肾动态显像与B超在婴幼儿肾积水诊断及治疗中应用效果的比较

Comparisons of clinic effects between DTPA renal dynamic imaging and B-ultrasound examination in diagnosis and treatment of infantile hydronephrosis

目的:探讨肾动态显像对婴幼儿肾积水中患肾功能的评价及其在诊治方面的应用价值,为肾动态显像在婴幼儿肾积水诊断及治疗中的应用奠定基础。方法:选择门诊及住院肾积水患儿70例,其中男性56例,女性14例,年龄37 d^6岁,平均(2.32±2.16)岁。另选18例同期同年龄正常婴幼儿作为对照组,其中男性15例,女性3例,年龄41 d^6岁,平均(2.66±2.01)岁。显像剂为99mTc-DTPA,剂量18.5 MBq/人次,采用GE Infinia SPECT行肾动态显像,通过系统自带软件获得肾图曲线,并通过感兴趣区(ROI)技术计算肾小球滤过率(GFR)等定量指标。70例肾积水患儿均先行肾脏B超检查,2 d内行肾动态显像。结果:70例肾积水患儿,B超诊断83个肾脏积水,其余肾脏正常;肾动态显像诊断104个肾脏功能异常,肾动态显像对于功能异常肾脏检出率明显高于B超(t=7.751,P=0.005)。B超诊断83个积水肾脏中,肾动态显像肾图呈持续上升型56例(67.47%),抛物线型6例(7.23%),高水平延长线型14例(16.87%),低水平延长线型7例(8.43%)。B超诊断83个积水肾脏中,肾动态显像肾图呈持续上升型、抛物线型和高水平延长线型GFR值与正常对照组比较差异无显著性;肾图呈低水平延长线型GFR值低于正常对照组(P<0.05)。结论:核素肾动态显像不仅可以观察婴幼儿肾积水患肾的形态,而且可以分析受累肾脏的分肾功能,为肾积水的诊断和治疗时机及治疗方式的选择提供客观依据。

Objective To study the clinic value of DTPA renal dynamic imaging in the functional evaluation of infantile hydronephrosis and clarify its applicational value,and lay the foundation for DTPA renal dynamic imaging in diagnosis and treatment of infantile hydronephrosis.Methods 70 infants with hydronephrosis in our hospital whose mean age was（2.32±2.1） years（rang from 37 d to 6 years） were selected.There were 56 males and 14 females.18 normal infants with mean age（2.66±2.01） years（rang from 41 d to 6 years,15 males and 3 females） were selected as control group during the same period.Technetium-99m-labelled DTPA（99mTc-DTPA） was taken as agent,and the dose of 99mTc was 18.5MBq per infant.GE Infinia SPECT was used as imaging equipment.The time-activity curve was generated in the imaging system automatically.The glomerular filtration rate（GFR） was detected by DTPA renal dynamic imaging through drawing the region of interest（ROI）.Results 83 kidneys were suffered from hydronephrosis diagnosed by B-ultrasound among 70 infant patients,while 104 abnormal kidneys were diagnosed by renal dynamic imaging.The detection rate of renal dysfunction by renal dynamic imaging was higher than that of B-ultrasound（t=7.751,P=0.005）.Among 83 kidneys suffered from hydronephrosis diagnosed by B-ultrasound,the continued rising type was 56 cases （67.47%）;the parabolic type was cases（7.23%）;the high linear extension type was 14 cases（16.87%）;and the low linear extension type was 7 cases（8.43%）.The GFR value of linear extension type was lower than normal control group,the difference was significant（P0.05）,and the another three types had no significant diffirences compared with control group.Conclusion For infantile hydronephrosis,DTPA renal dynamic imaging can observe not only the abnormal morphology of kidney,but also the function of split kidney;and it can provide objective basis for diagnosis and treatment of infantile hydronephrosis.