超声造影定量技术与核医学肾图评价肾功能不全的相关研究

Correlative analysis between contrast-enhanced ultrasonography and ^99Tc-DTPA renography in evaluation of renal insufficiency

目的评价超声造影定量参数在检测慢性肾功能不全中的应用价值。方法以^99Tc-DTPA。肾动态核素显像检查测得肾小球滤过率（GFR）为标准。以33例临床确诊慢性肾功能不全患者为对象，其中男15例，女18例，平均年龄（43．33±6．78）岁。用PHILIPS iU22超声仪器对所有患者双肾皮质进行实时灰阶超声造影灌注成像，超声造影剂为Sono Vue，每侧肾脏使用剂量为1ml。用QLAB图像分析软件计算感兴趣区域内造影剂回声信号的强度，生成时问．放射性核素强度曲线（TIC），得到超声造影灌注参数。静脉团注148～222MBq的^99Tc—DTPA后即刻进行。肾动态显像，计算双肾GFR0将各个超声造影定量灌注参数值分别与肾动态显像所得GFR值作相关性分析。结果慢性肾功能不全患者^99Tc-DTPA肾动态显像测得GFR与超声造影定量参数中的曲线下面积（AUC）、曲线上升支斜率（A）呈正相关，rAUC=0．886（P〈0．05），rA=0．804（P〈0．05）；而与曲线达峰强度绝对值（DPI）、达峰时间（TTP）、曲线下降支斜率（α）无相关，rDPI=0．021（P〉0．05），rTTP=0．043（P〉0．05），rα=0．039（P〉0．05）。结论部分超声造影灌注定量参数能反映慢性。肾功能不全肾皮质血流灌注改变，与核医学肾图测得的GFR有很好的相关性。

Objective To evaluate the contrast-enhanced ultrasonography （CEUS） in quantitative diagnosis of chronic renal insufficiency. Methods Correlation of CEUS indexes with glomerular filtration rate （GFR） detected by ^99mTc-DTPA renography was examined. Thirty-three cases of clinical chronic renal insufficiency were enrolled in the study. They were 15 males and 18 females with average age of （43.33±6.78） years. After intravenous bolus injection of 1 ml SonoVue, CEUS of renal cortex blood perfusion was performed successfully, and a time-intensity curve （TIC） was created with PHILIPS iU22 system＇s QLAB software. A 148 to 222 MBq dose of ^99mTc-DTPA was injected as a bolus from antecubital vein. Renal scintigraphic images were collected immediately and GFR was obtained. Results The significant correlation coefficients between GFR and CEUS quantitative indexes were as follows： rAUC （area under curve）=0.886 （P〈0.05）, rA （slope rate of ascending curve, A） =0.804（P〈0.05）. However, rDPI （derived peak intensity, DPI）=0.021 （P〉0.05）, rTTP （time to peak, TTP） =0.043 （P〉0.05）, rα （slope rate of descending curve,ct）=0.039 （P〉0.05）. Conclusion CEUS can precisely display the hemodynamic change of chronic renal insufficiency, which is well correlated with GFR by ^99mTc-DTPA renography.