85例儿童肾重复畸形核素肾动态显像

核素肾动态显像在儿童先天性肾重复畸形中的应用尚未普及，本研究回顾陛分析了本院1995年5月至2009年1月肾重复畸形患儿的核素肾动态显像结果，以了解核素肾动态显像在该病中的临床应用价值。     

单侧肾动脉狭窄支架治疗前后血压及核素肾动态显像比较

目的 探讨单侧肾动脉狭窄支架治疗后血压变化情况及核素肾动态显像总肾小球滤过率(GFR)的变化。方法 选取2018-01至2023-01在武警特色医学中心接受经皮单侧肾动脉支架置入的40例患者为研究对象,在支架置入前和支架置入后6个月行核素肾动态显像测定GFR,所有患者于术前和术后6个月检测SCr和Cys-C水平,采用不同GFR计算公式同步计算GFR,与核素肾动态显像进行对比分析。所有患者在支架置入后均完成6个月随访,并观察血压变化情况。结果 40例患者在肾动脉支架治疗后6个月,24 h动态血压检测收缩压和舒张压明显下降,使用降压药种类减少。支架治疗前核素肾动态显像GFR为(61.38±5.72) ml/min,支架治疗后6个月,核素肾动态显像GFR为(70.07±6.53) ml/min,和治疗前比较,GFR明显提高,差异有统计学意义(P<0.01)。核素肾动态显像测定的GFR,与采用MDRD公式、CKD-EPISCr公式和CKD-EPICys C公式计算的GFR结果,差异有统计学意义(P<0.01)。CKD-EPICys C公式计算的GFR与核素肾动态显像测定的GFR差值...     

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。     

核素肾动态显像在肾脏术前评价肾功能的临床意义

目的术前通过肾动态显像来评价肾功能对肾脏手术方案的指导价值。方法75例泌尿外科住院患者在手术前均做了核素肾动态显像,通过肾皮质动态图像及计算出的肾小球率过滤对分肾功能作出了准确评价。结果75例患者共有81个功能受损的肾脏,其中无功能肾11个,功能重度受损的22个,功能中度受损的12个,功能轻度受损的36个。根据肾功能情况73例进行了手术,另外2例因对侧肾功能重度受损而改为保守治疗。手术采用根治性肾切除17例和保留肾单位手术56例。结论术前行核素肾动态显像评价肾功能对临床治疗方案及手术方式有重要指导意义。     

小儿肾积水手术前后利尿性肾动态显像对比研究

目的探讨利尿性核素肾动态显像在小儿肾积水手术疗效评价和术后随访中的临床价值。方法回顾性分析49例肾积水患儿的利尿性肾动态显像(F15法,常规方法中第15 min注射呋塞米),对肾脏影像、单肾肾小球滤过率(SKGFR)及肾图曲线进行手术前后的比较。结果①以利尿性核素肾动态显像进行积水分类,术前轻、重度积水各9例,中度积水31例,均被手术证实。功能差的25例SKGFR术前为(26.99±13.85)ml·min-1,术后为(31.15±17.04)ml·min-1,平均提高4.16 ml·min-1。②术前完全梗阻30例,部分梗阻18例,无明显梗阻1例;术后部分梗阻12例,无明显梗阻37例,没有完全梗阻病例,术后梗阻改善明显(P<0.001)。③术前肾盂输尿管交界处梗阻(UPJO)47例,输尿管膀胱交界处梗阻(UVJO)2例,术前梗阻定位为手术证实。④综合梗阻和肾脏功能信息对患儿分类,术前最差型21例,较差型28例,无正常型;术后较差型15例,正常型34例,无最差型。手术前后患儿的构成类型差异有显著性(P<0.001)。结论利尿性核素肾动态显像是评价小儿肾积水的可靠方法,能准确反映手术疗效和疾病转归并指导治疗。     

改良法核素肝胆动态显像联合超声对先天性胆道闭锁的早期诊断

目的 探讨改良法核素肝胆动态显像联合超声早期诊断先天性胆道闭锁(CBA)的临床价值.资料与方法 回顾性分析254例持续性黄疸患儿的临床资料.比较改良法核素肝胆动态显像与常规核素肝胆动态显像对CBA检出率的差异,进一步评估改良法核素肝胆动态显像、超声及两者联合对CBA的诊断效能.结果 改良法核素肝胆动态显像与常规核素肝胆...     

99mTc-RBC显像对胃肠道出血的定位诊断价值探讨

目的：探讨胃肠道出血核素显像的价值。材料和方法：回顾性分析了52例胃肠道出血的^99mTc-RBC核素显像检查,常规作体内标记法,先途径动态血流灌注显像。然后于注射后10,20,30min,1和2h作静态显像,自1999年2月开始加作24h延迟显像。结果：（1）52例核素显像的阳性率为53.8%(28/52),定位准确率为82.1%(23/28).(2)52例中,血流灌注动态显像早期以及静脉显像的定位准确率分别是94.1%(16/17)和72.2%(13/18);11例24h的延迟显像中,发现出血者7例,定位准确者4例.(3)22例阳性显像中,大便隐血(OB)试验阴性7例,阳性3例,强阳性12例;阴性显像14例中,OB阴性11例.强阳性3例,(4)核素显像阳性与BUN/Cr阳性之间未见相关性.结论:为了提高^99mTc-RBC显像对小肠出血点定位的灵敏度和准确性.应注意观察早期动态血流灌注显像和一系列静脉显像.对于出血的预测,显像前的大便隐血试验、BUN/Cr不如核素显像准确。     

核素显像在阴囊急症的临床应用价值

目的 探讨放射性核素阴囊显像在急性睾丸扭转与急性睾丸附睾炎鉴别诊断中的临床应用价值。方法 对阴囊急症13例行SPECT核素阴囊显像，“弹丸”注射^99mTcO^-4 370 MBq后即刻行动态血流灌注显像，15min后行静态血池显像并进行显像结果分析。结果 10例血流灌注相呈血流减低，静态血池相放射性缺损，经急诊手术证实了9例为睾丸扭转，其中3例因及时确诊及手术纠正扭转而保留患睾。3例血流灌注相呈血流增高，静态血池相放射性分布仍明显高于对侧，符合睾丸附睾炎表现．经内科保守治疗后症状消失。结论 睾丸缺血的时间是影响其存活的重要因素。核素阴囊显像简便、快速、非创伤，对阴囊急症的鉴别诊断、治疗方法的选择具有重要的临床指导价值。     

气体加压注射器在核素心血管造影中的应用

“弹丸”式注射法是首次通过法核素心血管造影成功的关键因素之一.我院用双三通法弹丸注射合格率为81.9%.为了进一步提高效果,我们研制了气体加压注射器,配套双三通导管进行弹丸式注射,检查48人次,弹丸合格率达95.8%(46/48).经用155人次总结,安全率达100%.     

放射性核素肾动态显像对腹主动脉瘤患者术前肾功能的评价

本研究对比分析了20例健康人和35例腹主动脉瘤患者的术前肾动态显像结果,以了解腹主动脉瘤对肾功能的影响,并探讨腹主动脉瘤患者术前行核素肾动态显像检查的价值. 一、资料与方法 1.临床资料.选择体格检查健康者20名为对照组,男11名,女9名,年龄40 ～74(56.20±9.69)岁.选择腹主动脉瘤患者35例,男29例,女6例,年龄22 ～ 80( 63.05±14.37)岁,既往均无肾疾病史,其中近肾型腹主动脉瘤12例(组1),肾下型腹主动脉瘤16例(组2),夹层腹主动脉瘤7例(组3).腹主动脉瘤患者术前行放射性核素肾动态显像检查,并测定血尿素和SCr;对照组仅行放射性核素肾动态显像检查.     

Deadtime correction in measurement of fractional renal accumulation of 99Tcm-MAG3

Fractional renal accumulation of a radiotracer is often used to measure renal function with camera-based methods. We evaluated the effect of deadtime count loss on the calculation of fractional renal accumulation of 99Tcm-mercaptoacetyltriglycine (99Tcm-MAG3). In 15 patients, dynamic renal scintigraphy was performed after the injection of 250 MBq of 99Tcm-MAG3. A reference source was placed on the periphery of the field of view of the gamma camera to monitor the loss of counts in dynamic imaging. The activity in the syringe was also counted with the camera to measure the injected dose, and the deadtime count loss in the syringe was computed from the observed count rate and deadtime in imaging a point source. Fractional renal accumulation, the ratio of renal accumulation on dynamic imaging to the injected dose, was assessed with and without correction for deadtime loss. Fractional renal accumulation was over-estimated by 4.1% with no deadtime correction, when the value after correction for loss in both syringe counts and dynamic imaging was used as a standard. It was underestimated by 4.0% with correction for syringe counts only. The results suggest that correction for count loss only in measuring the injected dose does not lead to a significant improvement in the accuracy of estimating renal function with camera-based methods.     

动态增强MR血管成像对活体肾移植供体术前的评估

目的 探讨动态增强MRA对活体肾移植供体血管解剖的显示情况.方法 35名肾移植供体,术前行MRA检查.首先经静脉注入1 ml对比剂Gd-DTPA,测出循环至肾动脉时间.然后行冠状面3D T1加权快速扰相小角度梯度回波(3D FLASH)序列扫描.自动脉期开始连续扫描4期,每期间隔10 s,获得肾动脉、肾静脉、集合系统等各期图像.2名放射科医师观察原始图像及MIP重组后图像,观察肾动脉、肾静脉及其分支的显示情况,确定血管的走形及有无变异.并把MRA图像质量确定为5级,与32名手术结果进行比较.结果 MRA对于肾动脉、肾静脉系统的显示质量均较好.35名供者70个肾脏中发现5支左肾副动脉,9支右副肾动脉.3支左肾动脉过早分支,6只右肾动脉过早分支,其中1支右侧双肾静脉,2例左侧精索静脉粗大.1例右肾副上极动脉MRA术前未发现.结论 动态增强MRA安全无创,对肾动脉、肾静脉显示清楚,诊断变异准确度高,是术前肾移植供体血管评价较好的影像检查手段.     

动态增强MR血管成像对活体肾移植供体术前的评估

目的 探讨动态增强MRA对活体肾移植供体血管解剖的显示情况.方法 35名肾移植供体,术前行MRA检查.首先经静脉注入1 ml对比剂Gd-DTPA,测出循环至肾动脉时间.然后行冠状面3D T1加权快速扰相小角度梯度回波(3D FLASH)序列扫描.自动脉期开始连续扫描4期,每期间隔10 s,获得肾动脉、肾静脉、集合系统等各期图像.2名放射科医师观察原始图像及MIP重组后图像,观察肾动脉、肾静脉及其分支的显示情况,确定血管的走形及有无变异.并把MRA图像质量确定为5级,与32名手术结果进行比较.结果 MRA对于肾动脉、肾静脉系统的显示质量均较好.35名供者70个肾脏中发现5支左肾副动脉,9支右副肾动脉.3支左肾动脉过早分支,6只右肾动脉过早分支,其中1支右侧双肾静脉,2例左侧精索静脉粗大.1例右肾副上极动脉MRA术前未发现.结论 动态增强MRA安全无创,对肾动脉、肾静脉显示清楚,诊断变异准确度高,是术前肾移植供体血管评价较好的影像检查手段.     

动态增强MR血管成像对活体肾移植供体术前的评估

目的 探讨动态增强MRA对活体肾移植供体血管解剖的显示情况.方法 35名肾移植供体,术前行MRA检查.首先经静脉注入1 ml对比剂Gd-DTPA,测出循环至肾动脉时间.然后行冠状面3D T1加权快速扰相小角度梯度回波(3D FLASH)序列扫描.自动脉期开始连续扫描4期,每期间隔10 s,获得肾动脉、肾静脉、集合系统等各期图像.2名放射科医师观察原始图像及MIP重组后图像,观察肾动脉、肾静脉及其分支的显示情况,确定血管的走形及有无变异.并把MRA图像质量确定为5级,与32名手术结果进行比较.结果 MRA对于肾动脉、肾静脉系统的显示质量均较好.35名供者70个肾脏中发现5支左肾副动脉,9支右副肾动脉.3支左肾动脉过早分支,6只右肾动脉过早分支,其中1支右侧双肾静脉,2例左侧精索静脉粗大.1例右肾副上极动脉MRA术前未发现.结论 动态增强MRA安全无创,对肾动脉、肾静脉显示清楚,诊断变异准确度高,是术前肾移植供体血管评价较好的影像检查手段.     

Gd-DTPA-cascade-polymer: Potential blood pool contrast agent for MR imaging

Gadolinium-DTPA (diethylenetriaminepentaacetic acid)-cascade-polymer, a potential new blood pool contrast agent for magnetic resonance (MR) imaging, was compared with a known blood pool agent, Gd-DTPA-polylysine, in an animal model. The relative signal intensities of liver, renal cortex, pancreas, and trunk muscle were assessed in 12 pigs between 4 seconds and 120 minutes after injection of a 20 μmol/kg dose of each contrast agent, by using a FLASH (fast low-angle shot) sequence. Except for muscle, all tissues showed visible enhancement after injection of either contrast agent. After injection of Gd-DTPA-polymer, enhancement patterns in the liver, renal cortex, and pancreas were similar to those seen after injection of Gd-DTPA-polylysine. No statistically significant differences in enhancement between the two contrast agents were found at any time point. The authors conclude that the contrast kinetics of Gd-DTPA-cascade-polymer are similar to those of Gd-DTPA-polylysine and that this agent may also be used as a blood pool contrast agent for MR imaging.     

Functional MR of the kidney.

A bolus injection of Gadopentetate Dimeglumine with dynamic gradient echo MR imaging has allowed for the visualization of normal and abnormal renal function. Following an injection of gadopentetate dimeglumine, NMR T1 relaxation times obtained on serial collections of serum and urine at timed intervals were used to derive the glomerular filtration rate. The merger of dynamic contrast-enhanced MRI with an in vitro NMR-derived GFR provides for assessment of renal function without the use of radioactive agents.     

Comparison of static and dynamic MRI techniques for the measurement of regional cerebral blood volume.

Two different acquisition and processing strategies to determine the regional cerebral blood volume (rCBV) with magnetic resonance imaging (MRI) are compared. The first method is based on the acquisition of the signal time course during a bolus administration of a contrast agent (dynamic method). The second method evaluates signal changes before and after the contrast agent injection (static method), assuming the contrast agent remains primarily intravascular in the brain after the first pass. Both methods were applied to the same data sets, acquired with either echoplanar imaging (EPI, n = 18) or fast low-angle shot (FLASH, n = 28) techniques. A voxel-by-voxel correlation between the static and dynamic method yielded a correlation coefficient of 0.76 +/- 0.06 for the EPI and 0.71 +/- 0.10 for the FLASH measurements. The static method was less sensitive and showed higher standard deviations for rCBV than the dynamic method. With the development of truly intravascular contrast agents, the static perfusion MRI method, which can be performed with higher signal-to-noise ratio and higher spatial resolution, may become an alternative to ultra-fast MRI for measuring rCBV.     

兔急性肾功能衰竭CT灌注成像与核素显像对照的实验研究

目的探讨兔急性肾功能衰竭(ARF)早期的CT灌注情况及其与核素扫描结果的关系。方法兔后腿肌注50%甘油10ml/kg,建立急性肾小管坏死性ARF动物模型,分别于注射前、注射后6h行CT灌注扫描和核素扫描。运用GE公司Perfusion2软件,测量右肾皮质的CT灌注血流量(BF),并与核素显像ERPF结果进行相关性分析。结果两种检查方法,注药前后结果差异均具有显著性意义(P<0.01),且注药前后CT灌注扫描与核素扫描有较好的相关性。结论急性肾小管坏死性ARF时,CT灌注成像能较准确地评价早期血流动力学的改变。     

Ultrafast MR imaging of the pelvis.

MR gradient systems with higher slew rates and gradient amplitude enable certain forms of imaging that are not practical with older gradient systems. These newer pulse sequences include single shot half-Fourier T2-weighted images and echo planar imaging. More important in MR imaging of the pelvis, these gradient systems benefit more conventional imaging methods such as gadolinium-enhanced 3D MR angiography, dynamic gradient echo contrast-enhanced images, and T2-weighted fast spin echo images, by shortening echo times. For most MR imaging of the pelvis, spatial resolution is paramount, and therefore sequences such as half-Fourier acquisition Turbo spin echo (HASTE) and 3D gadolinium-enhanced dynamic imaging play a less important role than in the upper abdomen. The potential of these techniques for diffusion or perfusion studies in the pelvis has not been explored.     

Ultrasound contrast agents

Ultrasound contrast agents are introducing a new vision to ultrasonography. The increase in the Doppler signal intensity improves difficult examinations. Technical failures in the study of transcranial, liver and renal vessel might be rescued with the injection of these new compounds. The introduction of specific image sequences such as harmonic imaging and pulse inversion imaging allows detection of parenchymal enhancement in liver and renal examinations. The injection of ultrasound contrast agents also provides dynamic quantitative information to develop functional imaging. However, it is mandatory to understand the interaction with the ultrasound beam in order to optimise their use and define the adequate ultrasound sequence.