功能磁共振尿路造影对儿童肾积水单侧肾功能的评估价值

Evaluation value of functional magnetic resonance urography on unilateral renal function in children with hydronephrosis

目的研究在儿童肾积水中功能磁共振尿路造影（fMRU）对单侧肾脏功能的评估价值。方法收集首都医科大学附属北京儿童医院成功完成fMRU检查的肾积水患儿14例（单侧肾积水12例、双侧肾积水2例），其中7例同时进行了核医学利尿性肾动态显像（DRS）。fMRU所得主要功能参数为单肾体积、单肾patlak数（滤过率/mL）、单肾肾小球滤过率（GFR）指数，以及基于体积、patlak数及GFR的3种分肾功能（vDRF、pDRF和gDRF）。DRS所得参数为GFR、gDRF。使用SPSS 13.0软件进行统计分析。结果在行fMRU与DRS 2种检查的7例14个肾脏，前者所得单肾GFR指数与后者所得GFR高度相关（r＝0.892，P〈0.001）；2种方法所得的gDRF（均取左侧）分别为（46.80±19.20）%、（45.18±20.29）%，差异无统计学意义（t＝0.051 6，P＝0.624），且高度相关（r＝0.912，P＝0.004）。12例积水侧肾脏vDRF、pDRF、GFR指数及gDRF[（43.54±9.61）%、（42.80±10.83）%、（38.56±29.23） mL/min、（38.37±13.61）%]均较健侧小[（56.46±9.61）%、（57.19±10.83）%、（57.02±26.22） mL/min、（61.63±13.61）%]（t＝2.326、2.300、2.422、2.960，P＝0.040、0.042、0.034、0.013）；12例积水侧肾体积、patlak数虽较健侧小，但差异无统计学意义（t＝1.765、1.450，P＝0.105、0.175）。结论在儿童肾积水，fMRU是评估单肾功能非常有价值的检查方法，可显示积水肾脏vDRF、pDRF、GFR指数及gDRF降低，以gDRF改变明显。

ObjectiveTo assess the value of functional magnetic resonance urography （fMRU） for the unilateral renal function in children with hydronephrosis.MethodsFourteen children with congenital hydronephrosis （unilateral hydronephrosis in 12 cases, bilateral hydronephrosis in 2 cases） examined by fMRU in Beijing Children′s Hospital, Capital Medical University, were enrolled.In 7 patients of them, diuretic renal scintigraphy （DRS） was performed within 10 days before fMRU examination.The following parameters in fMRU, as renal parenchymal volume, volumetric differential renal function （vDRF）, Patlak, Patlak differential renal function （pDRF）, index of glomerular filtration rate （GFR） and differential renal function based on index of GFR （gDRF）, were calculated and analyzed.Statistical analysis was performed by using SPSS 13.0.ResultsIn 7 cases whose fMRU and DRS were examined, the indexes of GFR obtained from fMRU and GFR from DRS were well correlated （r=0.892, P〈0.001） in 14 kidneys.The gDRF determined by 2 methods on the left kidneys[the average was（46.80±19.20）% and（45.18±20.29）%, respectively] had no significant difference （t=0.051 6, P=0.624）, which was also highly correlated （r=0.912, P=0.004）. In 12 cases with unilateral hydronephrosis, vDRF, pDRF, index of GFR and gDRF in hydronephrotic side[（43.54±9.61）%, （42.80±10.83）%, （38.56±29.23） mL/min, （38.37±13.61）%] were all less than those in the contralateral side[（56.46±9.61）%, （57.19±10.83）%, （57.02±26.22） mL/min, （61.63±13.61）%]（t=2.326, 2.300, 2.422, 2.960; P=0.040, 0.042, 0.034, 0.013）. However, there was no statistical difference in both renal parenchymal volume and Patlak between the hydronephrotic and the contralateral side kidneys（t=1.765, 1.450; P=0.105, 0.175）.ConclusionsfMRU is a very valuable examination method in evaluating single kidney function in children with congenital hydronephrosis, and able to demonstrate that gDRF, indexes of GFR, vDRF and pDRF decrease in the hydronephrotic kidney.