^99Tc^m—DTPA肾皮质通过时间延迟预测肾盂输尿管连接部狭窄术后肾功能改善的价值

目的探讨^99Tc^m-DTPA利尿肾动态显像皮质通过时间（PTT）作为预测肾盂输尿管连接部狭窄（UPJO）离断式肾盂成形术后肾功能改善指标的可行性。方法回顾性分析47例[男37例,女10例,年龄（29．7±10．8）岁]单侧UPJO患者临床情况及手术前后^99Tc^m-DTPA利尿。肾动态显像,记录患者的年龄、性别、患肾位置、梗阻类型、手术方式、相对肾功能[RRF（患肾放射性摄取占总肾的百分比）]以及PTT,评价不同因素或指标对术后患肾RRF改善率（术后与术前RRF差值）的影响。符合以下情况之一即为PTT延迟：（1）在第2—7帧慢动态影像上,积水肾盂内未见放射性;（2）在第2～9帧慢动态影像上,肾皮质放射性无变化,肾大小、形态变化不明显;（3）肾皮质放射性持续增加;（4）自慢动态第2帧影像始,肾皮质放射性清除较对侧正常肾慢。采用配对t检验、KruskM—Wallis及Mann—Whitney秩和检验和Pearson相关分析对数据进行统计学分析。结果术后患肾RRF高于术前,分别为（40．70±13．30）％、（44．96±12．60）％,t=4．19,P〈0．01。PTT延迟组（16例）RRF改善率显著高于PTT正常组（27例）,分别为（11．69±6．52）％、（0．48±2．98）％,z=-5．13,P〈0．01;4例患肾PTT不能明确判断延迟或正常。术前不同RRF（〈40％与40％）、梗阻类型（机械性与非机械性）、患肾位置（左与右）、手术方式（开放手术与腹腔镜手术）以及性别（男与女）组间的患肾RRF改善率差异均无统计学意义（z=-1．93～1．25,均P〉0．05）。患肾RRF改善率与患者年龄之间未见有统计学意义的相关性（r=0．01,P〉0．05）。结论^99Tc^m-DTPA利尿肾动态显像PTT延迟是预测UPJO患者术后肾功能改善的唯一有效指标。     

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。     

SPECT肾动态显像在小儿先天性肾盂积水中的临床应用

目的探讨SPECT肾动态显像在诊断小儿先天性肾盂积水的价值.方法回顾性分析肾盂积水患儿30例,采用99mTc-DTPA肾动态显像方法,部分患儿静脉注射速尿,其中12例作手术前后比较.定量指标有高峰摄取率(PUR),肾血流灌注率(BPR),半排时间(T1/2)结果BPR随肾盂积水程度加重而明显下降,重度积水为16.8%±6.8%,中度积水为35.1%±6.9%,轻度积水为40.6%±9.2%.PUR在重度积水时为21.6%±12.9%.12例患儿手术后其中10例BPR明显升高,术后T1/2明显改善.结论SPECT可准确反映肾盂积水和肾功能受损程度,两者呈正相关,术后肾功能改善情况和应用速尿能正确判断集尿系统有无梗阻存在.     

肾动态功能显像在儿童先天性泌尿系统畸形的应用

目的 对儿童泌尿系统各种先天性畸形的肾动态显像特征作总结并评价其临床意义。方法 ５１例泌尿先天性畸形患儿按病因分为４组,进行９９＾Ｔｃ－ＤＴＰＡ肾动态显像,其中８例患儿加作了速尿介入试验。结果 肾动态显像可以：（１）从形态上识别各种畸形并了解分肾功能;（２）确定尿路梗阻部位。输尿管近端梗阻表现为肾盂积水较重,输尿管无积水,远端输尿管梗阻则肾盂积水较轻,输尿管积水;下尿路梗阻常为双侧积水。利尿肾图有     

^99mTc—DTPA肾动态显像在小儿肾盂积水中的应用

目的探讨９９ｍＴｃＤＴＰＡ肾动态显像诊断小儿肾盂积水的临床价值。方法常规９９ｍＴｃＤＴＰＡ肾动态显像方法，１５分钟后静脉注射速尿，共检查肾盂积水患儿４５例，其中７例作手术前后比较。定量分析指标包括：肾血流灌注率（ＢＰＲ），高峰摄取率（ＰＵＲ），半排泄时间（Ｔ１／２）。结果①ＢＰＲ随积水程度加重而明显下降，重度积水为１６８％±６８％，中度积水为３５１％±６９％，轻度积水为４０６％±９２％。ＰＵＲ在重度积水时为２１６％±１２９％。②７例患儿中６例术后ＢＰＲ明显升高。术前、术后Ｔ１／２分别为４１３±２０４和２２９±１１９分钟。术后Ｔ１／２明显改善。结论①ＢＰＲ可正确反映肾盂积水和肾功能受损程度，两者呈正相关；②术后肾功能改善情况和速尿介入能正确判断集尿系统有无梗阻存在     

婴儿先天性梗阻性肾病术后99Tcm-EC利尿肾动态显像

目的　探讨利尿肾动态显像 (DR)评价婴儿先天性梗阻性肾病术后肾功能的价值。方法　 32例术前确诊为先天性梗阻性肾病合并积水的患儿 ,术后行 1～ 4次DR复查。术后患肾功能的定性评估结合双肾形态、肾图及各项功能指标综合分析。单肾积水术后患肾功能定量评估以患肾血流灌注率 (BPR)为指标。结果　定性评估单个肾术后共 6 7次DR检查中肾功能的转归 ,完全好转 6次 (9 0 % ) ,明显好转 35次 (5 2 2 % ) ,好转 7次 (10 4 % ) ,不变 9次 (13 4 % ) ,恶化 10次 (14 9% )。各组BPR变化值差异有极显著性 (F =7 77,P <0 0 0 1) ;术后肾功能变化的定性与定量评估结果差异无显著性 (χ2 =0 0 17,P =0 897)。肾重复畸形术后转归较好。在影响单肾积水术后BPR提高的因素中 ,BPR提高与术前患肾面积比呈正相关 (r=0 5 5 2 ,P <0 0 5 ) ,与术前BPR值呈负相关 (r =0 85 2 ,P <0 0 0 1) ,与手术时年龄和随访间隔无相关性 (r=0 0 11,0 16 6 ,P均 >0 0 5 )。结论　DR评价婴儿先天性梗阻性肾病术后肾功能有较好的应用价值。     

99Tcm-二亚乙基三胺五乙酸肾动态显像对兔单侧急性上尿道梗阻的应用研究

目的 应用99Tcm-二亚乙基三胺五乙酸(99Tcm-DTPA)肾动态显像观察兔单侧急性上尿道梗阻不同时期肾功能的变化以及与梗阻解除后恢复状况的比较.方法 健康家兔24只,手术制作左侧输尿管完全梗阻模型,术前及术后1周均行基础99Tcm-DTPA肾动态显像.选择梗阻后1周、3周、5～7周和8周以上不同时间点解除梗阻,并行99Tcm-DTPA利尿肾动态显像(利尿显像).结果 兔左侧输尿管形成梗阻后1周和3周,利尿显像可见左肾显影,但左肾肾小球滤过率(GFR)、摄取率降低,达峰时间延长,与术前比较有显著性差异(t=2.916,t=7.034,P<0.01).梗阻5～7周后,左侧肾脏仅见皮质显影,左肾GFR、摄取率明显降低,达峰时间明显延长,与术前比较有显著性差异(t=6.722,t=7.470,t=3.678,P<0.01),梗阻后8周以上,未见明显肾皮质影像,无法进行图像分析.利尿显像示梗阻1～3周后解除梗阻4周观察到左肾GFR为31.23±14.4(f=2.627,P<0.05),摄取率为4.09±2.10(t=2.795,P<0.05),与解除梗阻前相比功能基本恢复;达峰时间与解除梗阻前无显著差异(t=1.435,P>0.05).梗阻5～7周后解除梗阻4周时左肾GFR、摄取率部分恢复,与解除梗阻前相比无显著差异.梗阻8周以上再解除梗阻,肾功能无法恢复.结论 急性单侧上尿道完全梗阻后肾功能降低迅速,以早期最为显著,早期梗阻解除后肾功能恢复明显.晚期梗阻,即使解除梗阻肾功能也不易恢复.99Tcm-DTPA肾动态显像方法是评价肾功能恢复的有效手段.     

MSCT灌注成像对积水肾脏单肾功能评价的实验研究

目的采用多层螺旋CT（MSCT）灌注成像技术测定肾积水模型的各项灌注参数,探讨其对积水肾脏单肾功能的诊断价值。材料与方法8周龄以上成年健康雄性实验大白兔20只,制作右侧输尿管部分梗阻模型．分别在梗阻前、梗阻后4周行MSCT灌注扫描、单光子正电子发射计算机体层成像（SPECT）检查及彩色多普勒超声显像（CDFI）检测,取积水肾脏标本,光镜下观察病理学变化。结果梗阻后4周MSCT灌注成像可见肾盂扩张,肾皮质明显变薄,皮、髓质血流量（BF）、血容量（BV）较梗阻前有明显下降（P〈0．01）,对比剂平均通过时间（MTT）变化无明显差异,肾皮质表面通透性（PS）有轻度下降趋势,但与梗阻前相比,无显著性差异,而肾髓质PS则较梗阻前有显著性降低（P〈0．01）。CDFI显示梗阻后肾动脉、肾内动脉收缩期峰值速度（PSV）均降低（P〈0．05）,舒张末速度（EDV）显著低于梗阻前（P〈0．01）,阻力指数（RI）显著高于梗阻前（P〈0．01）。SPECT测定结果显示梗阻后右肾肾小球滤过率（GFR）均显著低于梗阻前（P〈0．001）,达峰时间（Tb）显著延长（P〈0．001）,半排时间（T（1/2））显著延长,无测定意义。结论肾积水模型在梗阻前、后皮、髓质MSCT灌注参数的变化以BF、BV下降最明显。此结果与CDFI测定的PSV、EDV及RI所反映的肾血流动力学变化相一致。MSCT灌注技术的出现无疑为l临床评价单肾功能开拓了思路,随着MSCT灌注软件的不断发展,其在单肾功能评价方面一定会显示出巨大的临床应用价值。     

滤波反投影法和OSEM重建图像测量心功能参数的比较

目的比较静息门控心肌显像滤波反投影法（FBP）和OSEM重建图像后用定量门控心肌断层显像（QGS）、四维模型心肌断层显像（4D—MSPECT）、爱莫瑞心脏工具箱（ECToolbox）软件测量的心功能参数。方法临床疑诊或确诊冠心病患者144例,均行^99Tc^m-MIBI静息门控心肌SPECT显像,所有患者均用FBP和OSEM重建图像,用QGS、4D—MSPECT、ECToolbox软件计算心功能参数LVEF,EDV和ESV,采用Bland—Altman法检验2种重建方法的一致性,配对t检验方法检验心功能参数差异,相关性分析用直线回归分析。结果FBP和OSEM重建测量的心功能参数一致性和相关性好（r均〉0．93,P均〈0．001）。QGS软件FBP重建测得的EDV低于OSEM重建测得的EDV,其他2种软件为FBP高于OSEM[QGS：（82．2±39．1）ml和（83．5±40．8）ml,t=-2．53,P〈0．05;4D—MSPECT：（93．5±46．9）ml和（88．8±45．2）ml,t=5．95,P〈0．01;ECToolbox：（106．4±51．1）ml和（100．8±49．0）ml,t=3．99,P〈0．01]。对于ESV,4D-MSPECT软件FBP测量值高于OSEM[（37．5±41．4）ml和（34．8±37．6）ml,t=3．92,P〈0．01]。QGS软件FBP测得的LVEF低于OSEM测得的LVEF[（62．1±16．9）％和（63．1±16．1）％,t=-3．14,P〈0．01]。ECToolbox软件FBP测得的LVEF高于用OSEM测得的LVEF[（74．1±18．8）％和（71．3±17．1）％,t=5．28,P〈0．01]。结论2种重建方法所测量的心功能参数虽然相关性和一致性很好,但某些参数值差异有统计学意义。     

盆腔异位肾肾动态显像前后位像GFR测定值的差异比较

目的比较分析盆腔异位肾肾动态显像前、后位像肾小球滤过率（GFR）测定值的差异。方法回顾性分析10例盆腔异位肾患者的肾动态显像GFR测定结果,分别进行前位异位单肾处理和后位双肾处理,将后位像处理所获正常肾脏GFR与前位像处理所获异位肾GFR相加,获得总肾GFR,并与后位像处理所获双肾GFR和双血浆法GFR测定结果进行比较和相关性分析,并进行了相应随访。采用配对t检验法和双变量相关分析检验法对数据进行统计学分析。结果10例盆腔异位肾患者前位像处理所获异位肾GFR[（27．48±12．24）ml／（min·1．73m^2）]较后位像处理所获异位肾GFR[（10．71±4．74）ml／（min·1．73m^2）]高出46％,二者间差异有统计学意义（t=5．481,P〈0．01）。前位像处理所获总GFR与双血浆法GFR差异无统计学意义（t=-2．238,P〉0．05）,二者的相关性较好（r=0．704,P〈0．05）;后位像处理所获总GFR与双血浆法GFR差异有统计学意义（t=4．629,P〈0．01）,二者的相关性较差（r=0．576,P〉0．05）。结论在肾动态显像中,前位像处理所获GFR较后位像更能真实地反映盆腔异位。肾的功能状况。     

F+0 diuresis renography in infants and children.

The purpose of this study was to evaluate the feasibility of modifying diuresis renography by the simultaneous administration of 99mTc-mercaptoacetyltriglycine (MAG3) and furosemide in the investigation of hydronephrosis and hydroureteronephrosis in infants and children. Two parameters were assessed: the diuretic response in normal kidneys and the ability of the F+0 study to differentiate between renal obstruction and nonobstruction and to identify the level of obstruction in cases of renal obstruction. METHODS: Seventy-two patients (48 males, 24 females; age 2 d to 7 y; median age 6 wk) with sonographic diagnoses of hydronephrosis or hydroureteronephrosis were reviewed prospectively over a 3-y period. All patients had prior sonographic studies and micturating cystourethrography. Bladder catheterization was not routinely performed and was undertaken only if the child had suspected vesicoureteric junction (VUJ) obstruction or grade II or more vesicoureteric reflux. A weight-adjusted dose of 99mTc-MAG3 (maximum 200 MBq, minimum 20 MBq) and 1 mg/kg of furosemide (maximum 40 mg) were administered intravenously at the same time. Posterior imaging of the kidneys and bladder was performed for 20 min and followed by gravity-assisted drainage or imaging after voiding. All patients were followed-up for 6-12 mo, and the final diagnoses were based on either surgery or conservative management with repeated sonography or follow-up 99mTc-MAG3 studies (or both). The results of the F+0 diuresis renography were then compared with the final diagnoses. RESULTS: A renal unit was defined as a kidney and its ureter. There were 151 renal units with 1 patient having bilateral duplex kidneys, 6 patients having unilateral duplex kidneys and 1 patient having a solitary kidney. Fifty-five normal renal units and 96 abnormal renal units on the basis of sonographic findings were assessed. The furosemide clearance half-time for the 55 normal renal units was 1.3-6.3 min (mean 3.8 min). Of the 96 abnormal renal units, 53 were classified as nonobstructed and 43 were classified as obstructed. Of the 53 renal units classified as nonobstructed, there were 48 true-negative studies and 5 false-negative studies; of the 43 renal units classified as obstructed, there were 40 true-positive studies and 3 false-positive studies. The sensitivity was 88.9%, specificity was 94.1% and accuracy was 91.7%. The level of obstruction, either pelviureteric junction or VUJ, was also correctly identified. CONCLUSION: F+0 diuresis renography shows excellent diuretic responses in normal kidneys and is a valid method for the investigation of hydronephrosis and hydroureteronephrosis in infants and children.     

99Tcm-DTPA法肾小球滤过率在肾癌患者术前肾功能评价中的临床意义

目的 探讨99Tcm-DTPA法肾小球滤过率(GFR)在肾细胞癌(RCC)患者术前肾功能评价中的临床意义.方法　 99例RCC患者,其中行根治性肾切除术(RN)者89例,行保留肾手术(NSS)者10例.术前行99Tcm-二亚乙基三胺五乙酸(99Tcm-DTPA)显像测定GFR.比较RCC患者和对照组(正常供肾者)的GF...     

Value of Doppler ultrasonography in predicting deteriorating renal function after spinal cord injury

Purpose

The authors sought to study the relationship between Doppler ultrasonography and deterioration of renal function in patients with spinal cord injury.

Materials and methods

Nineteen patients who underwent follow-up with radioisotopic renography were evaluated. Median patient age was 50 [interquartile ratio (IQR) 35?C57] years, and time since injury was 4.7 (IQR 1.3?C9.2) years. Following Doppler ultrasound, patients were divided into groups based on baseline renal resistive index (RRI): normal RRI (??0.7), group 1 (n=14); and abnormal RRI (> 0.7), group 2 (n=5), and were followed up with radioisotopic renography 1 or more years later. Annual change in effective renal plasma flow (ERPF) was analysed.

Results

The 38 kidneys (two for each patient) were stratified by initial RRI, with 28 in group 1 and ten in group 2. Result of univariate generalised estimation equation (GEE) analysis for the factors affecting the change in effective renal plasma flow (ERPF) indicated that the high RRI value (RRI > 0.7) correlated with the change in ERPF. ERPF value in group 2 was significantly decreased (p=0.01) by an average of 60.33 ml/min (standard error = 23.26).

Conclusions

An RRI > 0.7 is a risk factor for future renal function deterioration in patients with spinal cord injury. Thus, annual Doppler ultrasonography to assess the RRI and the degree of hydronephrosis is recommended.     

Ureteral obstruction secondary to aortofemoral bypass

Hydroureteronephrosis is reported as a frequent late complication of aorto-femoral bypass grafts in patients with aorto-iliac obstruction. To define the actual incidence of this potentially critical complication, renal ultrasonography (US) was performed on 79 asymptomatic patients who had previously undergone aortic reconstruction, after a mean interval of 71.6 months. Unilateral hydronephrosis was found in 6 cases (7.6%). Dilatation was mild or moderate (grade I or II) in 4 cases, and severe (grade III) in 2. Ivp was performed in this selected group: hydronephrosis was mild in 3 patients with ureteral stenosis where the iliac limb of the graft crossed the ureter. In 2 cases nonfunctioning kidneys were demonstrated corresponding to severe sonographic hydronephrosis. These 2 patients underwent anterograde and retrograde pyelography, that showed the site and extent of the obstruction. One patient was a false positive because of obstruction of pyelo-ureteral junction. Even though X-rays showed high sensitivity and specificity in detecting this complication of aorto-femoral reconstruction, US is noninvasive and less expensive and does not require contrast medium. A routine pre- and post-operative ultrasound study is suggested in patients undergoing by-pass surgery to early recognise ureteral obstruction and to avoid irreversible renal damage.     

Diuretic renography in hydronephrosis: delayed tissue tracer transit accompanies both functional decline and tissue reorganization

The significance of delayed tissue tracer transit (TTT) of (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG3) has not been systematically evaluated in hydronephrosis. We sought to demonstrate that delayed TTT accompanies both functional decline and histomorphologic restructuring. METHODS: Twenty 2- to 3-mo-old piglets with surgically induced partial unilateral ureteral stenosis were examined with magnetic resonance urography (MRU) to evaluate morphology and with (99m)Tc-MAG3 diuretic renography (DR) to determine single-kidney function (SKF), evaluate the response to furosemide stimulation (RFS), and assess TTT. All animals had DR and MRU before and after surgery and a third DR after surgery. Piglets were sacrificed after the final DR for renal histology. A total histologic score (THS) was generated. RESULTS: Preoperative DR demonstrated nonobstructive RFS, timely TTT, and balanced SKF in all 20 kidneys. After ureteral ligature, MRU demonstrated pelvic dilatation in all piglets. The postoperative DRs revealed 12 kidneys with delayed TTT in one or both follow-ups. In these 12 kidneys, the SKF declined from 51% +/- 4% to 18% +/- 14%, and the THS was 9.0 +/- 4.0. Three kidneys always had timely TTT, balanced SKF, and a THS of 1.8 +/- 0.3. The contralateral, nonoperated kidneys had timely TTT and a THS of 1.2 +/- 0.9. Postoperative scintigrams showed that 3 of 8 kidneys (38%) with an obstructive RFS had timely TTT, which demonstrates that TTT and RFS are not equivalent. CONCLUSION: In hydronephrosis, a delayed TTT of (99m)Tc-MAG3 accompanies both functional decline and histomorphologic restructuring in obstruction. According to the literature, a delayed TTT is determined by the filtration fraction of the kidneys and appears to identify an obstruction-mediated upregulated renin-angiotensin system.     

Renal functional response to captopril during diuretic therapy.

Antihypertensive agents may modify the renal effects of angiotensin converting enzyme inhibition (ACEI). This potential interaction, which is important in the diagnosis of renovascular hypertension was studied in two rat models with and without diuretic treatment prior to ACEI. Acute intravenous administration of furosemide or hydrochlorothiazide in one-kidney, one-clamp animals (1K1C) did not change glomerular filtration rate (GFR) or effective renal plasma flow (ERPF). ACEI administration after furosemide and hydrochlorothiazide decreased GFR (p less than 0.001, p less than 0.01) but not ERPF. Chlorothiazide administered to 1K1C prior to ACEI, decreased GFR (p less than 0.02) but not ERPF captopril administration to 1K1C which received hydrochlorothiazide intraperitoneally for 7-10 days decreased GFR (p less than 0.007) and ERPF (p less than 0.02), while two-kidney, one-clamp animals (2K1C) decreased GFR only in the clamped kidney (p less than 0.005). ERPF in 2K1C increased only in the contralateral kidney (p less than 0.01). Without diuretic 1K1C animals decreased GFR and ERPF after ACEI (p less than 0.005, P less than 0.001). In the clamped kidney of 2K1C rats, GFR and ERPF decreased significantly (p less than 0.0005, p less than 0.004) and contralateral kidney ERPF increased (p less than 0.001), but GFR did not. The consequences of ACEI on GFR are similar with or without diuretic. These data suggest that diuretic therapy may not significantly interfere with ACEI evaluation of renovascular hypertension.     

Value of supranormal function and renogram patterns on 99mTc-mercaptoacetyltriglycine scintigraphy in relation to the extent of hydronephrosis for predicting ureteropelvic junction obstruction in the newborn.

We investigated the value of supranormal function and renogram patterns on (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG3) scintigraphy in relation to the extent of hydronephrosis for predicting ureteropelvic junction (UPJ) obstruction in the newborn. METHODS: We studied 48 patients with prenatally diagnosed unilateral hydronephrosis that was confirmed on postnatal ultrasonography. The anteroposterior pelvic diameter (APPD) and the Society for Fetal Urology (SFU) grade were measured on 1-mo ultrasonography to assess the extent of hydronephrosis. Neonates with an APPD of or=55%) and renogram grades (1, not obstructive; 2, indeterminate; 3, obstructive; and 4, prolonged parenchymal transit) were determined on 1-mo (99m)Tc-MAG3 renography. Multivariate logistic regression analysis was performed to predict the presence of obstruction. RESULTS: Of the 48 kidneys with hydronephrosis, 19 were diagnosed as having UPJ obstruction. Twenty-nine kidneys were classified as having nonobstructive hydronephrosis. The APPD of the 19 kidneys with obstruction (24.3 +/- 9.2 mm) was significantly larger than that of the 29 kidneys without obstruction (17.5 +/- 11.2 mm; P < 0.05). The SFU grades of UPJ obstruction (2 with grade 3, 17 with grade 4) were also significantly higher than those without UPJ obstruction (grades 1-4 in 1, 6, 10, and 12 kidneys, respectively; P < 0.01). Supranormal function was present in 4 kidneys with UPJ obstruction but in none without obstruction (P < 0.001). (99m)Tc-MAG3 renography of the 19 obstructions showed grades 2, 3, and 4 renograms in 4, 8, and 7 patients, respectively. The 29 without obstruction revealed significantly lower grades (grades 1-4 in 10, 13, 5, and 1 patient, respectively; P < 0.001). Multivariate logistic regression analysis revealed that the addition of supranormal function or renogram grade in the model significantly increased the likelihood ratio in comparison with that of the SFU grade only (chi(2) = 7.73 and 9.99, respectively; P < 0.01). Of the 29 neonates with SFU grade 4, supranormal function or renogram >or= grade 4 had a positive predictive value of 90% (9/10). CONCLUSION: (99m)Tc-MAG3 renography at 1 mo after birth has a significant additive value in relation to the degree of hydronephrosis in predicting UPJ obstruction in patients with prenatally diagnosed unilateral hydronephrosis with normal function.     

99Tcm-DTPA肾动态显像对单侧肾积水患者健侧肾代偿功能的研究

目的 探讨99Tcm-二亚乙基三胺五乙酸（99Tcm-DTPA）肾动态显像在评价单侧肾积水患者健侧肾代偿功能中的应用。 方法 回顾性分析2016年1月至2019年7月天津医科大学第二医院收治的257例单侧肾积水患者的临床资料,其中男性149例、女性108例,年龄12~87（52.84±14.23）岁。所有患者均行99Tcm-DTPA肾动态显像,并通过Gates法计算患者分肾及总的肾小球滤过率（GFR）。按照患者的肾积水程度、患肾受损程度、肾结石位置、患肾位置、性别和年龄进行分组。将各组的健侧肾与单侧肾的GFR正常值上限作比较,计算患者健侧肾的GFR的代偿率（%）。健侧肾与患侧肾的GFR的比较采用两独立样本t检验。患者健侧肾代偿能力的影响因素分析采用Mann-Whitney U 检验及Kruskal-Wallis检验。 结果 所有患者的患侧肾的GFR为（28.60±15.13） mL/min,健侧肾的GFR为（63.17±15.74） mL/min,总的GFR为（92.94±24.46） mL/min。患侧肾的GFR明显低于健侧肾的GFR,且差异有统计学意义（t=25.39,P<0.001）。患者健侧肾的GFR存在不同程度的代偿性增高,其代偿率为9.54%（?5.94%,26.45%）。患者不同年龄和患侧肾积水程度对健侧肾的GFR的代偿率有影响,且差异均有统计学意义（χ2=47.32、12.71,均P<0.01）;患侧肾受损程度、肾脏积水位置、肾结石位置和性别对健侧肾的GFR代偿率无影响,且差异均无统计学意义（χ2=4.34,Z=?0.51、?1.62、?1.41,均P>0.05）。 结论 99Tcm-DTPA肾动态显像可以更好地评估单侧肾积水患者健侧肾代偿能力,能够为单侧肾积水患者的诊治及预后评估提供依据。     

Functional evaluation of hydronephrosis by diffusion-weighted MR imaging. Relationship between apparent diffusion coefficient and split glomerular filtration rate

PURPOSE: To determine the relationship between apparent diffusion coefficient (ADC) values measured by diffusion-weighted MR imaging and split renal function determined by renal scintigraphy in patients with hydronephrosis. MATERIAL AND METHODS: Diffusion-weighted imaging on a 1.5 T MR unit and renal scintigraphy were performed in 36 patients with hydronephrosis (45 hydronephrotic kidneys, 21 non-hydronephrotic kidneys). ADC values of the individual kidneys were measured by diffusion-weighted MR imaging. Split renal function (glomerular filtration rate (GFR)) was determined by renal scintigraphy using 99mTc-DTPA. The relationship between ADC values and split GFR was examined in 66 kidneys. The hydronephrotic kidneys were further classified into three groups (severe renal dysfunction, GFR <10 ml/min, n=7; moderate renal dysfunction, GFR 10-25 ml/min, n= 10; normal renal function, GFR >25 ml/ min, n=28), and mean values for ADCs were calculated. RESULTS: In hydronephrotic kidneys, there was a moderate positive correlation between ADC values and split GFR (R2=0.56). On the other hand, in nonhydronephrotic kidneys, poor correlation between ADC values and split GFR was observed (R2=0.08). The mean values for ADCs of the dysfunctioning hydronephrotic kidneys (severe renal dysfunction, 1.32 x 10(-3) +/- 0.18 x 10(-3) mm2/s; moderate renal dysfunction, 1.38 x 10(-3) +/- 0.10 x 10(-3) mm2/s) were significantly lower than that of the normal functioning hydronephrotic kidneys (1.63 x 10(-3) +/- 0.12 +/- 10(-3) mm2/s). CONCLUSION: These results indicated that measurement of ADC values by diffusion-weighted MR imaging has a potential value in the evaluation of the functional status of hydronephrotic kidneys.