^(99)Tc^m-DMSA肾显像诊断肾盂肾炎和肾脏瘢痕的动物模型实验研究

Detection of pyelonephritis and renal scars by ^(99)Tc^m-DMSA renal scan: an experimental study in piglets

目的 制作猪肾盂肾炎和肾脏瘢痕动物模型 ,评价99Tcm 二巯基丁二酸 (DMSA)肾脏平面显像和SPECT断层显像诊断肾盂肾炎和肾脏瘢痕的灵敏度和特异性 ,并探讨SPECT的诊断价值。方法 中国实验动物小型猪 13只 ,先制成膀胱输尿管返流动物模型 ,然后引入大肠埃稀杆菌导致上尿路感染 ,感染前后用ADACVertex型双探头SPECT仪 ,配低能高分辨率准直器进行肾脏前后位平面和断层显像 ,将显像结果同组织病理学检查进行对比研究。结果 平面显像诊断肾盂肾炎和肾脏瘢痕的灵敏度为 71 2 % ,特异性为 10 0 % ,准确性为 87 5 % ;平面加断层显像诊断肾盂肾炎和肾脏瘢痕的灵敏度为 78 3% ,特异性为 10 0 % ,准确性为 90 5 %。以病理检查为标准 ,平面显像和平面加断层显像对病灶的检出率差异无显著性。结论 99Tcm DMSA肾脏显像是诊断肾盂肾炎和肾脏瘢痕的灵敏可靠方法。平面加断层显像可能有助于提高检测的灵敏度 。

Objective To provide an accurate and scientific method of radionuclide imaging for the clinical application and to study the value of SPECT imaging in detection and localization of the lesions in diagnosing pyelonephritis and renal scars in children, we evaluated the sensitivitiy and specificity of planar and planar+SPECT imaging with 99 Tc m DMSA renal scan in diagnosing the pyelonephritis and renal scars in an experimental piglet model of pyelonephritis and renal scars established in this hospital Methods We surgically created vesicoureteral reflux (VUR) in 13 female Chinese piglets, then we introduced Escherichia coli broth culture into the bladder of those presenting VUR two weeks later 99 Tc m DMSA renal scan (planar and SPECT) was performed before and after introducing infection by VETEX dual headed SPECT, then the animal and compared the images with histopathological findings were sacrificed At last, there were 7 piglets left, including 9 kidneys with abnormal renal scan and 4 kidneys with normal renal scan were analized Results The sensitivity of planar imaging was 71 2%, specificity was 100%, accuracy was 87 5% Using planar+SPECT imaging, the sensitivity of diagnosing pyelonephritis and renal scars was 78 3%, specificity was 100%, accuracy was 90 5% Conclusions 99 Tc m DMSA renal scan is a sensitive method in detection of pyelonephritis and renal scars Using planar+SPECT imaging may improve the sensitivity in detecting the foci and much more accurately evaluate the extent of the foci than using planar imaging only