肾动态显像分次处理法定量评价肾脏局部功能

Quantitative evaluation of regional renal function using renal dynamic imaging with segmental processing

目的 :明确正常情况下及不同肾脏疾病时 ,肾脏各部分对 99m Tc DTPA浓聚及清除速度的差别与特点 ,以定量评价肾脏各部分的局部功能状态。方法 :对 18例正常对照、74例不同肾病患者进行了肾动态显像 ,并应用常规肾动态处理软件及ROI技术分别对全肾、肾皮质、肾盂肾盏作了定量分析 ,获得肾脏各部分的Tb、C1/2及 2 0min残留率。结果 :在无肾脏疾病的正常对照组 ,全肾与肾皮质、肾盂肾盏部分之间的定量分析指标均无明显差别 ,在疾病组 ,肾脏各部分的指标则有不同程度的改变 ,尤其是在糖尿病、慢性肾炎及肾盂肾炎的患侧肾差异更明显 ,表现为肾盂肾盏部分的Tb延长。全肾、肾皮质和肾盂肾盏的Tb均值在糖尿病分别为 5 .8min、4.5min和 6.8min(P <0 .0 1) ;慢性肾炎为 7.9min、6.3min和 9.1min(P <0 .0 5 ) ;肾盂肾炎为 6.0min、4.0min和 7.6min(P <0 .0 5 ) ;在高血压病患者三者无显著差异。而在 13例有上尿路排泄不畅的患者 ,三种处理方法时 ,Tb、C1/2及 2 0min残留率均有差异 (P <0 .0 5～ 0 .0 0 1)。结论 :定量评价肾脏各部分的功能对于正确反映和认识肾功能受损程度及其部位有参考价值 。

Objective:To evaluate regional renal function quantitatively in the aspects of the feature and functions of uptake and clearance 99m Tc DTPA in regional kidney in both normal group and renal disease group.Methods:18 normal and 74 patients with renal disease underwent dynamic renal imaging in order to evaluate kidney,renal cortex, calyx and pelvis with quantiative analysis,and acquire Tb,C1/2 and 20min residual rate(20min RR) using ROI technique and renal processing software.Results:In control group,there is no signficant difference among the indexes of quantitative analysis of kidney,renal cortex,calyx and pelvis.On the other hand,in renal diseases group,regional renal functional index changed in some extents,especially with diabetes,chronic glomerulonephritis and pyelonephritis.Tb of renal calyx and pelvis was delayed in renal disease group.Average Tb of kidneys,renal cortex and pelvis was 5.8 min,4.5 min and 6.8 min( P <0.01) in diabetes, and 7.9 min,6.3min and 9.1 min( P <0.05) in chronic glomerulonephritis, and 6.0 min,4.0 min and 7.6min( P <0.05) in chronic phelonephritis,respectively.There was no significant difference in patients with hypertension.There was significant difference among Tb,C1/2 and 20minRR using three different processing methods in 13 patients with upper urinary excretion disturbance.Conclusion:A quantitative assessment of regional renal function is of important reference value in reflection and recognization of the degree and location of renal damage,especially to patients with unsmooth upper urethra excretion.