肾脏64层螺旋CT灌注成像对梗阻性肾积水患者患肾功能的评价

64-slice spiral CT perfusion imaging in the single renal functional assessment for hydronephrotic kidney

目的探讨64层螺旋CT灌注成像检查对梗阻性肾积水患者患肾功能的评估价值。方法梗阻性肾积水患者36例行64层螺旋CT灌注扫描和肾动态显像（SPECT）测定单侧GFR。其中有肾积水表现者48侧（积水组），28例健康志愿者作为正常对照1组，比较2组各灌注参数值。根据GFR结果将36例患者72侧肾脏分为正常对照2组、肾功能轻度受损组、重度受损组，比较3组肾皮质和髓质血流灌注参数的差异；将各灌注参数与单侧肾脏GFR行Pearson相关性分析。结果①36例患者CT灌注成像表现为双侧时间密度曲线（TDC）不对称，积水组肾皮质、髓质TDC斜率与峰高降低。积水肾皮质血流量（BF）为（203．2±44．9）ml·100ml^-1·min^-1，血容量（BV）为（27．6±3．9）ml／100ml，表面通透性（PS）为（30．7±6．5）ml·100ml^-1·min^-1，Patlak血容量（PBV）为（46．5±10．9）ml／100ml；肾髓质分别为（99．9±24．1）ml·100ml^-1·min^-1、（18．3±4．3）ml／100ml、（51．8±12．1）ml·100ml^-1·min^-1、（21．3±3．0）ml／100ml。与对照1组肾皮质的（301．6±68．8）ml·100ml^-1·min^-1、（38．9±5．8）ml／100ml、（42．9±10．9）ml·100ml^-1·min^-1、（67．5±10．3）ml／100ml及肾髓质的（157．8±34．6）ml·100ml^-1·min^-1、（28．54±3．9）ml／100ml、（75．6±22．7）ml·100ml^-1·min^-1、（28．2±0．9）ml／100ml比较，灌注参数值均下降，差异均有统计学意义（P值均〈0．05）。②对照2组肾皮髓质BF、BV、PS、PBV分别为（314．2±28．7）ml·100ml^-1·min^-1、（39．7±2．2）ml／100ml、（45．2±3．4）ml·100ml^-1·min^-1、（68．6±4．3）ml／100ml和（161．2±10．4）ml·100ml^-1·min^-1、（28．7±1．8）ml／100ml、（80．1±6．7）ml·100ml^-1·min^-1、（27．9±6．9）ml／100ml；肾功能轻度受损组分别为（245．8±16．8）ml·100ml^-1·min^-1、（30．5±3．2）ml／100ml、（34．7±5．7）ml·100ml^-1·min^-1、（54．9±7．2）ml／100ml和（120．7±19．6）ml·100ml^-1·min^-1、（22．0±2．7）ml／100ml、（61．9±10．5）ml·100ml^-1·min^-1、（23．0±2．2）ml／100ml；肾功能重度受损组分别为（170．1±29．0）ml·100ml^-1·min^-1、（25．4±2．8）ml／100ml、（27．5±5．2）ml·100ml^-1·min^-1、（40．0±8．4）ml／100ml和（83．7±11．5）ml·100ml^-1·min^-1、（15．5±2．9）ml／100ml、（44．0±5．8）ml·100ml^-1·min^-1、（20．0±2．8）ml／100ml。3组间肾皮髓质血流灌注参数比较差异均有统计学意义（P〈0．05）。③肾皮髓质各灌注参数与GFR有良好的相关性。其中肾皮质BF相关性最好，r=0．852。结论64层螺旋CT肾脏灌注成像可对积水肾肾皮髓质血流灌注状态与肾功能损害进行定量评估，对受损肾功能可进行分级诊断，测定的肾皮髓质各灌注参数值与GFR有良好的相关性。

Objective To evaluate the value of MSCT perfusion imaging in assessment of single renal function of hydronephrotic kidney. Methods 64-slice spiral CT perfusion was performed in 36 obstructive nephrohydrosis patients whose split renal glomerular filtration rate（GFR） was measured by SPECT renal dynamic imaging. ①The perfusion parameters of the renal cortex and renal medulla of the hydronephrotic kidney were compared with the normal kidney studied by contrast group. ②The 72 kidneys were divided into normal renal function, mild and severe renal impairment groups according to renal function. Differences between the groups respect to all the mean perfusion parameters of the renal cortex and renal medulla were assesses by ANOVA. ③Using Pearsons correlation test, the correlations between all the mean perfusion parameters of the renal cortex and renal medulla and renal GFR were examined. Results ①The time-density curves of bilateral normal renal cortex and medulla were not symmetric. The mean BF, BV, PS, PBV of renal cortex were （203.2±44.9）ml·100ml^-1·min^-1, （27.6±3.9）ml/100 ml, （30.7±6.5）ml·100ml^-1·min^-1, （46.5±10.9）ml/100 ml; and the mean BF, BV, PS, PBV of renal medulla were （99.9±24.1）ml·100ml^-1·min^-1 ,（18.3±4.3）ml/100 ml, （51.8±12.1）ml·100ml^-1·min^-1, （21.3±3.0）ml/100 ml. The mean perfusion parameters of the cortex and medulla of obstructed kidney were lower compared to that of normal kidney. ②There were significant differences of all the perfusion parameters of the renal cortex and medulla between 3 groups （P〈0.05）. ③The perfusion parameters of the renal cortex and medulla had positive linear correlation with GFR. The best correlation was the blood flow of the cortex of kidney. The correlation coefficient r=0. 852. Conclusions 64-slice spiral CT perfusion imaging can quantita tively evaluate the haemodynamic condition and functional lesion of the kidney, classify the impaired kidney function. The perfusion parameters of the renal cortex and medulla had positive linear correlation with GFR.