SPECT肾动态显像评价肾功能与静脉肾盂造影的对比研究

目的比较单光子发射计算机化体层显像术(SPECT)和静脉肾盂造影(IVP)评价肾功能的价值。方法回顾性分析53例经临床症状、体征、B超、CT及生化检查等确诊为肾脏疾病患者的99mTc-DTPA肾动态显像和IVP检查资料。结果 53例受检者中核素显像显示有功能者92.1%,无功能者7.9%;IVP检查显示有功能者39.2%,无功能者67.8%。可见核素显像有功能明显高于IVP检查(P<0.01),IVP不显影的患肾99mTc-DTPA动态显像主要表现为2～3级,即放射性摄取中度以上减少82.1%GFR均值23.1 ml/min,肾实质不显影占17.9%。结论99mTc-DTPA肾动态显像是评价肾功能的理想方法,优于IVP,IVP患肾不显影时应进一步行99mTc-DTPA肾动态显像。     

346例上尿路结石患者99Tcm-DTPA肾动态显像结果分析

目的 探讨99Tcm-二亚乙基三胺五乙酸(99Tcm-DTPA)肾动态显像在上尿路结石患者肾功能评价中的临床价值.方法 回顾性分析了346例上尿路结石患者的核素肾动态显像、静脉肾盂造影(IVP)和血尿素氮(BUN)、血清肌酐(SCr)值,并依据总肾肾小球滤过率(GFR)将BUN和SCr结果分成4组进行分析.结果 ①346例肾动态显像患者,总肾GFR与BUN、SCr水平呈明显负相关(r=-0.458,P=0.000;r=-0.542,P=0.000).②4组之间比较,BUN和SCr均存在统计学差异(F=49.23,P=0.000;F=80.66,P=0.000);经最小显著差别法分析,组1与组2之间比较,BUN和SCr均无统计学差异(P=0.119和P=0.088);而其余各组之间比较,BUN和SCr均存在统计学差异(P均＜0.05).③IVP不显影的43只患肾中,经99Tcm-DTPA肾动态显像提示有18只(41.9%)有残余肾功能(GFR≥10 ml/min),平均GFR为(21.89±12.81)ml/min.结论 99Tcm-DTPA肾动态显像能早期评价肾功能,特别是对IVP不显影的患肾功能的评价具有重要临床价值.     

肾结核的影像学诊断（附3O例IVP及CT病例分析）

目的：探讨肾结核IVP及CT检查的影像学特点及鉴别诊断。方法：分析经病理证实或临床综合诊断的30例肾结核的IVP及CT表现。结果：IVP的特征性表现：(1)肾小盏杯口模糊，虫蚀状破坏，变形；(2)患肾积水，对侧肾因膀胱受累引起对侧输尿管狭窄亦出现肾积水；(3)患肾排泄功能损害，显影呈云朵状或不显影；(4)输尿管、膀胱继发性改变。CT特征性表现：(1)肾实质多发空洞或脓腔；(2)肾皮质萎缩变薄；(3)肾盂、输尿管壁增厚；(4)点状、弧线状、贝壳状钙化；(5)肾积水及肾功能损害。结论：IVP对肾结核早期诊断具有特异性，CT检查适用于中晚期肾结核。对于临床症状不典型的肾结核，应综合运用各种检查方法并密切联系临床，以明确诊断，选择最佳治疗方案。     

儿童肾重复畸形

目的评价99Tcm-双半胱氨酸(EC)肾动态显像(RDI)在儿童肾重复畸形诊断中的意义以及对选择手术方式的价值。方法对20例肾重复畸形患儿行RDI、静脉肾盂造影(IVP)、B超等检查，分析肾重复畸形的RDI影像特征，并对3种检查结果进行比较。对14例手术切除的上半肾作临床病理分型发育型、积水型、发育不良型。99Tcm-EC肾动态显像处理把24min内图像叠加成1帧/2min连续影像，设置重复上半肾、同侧下半肾、对侧上半肾感兴趣区，获得其放射性计数率(D、L、C)，以D/L或D/C中较小者为重复上半肾功能指标(D/N)，并与病理分型比较。结果肾重复畸形在RDI连续影像中有4种表现上肾稀疏、上肾缺损、肾影增长、肾盂分离；RDI对合并输尿管囊肿检出率较高，并可检出部分输尿管扩张积水。RDI、B超、IVP对重复肾的检出率分别为73.1％、57.7％、73.1％，三者较为一致(P＞0.05)；RDI的灵敏度、特异性、准确性分别为73.1％、92.2％、80.0％。发育不良型的上肾D/N值均小于60％，发育型均大于60％。结论肾重复畸形的99Tcm-EC肾动态显像有较好的诊断价值，可为临床术前判断是否保留上肾提供重要依据。     

排泄性尿路造影对肾功能的评价

肾脏排泄血循环中有机碘化合物的能力足以使它在尿液的浓度达到不透X线为排泄性尿路造影(IVP)的基础。当肾功能正常或仅中度减低时集尿系统显影一般是良好的;当肾功能严重损害,病侧或双侧肾显影不良或不显影。基于此观察,曾推荐IVP作为肾功能试验,但肾显影的生理性测验并不支持此推论。虽然造影剂的排泄,在广义上依赖于肾功能状况,然而现代造影剂每分子含碘原子较多,而且毒性又低,因此常利用相当大的剂量,在血中造影剂被高度浓缩以致既或在肾功能严重减退时,也可排泄足够的造影剂得到可成立诊断的肾盂造影片。正常IVP     

静脉肾盂造影未显影的肾脏行^99Tc^m-喷替酸盐肾动态显像检测GFR价值

目的泌尿系疾病患者行常规的静脉肾盂造影（IVP）检查结果为肾不显影时,进一步行肾动态显像来定量测定肾小球滤过率（glom eru lar filtration rate,GFR）的意义。方法将研究对象分为3组：IVP不显影组为76例（37例左肾,39例右肾）,其IVP检查为单侧肾脏肾盏肾盂及输尿管不显影,正常对照组为57例肾移植供体,阳性对照组为12例肾功能不全尿毒症期患者,均采用锝-99m-喷替酸盐（99Tcm-DTPA）肾动态显像Gates法计算其GFR,并通过多个独立样本的非参数秩和检验进行统计分析。结果 IVP不显影组中,左肾GFR为：（18.73±9.33）m l/（min.1.73 m2）,右肾GFR值为：（16.71±7.02）m l/（min.1.73 m2）;正常对照组左肾GFR值为：（43.41±7.40）m l/（min.1.73 m2）,右肾GFR值为：（45.37±8.07）m l/（min.1.73 m2）;阳性对照组GFR值为：左肾GFR值为：（6.84±3.81）m l/（min.1.73 m2）,右肾GFR值为：（7.08±4.75）m l/（min.1.73 m2）;3组间存在显著性差异（P〈0.01）。结论 IVP检查结果为肾不显影时,仍然需要进一步行肾动态显像来定量其单侧GFR,这对临床治疗决策具有指导意义。     

核素肾动态显像与静脉肾盂造影评价肾功能的对比研究

对肾脏疾患患者进行分肾功能测定及静脉肾盂造影 (ＩＶＰ) ,判断不显影或显影差的患肾有无功能 ,在临床上具有重要意义。放射性核素肾动态显像具有简便、无创伤、灵敏度高的特点 ,是评价肾功能的理想方法。本研究就 31例肾疾患患者进行99Ｔｃｍ ＤＴＰＡ或99Ｔｃｍ 双半胱氨酸 (ＥＣ)肾动态显像 ,并与ＩＶＰ检查结果进行对比 ,现报告如下。一、资料和方法1 临床资料。受检者 31例 ,男 2 1例 ,女 10例 ,年龄 2 5～ 6 8(平均 49 5 )岁 ,均为我院门诊或住院患者。经临床症状、体征、Ｂ超、ＣＴ、ＩＶＰ及生化检查等确诊为肾结石及肾积液 2 5例…     

中晚期肾结核放射学检查方法评估

目的:分析中晚期肾结核放射学表现,评价各种检查方法的优缺点,选择敏感的检查手段。方法:搜集经手术病理证实的中晚期肾结核24例,分析并比较其泌尿系统平片(KUB)、静脉肾盂造影(IVP)、肾逆行造影及CT表现。结果:对于中晚期肾结核的诊断符合率,KUB及IVP为41.7%(10/24),肾逆行造影为62.5%(5/8),CT为100%(24/24)。CT特点为断面上聚集成花瓣状的多发低密度区。结论:CT扫描对于中晚期肾结核(特别是肾功能不全)的诊断具有重要价值。     

儿童肾重复畸形99Tcm-EC肾动态显像

目的 评价^99Tc^m-双半胱氨酸（EC）肾动态显像（RDI）在儿童肾重复畸形诊断中的意义以及对选择手术方式的价值。方法 对20例肾重复畸形患儿行RDI、静脉肾盂造影（IVP）、B超等检查，分析肾重复畸形的RDI影像特征，并对3种检查结果进行比较，对14例手术切除的上半肾作临床病理分型：发育型、积水型、发育不良型。^99Tc^m-EC肾动态显像处理：反24min内图像叠加成1帧／2min连续影像，设置重复上半肾、同侧下半肾、对侧上半肾感兴趣区，获得其放射性计数率（D、L、C），以D／L或D／C中较小者为重复上半肾功能指标（D／N），并与病理分型比较，结果 肾重复畸形在RDI连续影像中有4种表现：上肾衡疏、上肾缺损、肾影增长、肾盂分离；RDI对合并输尿管囊肿检出率较高，并可检出部分输尿管扩张积水。RDI、B超、IVP对重复肾的检出率分别为73.1%、57.7%、73.1%，三者较为一致（P＞0.05）；RDI的灵敏度、特异性、准确性分别为73.1%、92.2%、80.0%。发育不良型的上肾D／N值均小于60％，发育型均大于60％。结论 肾重复畸形的^99Tc^m-EC肾动态显像有较好的诊断价值，可为临床术前判断是否保留上肾提供重要依据。     

显影不良或不显形肾脏的CT检查

作者对10例在IVP 中显影不良或未显影病人的肾脏立即进行了CT 检查,以了解其病因。检查一般仅需4个以下层面,偶需多层面。扫描证实IVP中肾显影不良的常见,原因为肾盂积水、慢性肾盂肾炎和先天性肾缺如。CT 可证实肾盂积水时肾实质或集尿系统中有造影剂排泄或集尿系统扩张以及肾脏大小的变化,从而可与肾病的晚期改变区别。因持久的尿路梗阻而不显影的肾脏在CT 扫描中表现为一小的、瘢痕样的肾影,无造影剂排泄。     

单侧肾功能严重受损者99Tcm-二亚乙基三胺五乙酸肾动态显像测定对侧肾肾小球滤过率的临床意义

目的 探讨99Tcm-二亚乙基三胺五乙酸(99Tcm-DTPA)肾动态显像在单侧肾脏功能严重受损患者中的应用.方法 应用99Tcm-DTPA肾动态显像,测定82例单侧肾脏功能严重受损患者的对侧肾脏肾小球滤过率(GFR),并将其与血清肌酐(SCr)值进行相关性分析,同时对对侧肾脏功能受损的病因进行分析.结果 对侧肾GFR与SCr值呈负相关(r=-0.643,P<0.001);在一侧肾脏功能严重受损患者中,肾结石和泌尿系移行细胞肿瘤患者的对侧肾脏易受损害.结论 单侧肾脏功能严重受损患者有必要通过99Tcm-DTPA肾动态显像密切观察对侧肾脏情况,以便及时治疗,防止对侧肾功能的衰竭.     

Tomographic renal cortical scintigraphy: correlation with intravenous urography, computed tomography, ultrasonography, angiography, and nuclear magnetic resonance imaging

This study evaluates single-photon renal tomoscintigraphy (SPECT) in the evaluation of renal masses and correlates this modality, where indicated, with computed tomography (CT), ultrasonography (US), angiography (ANGIO) and nuclear magnetic resonance imaging (NMR). Eight patients with renal cortical lesions detected on intravenous urography (IVP) were evaluated by SPECT and planar nuclear imaging using Tc-99m glucoheptonate (GH). Three of these patients were felt particularly likely to have renal tumors and were additionally evaluated with US, CT, ANGIO and NMR. The five patients with nodules on IVP that were not particularly suggestive of malignancy had functioning, benign, renal tissue accounting for their IVP lesions. Four of five were found by planar-GH nuclear imaging, five/five by SPECT-GH. In addition, SPECT-GH allowed better "confidence" in the normal renal tissue diagnosis in three/five cases. Of the three renal lesions that were highly suggestive of malignancy, two were hypernephromas and one was hypertrophied functioning cortical tissue. All three were correctly identified prospectively on SPECT-GH; however, one hypernephroma was missed on planar-GH. NMR, CT, and ANGIO detected only one of two hypernephromas prospectively (US detected both); all four modalities incorrectly diagnosed the hypertrophied tissue suggestive of malignancy.     

囊性肾癌的影像分析

目的：讨论各种影像检查对囊性肾癌的诊断价值。方法：对经影像检查并得到病理证实的囊性肾癌15例进行分析,其中5例行静脉肾盂造影（IVP）,15例行B超及CT检查,14例同时行增强扫描,比较各种检查方法对囊性肾癌的检出率。结果：15例中,IVP检查诊断符合3例（60．0％）,B超诊断符合12例（80．0％）,CT扫描诊断符合13例（86．6％）。结论：联合影像学检查可提高囊性。肾癌的术前诊断率。     

Tomographic renal cortical scintigraphy: Correlation with intravenous urography,computed tomography,ultrasonography, angiography,and nuclear magnetic resonance imaging

This study evaluates single-photon renal tomoscintigraphy (SPECT) in the evaluation of renal masses and correlates this modality, where indicated, with computed tomography (CT), ultrasonography (US), angiography (ANGIO) and nuclear magnetic resonance imaging (NMR). Eight patients with renal cortical lesions detected on intravenous urography (IVP) were evaluated by SPECT and planar nuclear imaging using Tc-99m glucoheptonate (GH). Three of these patients were felt particularly likely to have renal tumors and were additionally evaluated with US, CT, ANGIO and NMR. The five patients with nodules on IVP that were not particularly suggestive of malignancy had functioning, benign, renal tissue accounting for their IVP lesions. Four of five were found by planar-GH nuclear imaging, five/five by SPECT-GH. In addition, SPECT-GH allowed better confidence in the normal renal tissue diagnosis in three/five cases. Of the three renal lesions that were highly suggestive of malignancy, two were hypernephromas and one was hypertrophied functioning cortical tissue. All three were correctly identified prospectively on SPECT-GH; however, one hypernephroma was missed on planar-GH. NMR, CT, and ANGIO detected only one of two hypernephromas prospectively (US detected both); all four modalities incorrectly diagnosed the hypertrophied tissue suggestive of malignancy.     

Percutaneous transluminal renal angioplasty and renal function

Renal function was studied before and after percutaneous transluminal renal angioplasty (PTRA) in 79 patients. In a prospective study of 28 patients with unilateral renal artery stenosis, renal function was similar during angiotensin-converting enzyme (ACE) inhibition and after PTRA. In 37 patients with bilateral renal artery stenoses, 9 patients with solitary kidneys and renal artery stenoses and 5 patients with transplant renal artery stenoses, there was no statistical difference in the renal function before and after PTRA. Of the 79 patients studied, 50 had normal renal function before PTRA. In 5 of these renal function decreased, requiring temporary hemodialysis in 1. Of 29 patients with impairment of renal function due to renal artery stenosis, improvement was noted in 14, stabilization of renal function in 11, and decrease of renal function in 4. It is concluded that PTRA is a safe technique that can make life-long drug treatment unnecessary in antihypertensive patients. It can restore or stabilize renal function in renal insufficiency caused by renal artery stenosis. It has to be kept in mind that contrast medium toxicity and cholesterol embolization can induce severe renal insufficiency after PTRA.     

Asymmetric abnormality of renal perfusion with symmetric function in aortic dissection.

Two cases of aortic dissection are presented in which discordance between renal perfusion and function has been demonstrated with Tc-99m DTPA. Renal perfusion on the affected side was decreased on blood flow imaging, whereas renal function, including parenchymal accumulation and excretion assessed by subsequent sequential imaging, were similar for both kidneys. These results suggest that blood flow imaging more readily demonstrates a unilateral renal abnormality in patients with aortic dissection.     

Supranormal renal function in unilateral hydronephrotic kidney can be avoided

INTRODUCTION: There are reports and controversy in the literature of supranormal (defined as >55%) differential renal function (DRF) in the hydronephrotic kidney in children with unilateral hydronephrosis. It is not confirmed whether supranormal DRF is an artifact or a true finding. In patients in whom the relative renal function deteriorates, relief of obstruction becomes surgically necessary and if this artifact can be removed. Supranormal function in an obstructed kidney is confusing and there is no consensus on how to manage these patients. There is no agreement if this is a true entity or an artifact. We wanted to address this issue by reporting our experience. METHODS: We reviewed all the consecutive cases from August 2000 to October 2001 who were studied in our center with the diagnosis of unilateral renal obstruction for confirmation or evaluation of DRF. All patients had MAG-3 studies that were interpreted by experienced nuclear medicine physicians. The DRF were measured within the first to second minute of the MAG-3 injection. Regions of interest were drawn by the imaging software and the images were corrected for background counts by drawing regions of interest 2 pixels away from the edge of the renal cortex. RESULTS: Fifty-seven patients were confirmed to be obstructed unilaterally; 41 (72%) patients had obstructive lesions in the left kidney and 16 (28%) in the right kidney. There was no case of supranormal DRF in the obstructed kidneys in our study. CONCLUSION: The supranormal renal function, as noted in some reports in the literature, was not seen in any patients at our institution. We believe that this entity is an artifact and can be avoided by using MAG-3 and projecting regions of interest by computer software; we plan to start analyzing multiple algorithms in phantoms with different ROI selection for background analysis.