CT增强扫描评估单肾肿瘤患者肾小球滤过率的临床研究

Measurement of glomerular filtration rate using multiphasic computed tomography in patients with unilateral renal tumors:a feasibility study

目的:探究CT多期增强扫描结合自主研发定量肾小球滤过率(glomerular filtration rate,GFR)软件评估肾肿瘤患者术前肾小球滤过率(GFR measurement based on computed tomography,CT-GFR)的可行性。方法:纳入2017年2—7月诊断单肾肿瘤且无急性肾功能不全52例。所有患者术前均行肾脏CT扫描和血清肌酐值(serum creatinine,Scr)测定,其中15例进行了放射性核素检查。用自主研发的定量GFR软件分别测量包含和除外肾肿瘤的总肾CT-GFR,将之与估算的肾小球滤过率(estimated glomerular filtration rate,e GFR)进行相关性分析,将分肾相对CT-GFR与放射性核素显像法测定的相对GFR(GFR measurement based on radionuclide examination,R-GFR)进行相关性分析。每例均计算2期CT-GFR,包括肾实质早期和肾实质晚期。结果:包含肾肿瘤的肾实质早期总肾CT-GFR与e GFR高度相关(r=0.81,y=0.94+0.92x),包含肾肿瘤的肾实质早期患肾相对CT-GFR与患肾相对R-GFR高度相关(r=0.850,y=18.24+0.62x)。结论:CT增强扫描为肾肿瘤患者肾小球滤过率的精确评估提供了一种可行方法。

Objective：To investigate the feasibility of multiphasic computed tomography scanning combined with a homemade software quantitative measurement of glomerular filtration rate（glomerular filtration rate measurement based on computed tomography,CT-GFR）. Methods：Fifty-two patients with unilateral renal tumors from February 2017 to July 2017 were included. All of them did not suffer from acute renal insufficiency. All patients underwent renal CT scans and serum creatinine（serum creatinine,Scr）tests preoperatively,of which 15 cases underwent additional radionuclide examination. Total CT-GFR and relative CT-GFR,with or without renal tumors,were calculated by a homemade GFR quantitative software. The correlation between total CT-GFR and estimated glomerular filtration rate（e GFR）was analyzed by Pearson＇s method. The correlation between relative CT-GFR and relative GFR measurement based on radionuclide examination（R-GFR）of split kidneys was also analyzed by Pearson＇s method. Total CT-GFR and relative CT-GFR were calculated in early and late renal parenchymal phases respectively with or without renal tumors. Results：Total CT-GFR in early renal parenchymal phase was highly correlated with e GFR（r=0.81,P〈0.01）. Relative CT-GFR in early renal parenchymal phase was highly correlated with relative R-GFR in the split kidneys（r=0.85,P〈0.01）. Conclusion：Split and total GFR can be measured accurately using multiphasic CT combined with homemade software in patients with unilateral renal tumors.