多排螺旋CT与核素肾图评价梗阻性肾积水肾功能的相关性研究

Evaluation of Renal Function in Patients with Obstructive Hydronephrosis by MDCT and Radionuclide Renography

目的:研究多排螺旋CT(MDCT)评价梗阻性积水肾功能的临床应用价值。方法:研究对象为临床诊断慢性单侧上尿路梗阻积水病例20例,男12例,女8例,平均年龄48±5.3岁,其中肾盂结石4例,输尿管结石7例,肾结石伴输尿管结石3例,肾盂输尿管连接处狭窄3例,输尿管狭窄3例,孤立肾、急性肾炎、急性梗阻、尿路肿瘤的患者不录入。同时行尿路CTU检查及^(99m)Tc-DTPA肾动态显像检查。采用SIEMENS Definition AS64排螺旋CT机进行尿路CTU扫描,应用螺旋CT后处理技术测量平扫、皮髓期、实质期各期腹主动脉CT值及肾实质体积和CT值,计算分肾功能相关参数、CT滤过值及占总肾滤过百分比;同时进行^(99m)Tc-DTPA肾动态显像检查,测定分肾及总肾GFR,将获得的CT评价肾功能的各项参数分别与核素肾动态显像所得GFR值作相关性分析。结果:CT评价肾功能的各项参数值与核素肾图评价肾功能的GFR值比较相关性,P值均<0.01,r值均>0.5,均有显著性正相关,相关程度为中、高度。结论:CT测得的评价肾功能参数值能够反映肾功能,可作为评价肾功能的方法,应用于尿路梗阻性疾病CT增强检查时可同时获得形态和功能的诊断。

Purpose： To evaluate the clinical value of MDCT in evaluation of the renal function in patients with obstructive hydronephrosis. Methods： Twenty patients （12 males and 8 females with average age of 48± 5.3） with clinical diagnosed chronic unilateral upper urinary obstructive hydronephrosis were enrolled in the study. The causes of obstruction included 4 cases of renal pelvic calculi, 7 cased of ueter calculi, 3 cases of reno-ureteral calculi, 3 cases of renopelvic ureteral junction stenosis and 3 cases of ureteral stenosis. Patients with solitary kidney, acute nephritis, acute obstruction and urinary tumors were all excluded. Urinary CTU and 99mTc-DTPA renal dynamic imaging were carried out simultaneously. Urinary CTU scanning was performed on a SIEMENS Definition AS 64-MDCT scanner, and the CT attenuation value of abdominal aorta and renal parenchyma, the volume of renal parenchyma were measured on images acquired during plain scan, enhanced cortico-medullary phase and parenchymal phase. The CT parameters for evaluating renal function were obtained, and the rate） with total renal functional rate was calculated. ratio of renal function of GFR （glomerular filtration The results from CT were compared with those from 99mTc-DTPA renal dynamic imaging, correlation between these two methods were also analyzed. Re- sults： The correlation between renal functional parameters obtained through enhanced MDCT and the renal function GFR gained from 99mTc-DTPA radionuclide scans was with statistical significance,（P〈0.01, r〉0.5）. Conclusion： The renal parameters obtained through enhanced MDCT can represent the fractional renal function and MDCT can be used to evaluate the renal function especially in patients with obstructive uropathy.