动脉血管收缩可引起肾实质缺血、水肿及坏死 ,放射学上显示肾实质减少、变薄及坏死[1,2 ] 。当病变修复后可发生瘢痕形成 ,伴发高血压 ( 2 0 % )、肾小球滤过率下降…     

肾动态显像辅助诊断原发性高血压早期肾损害的价值分析

目的：探讨单光子发射电子计算机断层扫描（SPECT）肾动态显像对原发性高血压（EH）早期肾损害的辅助诊断价值。方法：对EH41例行SPECT肾动态显像检查,测定肾功能参数,各段峰值、峰时、半排时间,以及肾小球滤过率（GFR）。同期检测患者血尿素、肌酐,尿NAG、尿β2-MG,比较各指标的诊断准确率。结果：肾动态显像GFR检测EH早期肾损害的阳性率为82.9%,显著高于尿β2-MG和NAG检测的阳性率（51.2%和63.4%,P〈0.05）。结论：肾动态显像检查对明确EH早期肾损害诊断有较好的临床应用价值。     

Imaging Manifestations of Acute and Chronic Renal Infection That Mimics Malignancy: How to Make the Diagnosis Using Computed Tomography and Magnetic Resonance Imaging

PurposeTo review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis.ConclusionAcute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Infection may be suspected when patients are young and otherwise healthy when there is marked associated perinephric changes and in the absence of metastatic adenopathy or disease elsewhere in the abdomen and pelvis. Renal abscesses, from bacterial or atypical microbial agents, can appear as complex cystic renal masses mimicking cystic renal cell carcinoma. Associated inflammatory changes in and around the kidney and local invasion favour infection. Emphysematous pyelonephritis can mimic necrotic or fistulizing tumour; however, infection is more likely and should always be considered first. Xanthogranulomatous pyelonephritis can mimic malignancy when focal or multifocal and in cases without associated renal calculi. Malacoplakia is an inflammatory process that may mimic malignancy and should be considered in patients with chronic infection. Bacillus Calmette-Guerin (BCG)-induced pyelonephritis is rare but can mimic renal malignancy and should be considered in patients presenting with a renal mass when being treated with BCG for urinary bladder UCC.     

Renal cortical scintigraphy in the diagnosis of acute pyelonephritis

Comparative clinical studies have shown renal cortical scintigraphy, using technetium-99m (99mTc)-labeled glucoheptonate or dimercaptosuccinic acid (DMSA), to be significantly more sensitive than either intravenous pyelography or renal sonography in the diagnosis of acute pyelonephritis. However, due to uncertainties about the diagnostic accuracy of the clinical and laboratory parameters used in these studies, true sensitivity of renal cortical scintigraphy was unknown. Therefore, we evaluated the accuracy of [99mTc]DMSA scintigraphy in the diagnosis of experimentally induced acute pyelonephritis in piglets using strict histopathologic criteria as the standard of reference. The sensitivity and specificity of the DMSA scan for the diagnosis of acute pyelonephritis were 91% and 99%, respectively, with an overall 97% agreement between the scintigraphic and histopathologic findings. Based on the results of this experimental study, we used the [99mTc]DMSA scan as the standard of reference for the diagnosis of acute pyelonephritis, and conducted a prospective clinical study of 94 children hospitalized with the diagnosis of acute febrile urinary tract infection (UTI). The aims of this study were (1) to determine the relationship among vesicoureteral reflux, P-fimbriated Escherichia coli, acute pyelonephritis, and renal scarring, and (2) to evaluate the diagnostic reliability of the clinical and laboratory parameters commonly used in the diagnosis of acute pyelonephritis. We documented acute pyelonephritis in 62 (66%) of 94 patients. Vesicoureteral reflux was demonstrated in 29 (31%) of the total group and in only 23 (37%) of 62 patients with acute pyelonephritis. The prevalence of P-fimbriae in the E coli isolates was 64% in the patients with acute pyelonephritis and 78% in those with a normal DMSA scan. Even in patients without reflux, P-fimbriae were found in 71% of isolates from the patients with acute pyelonephritis and in 75% of those with a normal renal scan. Follow-up DMSA scans were obtained in 33 patients with acute pyelonephritis in 38 kidneys. We found complete resolution of the acute inflammatory changes in 58% of the involved kidneys and renal scarring in the remaining 42%, including 40% of the kidneys associated with reflux and 43% of those without reflux.(ABSTRACT TRUNCATED AT 400 WORDS)     

Urinary tract infection and other pediatric considerations.

Urinary tract infection in childhood can lead to chronic sequelae, particularly in the presence of vesico-ureteric reflux or obstruction. The renal complications of acute pyelonephritis or residual chronic renal cortical scarring are most accurately evaluated with scintigraphy using (99m)Tc dimercaptosuccinic acid. The diagnosis of renal obstruction can be problematic, particularly in infants and children. Diuresis renography is an established tool in diagnosing and assessing the severity of obstruction. However the methodology for performing diuresis renography is a very controversial area in paediatric nuclear medicine, due to the lack of a gold standard. The surgical management of neonatal hydronephrosis is similarly controversial.     

Diagnosis of acute pyelonephritis in children: comparison of sonography and 99mTc-DMSA scintigraphy.

Ninety-one children 1 week to 10 years old with culture-documented febrile urinary tract infection were evaluated with renal sonography and renal cortical scintigraphy by using 99mTc-labeled dimercaptosuccinic acid (DMSA). On the basis of previous experimental studies, DMSA scintigraphy was used as the standard of reference for the diagnosis of acute pyelonephritis. The DMSA scans showed changes consistent with acute pyelonephritis in 63% (57/91) of the patients. Sonograms showed changes consistent with acute pyelonephritis in 24% (22/91) of the whole group and in only 39% (22/57) of the patients with scintigraphically documented acute pyelonephritis. Pertinent sonographic findings were areas of increased cortical echogenicity in 14 patients and decreased echogenicity in eight, including three patients with renal abscesses. Dilatation of the renal collecting system was noted in nine patients and renal enlargement was noted in three. We conclude that renal sonography is a relatively insensitive test for the detection of acute inflammatory changes of renal cortex. Therefore, it should not be used as the primary imaging technique for the diagnosis of acute pyelonephritis. However, sonography is a useful technique in evaluating the nature of the defects seen on the DMSA scan and in detecting obstructive uropathies that may be associated with urinary tract infections.     

Urinary tract infection: an update on imaging strategies

Urinary tract infections (UTIs) are a common cause of morbidity in children. The distinction between upper and lower tract UTI is clinically difficult but important, as permanent renal damage can occur when the UTI involves the kidneys. Children with a history of UTI need investigated promptly and thoroughly. The goal of imaging in UTI is to aid in the diagnosis of acute pyelonephritis, to identify those children who are at high risk of developing permanent renal damage, and to confirm and monitor the presence of renal scarring. This article reviews the role of radiology in each of these aims.     

Urinary tract infection: an update on imaging strategies

Urinary tract infections (UTIs) are a common cause of morbidity in children. The distinction between upper and lower tract UTI is clinically difficult but important, as permanent renal damage can occur when the UTI involves the kidneys. Children with a history of UTI need investigated promptly and thoroughly. The goal of imaging in UTI is to aid in the diagnosis of acute pyelonephritis, to identify those children who are at high risk of developing permanent renal damage, and to confirm and monitor the presence of renal scarring. This article reviews the role of radiology in each of these aims.     

Comparison of MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis: preliminary experience

OBJECTIVE: The diagnosis of acute pyelonephritis in children remains a clinical challenge. It may cause permanent renal scar formation and results in the chronic renal failure if prompt diagnosis and treatment are delayed. The purpose of this study is to compare magnetic resonance imaging (MRI) and renal cortical scintigraphy (RCS) findings in childhood acute pyelonephritis and to determine pyelonephritic foci in the acute phase. MATERIALS AND METHOD: Twenty children (15 females and five males) with symptoms dysuria, enuresis, costovertebral pain, fever of 37.5 degrees C or more and/or positive urine culture were imaged by unenhanced turbo spin echo T2, spin echo T1-weighted, pre- and post-gadolinium inversion recovery MRI and RCS. Both imaging techniques were read independently by two radiologists and nuclear medicine specialists. Sensitivity and specificity of MRI in detecting acute pyelonephritic foci and scar lesions were calculated. Furthermore, in order to calculate the reliability of MRI over RCS in differentiating scar tissue and acute pyelonephritic foci, follow-up MRI studies were done in six patients after treatment of acute pyelonephritis. RESULTS: Sensitivity and specificity of MRI in the detection of pyelonephritic lesions were found to be 90.9 and 88.8%, respectively. There is no statistically significant difference in lesion detection between the two diagnostic modalities (P>0.05). CONCLUSION: Post-gadolinium MR images show significant correlation with RCS in the determination of renal pathology. Moreover, the ability of discriminating acute pyelonephritic foci and renal scar in early stages of disease is the superiority of MRI.     

Multimodality imaging of renal inflammatory lesions

Spectrum of acute renal infections includes acute pyelonephritis, renal and perirenal abscesses, pyonephrosis, emphysematous pyelonephritis and emphysematous cystitis. The chronic renal infections that we routinely encounter encompass chronic pyelonephritis, xanthogranulomatous pyelonephritis, and eosinophilic cystitis. Patients with diabetes, malignancy and leukaemia are frequently immunocompromised and more prone to fungal infections viz. angioinvasive aspergillus, candida and mucor. Tuberculosis and parasitic infestation of the kidney is common in tropical countries. Imaging is not routinely indicated in uncomplicated renal infections as clinical findings and laboratory data are generally sufficient for making a diagnosis. However, imaging plays a crucial role under specific situations like immunocompromised patients, treatment non-responders, equivocal clinical diagnosis, congenital anomaly evaluation, transplant imaging and for evaluating extent of disease. We aim to review in this article the varied imaging spectrum of renal inflammatory lesions.     

Imaging of acute pyelonephritis in the adult

The diagnosis of acute pyelonephritis in adults is predominantly made by a combination of typical clinical features of flank pain, high temperature and dysuria combined with urinalysis findings of bacteruria and pyuria. Imaging is generally reserved for patients who have atypical presenting features or in those who fail to respond to conventional therapy. In addition, early imaging may be useful in diabetics or immunocompromised patients. In such patients, imaging may not only aid in making the diagnosis of acute pyelonephritis, but more importantly, it may help identify complications such as abscess formation. In this pictorial review, we discuss the role of modern imaging in acute pyelonephritis and its complications. We discuss the growing role of cross-sectional imaging with computed tomography (CT) and novel magnetic resonance imaging (MRI) techniques that may be used to demonstrate both typical as well as unusual manifestations of acute pyelonephritis and its complications. In addition, conditions such as emphysematous and fungal pyelonephritis are discussed.     

肾脏缺血再灌注损伤的功能MRI实验研究进展

肾脏缺血再灌注损伤是导致急性肾损伤和移植肾功能延迟恢复的重要因素,严重者甚至会发生急性肾衰竭。扩散加权成像（DWI）、体素内不相干运动（IVIM）、血氧水平依赖（BOLD）、动脉自旋标记（ASL）、纵向弛豫时间定量成像（T1 mapping）等功能MRI能够无创、敏感、多次地监测不同程度的肾损伤,提供水分子扩散、微循环、血流灌注及血氧水平等微观信息的动态变化,为了解肾脏缺血再灌注损伤的发生机制、早期诊断、预后评估等提供更多信息。就肾脏缺血再灌注损伤的功能MRI实验研究进展予以综述。