单光子发射型计算机断层仪在肾移植监测中的价值

肾移植术后３个月内移植肾急性排斥发生率约为１７％,慢性移植肾失功发生率达 ８．１％～３９％。应用精确、灵敏、早期全面反映肾功能的检测方法,对移植肾急、慢性排斥反应监测,指导临床及时采取措施是非常关键的。我们应用单光子发射型计算机断层仪（简称ＳＰＥＣＴ）对6３例肾移植后患者的肾功能进行了监测,现报告如下。 资料与方法 １．对象的选择与分组方法：选择华西医科大学和济宁医学院附属医院１９９６年 １月～１９９８年 １２月首次行同种异体肾移植患者６３例,对照１３例。均于术后3周做ＳＰＥＣＴ（Ｅｌｓｉｎｔ ＳＰＸ－…     

肾移植术后早期氧自由基的变化

我们通过监测２０例肾移植病人术前，术后早期血ＳＯＤ、ＬＰＯ、ＧＳＨ－ＰＸ的变化，研究移植术后早期自由基对肾功能的影响。结果显示移植肾恢复血液灌流１小时，ＳＯＤ变化较ＬＰＯ、ＧＳＨ－ＰＸ敏感；与术前比较，ＳＯＤ明显下降，移植肾恢复正常功能时间明显延长，ＳＯＤ成倍下降时，预示移植肾不可逆性损伤；低流量，低Ｏ２灌注是否影响自由基的生成，仍需进一步探讨。     

同种异体肾移植患者血清SIL－2R水平变化及其临床意义

作者采用双抗体夹心酶联免疫吸附法（ＥＬＩＳＡ）对２０例同种异体尸肾移植患者进行了８９例次可溶性白介素２受体（ＳＩＬ－２Ｒ）检查。结果表明：移植前明显高于正常对照组，Ｐ＜０．００１。移植后随着肾功能的恢复而接近正常，但仍轻度高于正常对照组，Ｐ＜０．０１。发生急性排斥反应时较稳定期明显升高，Ｐ＜０．００１，且其上升时间早于血肌酐上升２～７天。而发生环孢素Ａ肾中毒或急性肾小管坏死时，血清ＳＩＬ－２Ｒ水平则变化不明显，Ｐ＜０．０５。因此，ＳＩＬ－２Ｒ的测定可作为移植肾排斥反应诊断和鉴别诊断的重要非创伤性指标。     

肾移植后上尿路梗阻的SPECT诊断及鉴别诊断

本研究应用单光子发射型计算机断层（ＳＰＥＣＴ）对８３例肾移植作了９５次检测。本研究发现上尿路梗阻的ＳＰＥＣＴ图像分两种：普通型占大多数，特征是肾实质早期放射性稀疏区伴肾盂输尿管显像剂滞留；肾小管梗阻型少见，特征是肾皮质放射性滞留及髓质全程放射性稀疏而呈特征性“空心”肾。假性梗阻图像与普通上尿路梗阻的相同，利尿试验可区别之。排斥及急性肾小管坏死（ＡＴＮ）时，放射性滞留在肾实质并伴其它功能损伤。     

外周血及移植肾内嗜酸性粒细胞变化的临床意义

为了解移植肾在急性排斥时外周血和移植肾内嗜酸性粒细胞（ＥＯ）变化的意义，动态观察３１例同种异体肾脏移植病人的外周血和移植肾内ＥＯ的变化。结果发现在急性排斥反应时，移植肾内ＥＯ数＞２％者占８０．９％，明显高于肾功能稳定时，Ｐ＜０．０１；重度排斥中血ＥＯ数＞４％者占８２．６％，明显高于肾功能稳定时和中度以下排斥者，Ｐ＜０．０１。结果认为，测定移植肾内的ＥＯ变化可以做为监测急性排斥反应的可靠指标，外周血中的ＥＯ明显增多常提示排斥反应较为严重。     

肾移植后红细胞增多症的临床流行病学研究

对肾移植后红细胞增多症（ＰＴＥ）的临床流行病学进行研究。在本中心完成的９０１例同种异体尸肾移植病人中，共发生肾移植后ＰＴＥ８４例，发病率为９．３％，发生于移植后１６．８±１１．３个月。就其性别组成、移植前Ｈｂ、移植前后高血压发病情况、利尿剂应用、免疫抑制药、自体肾是否切除、移植后发病前ＳＣｒ／ＢＵＮ（血肌酐／尿素氮）及移植前淋巴毒试验结果等，与非ＰＴＥ组对照，发现ＰＴＥ好发于移植前Ｈｂ相对较高、移植前后血压较高、不服用Ａｚａ而肾功能良好的男性肾移植病人。     

SPECT检查结合FNAB在肾移植术后监测中的应用价值

随机选择３４例异体肾移植病例，将单纯单光子发射型计算机断层（ＳＰＥＣＴ）和细针抽吸活检（ＦＮＡＢ）诊断与两者相结合得出的结论作对比，发现其诊断准确率分别为７０．６％、７９．４％和９７．１％，其差异具有统计学意义（Ｐ＜０．０５）。由此认为，ＳＰＥＣＴ检查和ＦＮＡＢ技术相结合，能弥补彼此之不足，是一咱理想搭配方式，可作为肾移植术后监测的常规手段，在临床上较高的应用价值。     

慢性肾功能不全与内源性洋地黄物质

我们用放免法（ＲＩＡ）测定了４７例慢性肾功能不全、３５例维持血透、２５例移植患者血中内源性洋地黄物质（ＥＤＬＳ）水平。结果显示：随着肾功能的降低，血中ＥＤＬＳ水平升高。ＥＤＬＳ与内生肌酐清除呈负相关，ｒ＝－０．６３８，Ｐ＜０．００１。认为ＥＤＬＳ深度升高产生对钠－钾－三磷酸腺苷酶（Ｎａ－Ｋ－ＡＴＰ酶）的抑制在慢性肾功能不全发病过程中具有重要意义，血透可使ＥＤＬＳ水平降低。当移植肾功能正常后，ＥＤＬ     

肾移植患者术后早期血浆内皮素的变化

对３２例尸体肾移植患者术前及术后早期３个月的血浆内皮素－１（ＥＴ－１）浓度进行了动态观察，同时行前列腺素Ｅ－２（ＰＧＥ－２）、血栓素Ｂ－２（ＴＸＢ－２）与环孢素Ａ（ＣｓＡ）血浓度的测定及移植肾功能与血压的监测。ＥＴ－１、ＰＧＥ－２及ＴＸＢ－２均采用放射免疫法测定，ＣｓＡ血浓度采用多克隆抗体偏振免疫荧光法（ＴＤＸ）进行。结果显示：移植前患者的血浆ＥＴ－１平均浓度为１０．２７±０．５７ｐｇ／ｍｌ，移植后３个月各阶段的ＥＴ－１值均显著降低，平均浓度为４．６２±０．１４ｐｇ／ｍｌ。与此同时，血浆Ｃｒ和ＢＵＮ值以及收缩压、舒张压也呈现相似的变化，与移植前相比有非常显著性差异（Ｐ＜０．０１），且血浆ＥＴ－１浓度的变化与移植肾功能及血压密切相关。血浆ＥＴ－１浓度可作为肾移植术后的一项监测参考指标。     

肾移植患者血小板活化指标测定的临床研究

为探讨移植肾排斥反应与血小板活化指标的关系，应用抗人活化血小板ＧＭＰ－１４０（α－颗粒膜蛋白）特异单克隆抗体Ｓｚ－５１（苏州－５１），检测６８例肾移植患者外周血血小板表面及血浆ＧＭＰ－１４０含量；同时采用放射免疫法测定血浆ＴｘＢ２（血栓烷Ｂ２）含量。术后肾功能正常者ＧＭＰ－１４０及ＴｘＢ２略有升高；发生急慢性排斥反应时两者均显著升高（Ｐ＜０．００１），排斥逆转或移植肾切除后逐渐下降。发生环孢素中毒者其含量无明显变化（Ｐ＞０．０５）。提示移植肾排斥与体内血小板活化有关，活化指标ＧＭＰ－１４０、ＴｘＢ２检测对早期诊断肾移植后排斥反应及环孢素中毒具有一定的临床价值，是监测移植肾排斥反应的一个较灵敏的生物学指标。     

On the lymphatics of the cardia--with special reference to the study of using endoscopic lymphoscintigraphy with SPECT

Endoscopic lymphoscintigraphy was performed on 29 patients. In 15 of 29 cases, Single Photon Emission Computed Tomography (SPECT) was performed to observe the lymphatics of the cardia. The rate of detection of paraaortic lymph nodes by SPECT was 66.6%, and in particular the paraaortic lymph nodes in the upper portion of the left renal vein were detected at a rate of 58.3%. The ascending lymph flow from the cardia to the mediastinum could be depicted by SPECT. The SPECT images and the distribution of accumulation of Tc-99m Rhenium colloid into the regional lymph nodes indicated a similar tendency to the actual metastatic rate of carcinoma of the cardia. Endoscopic lymphoscintigraphy with SPECT is considered to be useful for imaging the lymph flow from the cardia to the regional lymph nodes. On the other hand, the conventional planar image was poor in depicting lymph nodes, and was impossible in dynamic analysis. In the early stage of carcinoma of the cardia, if the area limited, proximal gastrectomy seems reasonable, but in progressive and deepseated cancer, it is suggested that it is necessary to remove the lymph nodes in a wide area, including the paraaortic lymph nodes, in addition to performing total gastrectomy.     

SPECT/CT同机图像融合诊断股骨头缺血性坏死

目的 评价SPECT/CT同机图像融合技术诊断股骨头缺血性坏死的临床应用价值.方法 53例临床可疑股骨头缺血性坏死患者行全身骨显像及骨盆局部SPECT/CT断层显像并对SPECT和CT同机图像进行重建与融合.结果 ①融合图像诊断阳性率高于断层图像及平面图像,差异具有显著性;②融合图像对早期病变诊断阳性率高于断层显像及平面显像,差异具有显著性.结论 SPECT/CT同机图像融合技术对于股骨头缺血性坏死的早期诊断、鉴别诊断及疾病分期均有一定的临床价值.     

Utility of SPECT DMSA renal scanning in the evaluation of children with primary vesicoureteral reflux

OBJECTIVES: DMSA renal scanning is more sensitive than ultrasound in detecting renal parenchymal scars. We proposed to determine the utility of single-photon emission computed tomography (SPECT) dimercaptosuccinic acid (DMSA) renal scanning in children with primary vesicoureteral reflux (VUR). METHODS: During a 24-month period, we evaluated the charts of 368 patients who had undergone SPECT DMSA renal scanning for primary VUR. Patients were divided into three age groups: (a) less than 1 year, (b) between 1 and 5 years, and (c) older than 6 years. Renal scars were deemed severe or focal. The data were analyzed to evaluate the utility of SPECT DMSA scanning in children with primary VUR and to determine the indications for performing SPECT DMSA. We also evaluated the sensitivity of recent renal ultrasound technology in detecting focal and diffuse scars. RESULTS: One hundred twenty-eight patients were younger than 1 year at presentation. These included 24 cases that were detected prenatally. One hundred eighty-five were between the ages of 1 and 5 years, and 55 were 6 years or older. Reflux nephropathy at presentation was found in 99 (26.9%) of 368 patients. DMSA scanning changed the treatment in only 13 patients (3.5%). When scarring was diffuse, ultrasound examination correlated 100% with DMSA scanning; when focal scarring was present, the correlation was poor. CONCLUSIONS: Our results suggest that DMSA scans should be tailored to children who have ultrasound abnormalities, high-grade reflux, or recurrent breakthrough urinary tract infections. These guidelines will result in a substantial cost savings and a significant decrease in radiation exposure.     

Determination of functional kidney volume by single-photon emission computed tomography in patients with insulin-dependent diabetes mellitus.

Functional parenchymal kidney volume was determined by single-photon emission computed tomography (SPECT) for 99mTc-dimercaptosuccinic acid (DMSA) using a rotating gamma camera in phantom experiments and in patients with insulin-dependent diabetes mellitus (IDDM). The results from the patient examinations were corrected according to the phantom studies and were thereafter set in relation to renal haemodynamics, blood pressure, and urinary albumin excretion. Functional parenchymal kidney volume was significantly greater in diabetic patients compared to that of 11 healthy controls (P < 0.003). Urinary albumin excretion was increased and glomerular filtration rate (GFR) per renal parenchymal volume significantly less in patients with a duration of diabetic disease of more than 15 years compared to patients with shorter duration of disease (P < 0.03 and P < 0.05 respectively). Diabetic patients with a GFR of more than 120 ml/min had greater renal parenchymal volume than patients with lower GFR (P < 0.02). Patients with increased GFR, renal plasma flow (RPF), renal blood flow, or filtration fraction had significantly greater functional parenchymal volume than the healthy subjects (P < 0.01 for all comparisons). We conclude that by application of SPECT for DMSA we were able to show that IDDM patients have greater renal parenchymal volumes than healthy subjects. GFR/kidney volume was increased in IDDM patients with a duration of disease of < 15 years compared to patients with long-standing diabetes. The SPECT technique seems suitable for prospective long-term follow-up studies of functional kidney volume in IDDM patients.     

Renal scarring sequelae in childhood Kawasaki disease

To assess renal inflammation and its sequelae in Kawasaki disease (KD) patients, we conducted a prospective study in a university medical center setting in Taiwan. From June 2002 to January 2005, 50 children with KD were enrolled, and after admission, all received technetium-99m dimercaptosuccinic acid scintigraphy single photon emission computed tomography (DMSA renal SPECT), the results of which were used as the reference standard for determining renal inflammation. Patients with renal inflammation underwent another DMSA renal SPECT more than 6 months later to evaluate the sequelae. We found that 26 of the 50 patients (52%) had renal inflammatory foci. There were no significant relationships between clinical or laboratory parameters and renal involvement in KD, except the presence of coronary artery lesions [P < 0.01; odds ratio (OR) 5.18; 95% confidence interval (CI) 1.52–17.65]. Although all patients were free of clinical symptoms, the 6-month follow-up DMSA renal SPECT showed renal scarring in 11 of the 24 patients (46%). Patients with an initial abnormal renal ultrasound did predict a greatly increased risk of scarring (P < 0.05; OR 16.2; 95% CI 1.27–206.20). In conclusion, this study demonstrated that the potential long-term clinical impact of KD is not limited to coronary artery lesion sequelae but also includes renal scar formation. Financial support: Grants from the National Cheng Kung University Medical Center.     

Myocardial scintigraphy using a fatty acid analogue detects coronary artery disease in hemodialysis patients

BACKGROUND: Coronary artery disease contributes significantly to mortality in end-stage renal disease (ESRD) patients. Single-photon emission computed tomography (SPECT) using an iodinated fatty acid analogue, iodine-123-methyl iodophenylpentadecanoic acid (123I-BMIPP), can assess fatty acid metabolism in the myocardium. We investigated the ability of 123I-BMIPP SPECT to detect coronary artery disease in hemodialysis patients compared with 201thallium chloride (201Tl) SPECT. METHODS: We prospectively studied 130 ESRD patients undergoing hemodialysis for a mean of 88.6 months (male/female, 77/53; mean age, 63.8 years). Dual SPECT using 123I-BMIPP and 201Tl was performed, followed by coronary angiography. SPECT findings were graded in 17 segments on a five-point scale (0, normal uptake; 4, none) and assessed as a summed score. RESULTS: By coronary angiography, 71.5% of patients (93/130) had significant coronary stenosis (> or =75%), and five patients showed coronary spasm without coronary stenosis. When a BMIPP summed score of 6 or more was defined as abnormal, sensitivity, specificity, and accuracy for detecting coronary artery disease by BMIPP SPECT were 98.0%, 65.6%, and 90.0%, respectively; in contrast, these parameters for detecting coronary artery disease by Tl SPECT were 84.7%, 46.9%, and 75.0%, respectively, when a Tl summed score of 1 or more was defined as abnormal. In receiver operating characteristic analysis, the area under the curve was 0.895 in BMIPP and 0.727 in Tl SPECT, respectively. CONCLUSION: Resting BMIPP SPECT is superior to Tl SPECT for detecting coronary lesions, and provides safe screening for coronary artery disease among maintenance hemodialysis patients.     

Influence of diabetes mellitus on diagnostic potential of iodine-123-BMIPP imaging for coronary artery stenosis in hemodialysis patients

BACKGROUND: Single-photon emission computed tomography (SPECT) using a fatty acid analogue, iodine-123-beta-methyl iodophenyl-pentadecanoic acid (123I-BMIPP), as a tracer may be effective for detecting coronary artery disease in end-stage renal disease (ESRD) patients. In this study, we investigated whether the presence of diabetes mellitus may affect the diagnostic potential of BMIPP SPECT for detecting coronary stenosis in ESRD patients. METHODS: 123I-BMIPP SPECT was performed in 98 diabetic hemodialysis patients (male to female ratio 66:32; mean age 63.6+/-9.8 years) and 103 nondiabetic hemodialysis patients (68:35; 64.5+/-10.4 years), followed by coronary angiography within 60 days of the SPECT. SPECT imaging was evaluated and graded on a 5-point scale (0=normal, 4=absence of tracer) and assessed as a BMIPP summed score for 17 left ventricular segments. RESULTS: Coronary angiography revealed that 72.4% (71/98) of the diabetic patients and 56.3% (58/103) of the non-diabetic patients had significant coronary stenosis more than 50%; incidences of asymptomatic coronary stenosis were 77.5% in diabetic patients and 72.4% in nondiabetic patients. When a BMIPP summed score of 8 or more was defined as abnormal, sensitivity, specificity and accuracy for detecting coronary stenosis by BMIPP SPECT were 97.2, 63.0 and 87.8% in diabetic patients, and 96.6, 73.3 and 86.4% in nondiabetic patients. In receiver operating characteristic analysis, the areas under the curve of BMIPP SPECT to diagnose coronary stenosis were 0.897 in diabetic and 0.906 in nondiabetic patients. CONCLUSIONS: BMIPP SPECT seems to be able to detect coronary stenosis in diabetic as well as nondiabetic hemodialysis patients.     

肾移植术后Tru-cut针活检、多谱勒超声检查和同位素肾血流动态观察的应用价值

目的　评估Tru-cut针活检、多谱勒超声检查（CDFI）、同位素肾血流动态观察（SPECT）在肾移植术后的应用价值。方法　随机选择30例肾移植患者,将单纯Tru-cut针活检、CDFI以及SPECT检测所得结论作对比。结果　三种方式诊断准确率依次分别是82%、73%、79%。结论　Tru-cut针活检、CDFI和SPECT检查,均可作为肾移植术后的常规检测手段,三种方法联合使用,在临床上有较高的应用价值。     

Quantitative assessment with SPECT imaging of stress injuries of the pars interarticularis and response to bracing

The evaluation and management of acute spondylolysis remains unclear in part because of outcome data that are primarily subjective. The aim of this study was to evaluate and monitor these patients objectively using quantitative single-photon emission computed tomography (SPECT). Thirty-four patients were so observed clinically between 1987 and 1996 and were studied with an initial and at least one follow-up SPECT scintigram. Initial radiographs and planar bone scans failed to demonstrate the pars lesion in 53 and 19% of the patients, respectively. The average SPECT ratio before brace treatment was 1.45. After treatment, this ratio significantly decreased to 1.27 (p = 0.03). A subset of patients remained symptomatic at follow-up. Their reduction in SPECT ratio averaged only 2.8% as compared with 13% for the remainder of the patients (p = 0.01). Patients diagnosed and braced in the early, more active stage of the condition (with greater intensity on SPECT) had more predictable symptom relief. An initial SPECT ratio of >1.5 was associated with complete symptom resolution after brace treatment. Patients treated with activity restriction only (>3 months) before bracing were more likely to have persistent symptoms and more modest improvement on SPECT (p = 0.01). These data, which use SPECT scintigraphy, support prompt treatment with brace immobilization for acute spondylolysis in children and adolescents.     

Ineffectiveness of dipyridamole SPECT thallium imaging as a screening technique for coronary artery disease in patients with end-stage renal failure

The efficacy of dipyridamole single photon emission computed tomography (SPECT) thallium as a screening test for coronary artery disease (CAD), was studied in 45 patients with end-stage renal failure undergoing evaluation for renal transplantation. Coronary arteriography, dipyridamole SPECT thallium imaging and clinical follow-up were performed in all patients. Nineteen patients (42%) had an obstruction of 50% or more in at least one coronary artery. Fourteen patients had a positive thallium scan, but 7 of these were false-positives (sensitivity 37%, specificity 73%). The sensitivity was considerably lower than that quoted for non-ESRF patients in the literature, and significantly lower than a control group of 19 patients without ESRF having comparable severity and distribution of CAD. Five of the 6 patients who died of cardiac causes over a mean follow-up period of 25 months had normal thallium imaging, but all had significant coronary artery disease at cardiac catheterization. Dipyridamole SPECT thallium imaging has not proved a useful screening test for angiographically significant CAD, and does not predict cardiac prognosis in this population.