核素利尿肾动态显像在儿童肾重复畸形中的临床应用  

Clinical evaluation of ^(99)Tc^m-EC diuretic renal dynamic imaging in childhood duplex kidney

作　　者：李佳宁[1] 王燕[2] 李劲松[1] 吴靖川[1] 杨淑蓉[1] 冯国强[1] 

机构地区：[1]上海第二医科大学附属新华医院核医学科,上海200092 [2]上海第二医科大学附属新华医院病理科,上海200092

出　　处：《临床儿科杂志》2001年第5期293-295,共3页Journal of Clinical Pediatrics

摘　　要：为评价^(99)Tc^m-EC利尿肾动态显像在儿童肾重复畸形中的临床价值,对23例肾重复畸形住院患儿行^(99)Tc^m-EC利尿肾动态显像(RDI),分析其影像特征和主要功能指标的变化;设计可反映重复上半肾功能的指标(D/N),并以之与临床病理分型比较。结果显示:肾重复畸形在RDI连续叠加影像中有4种表现:上肾稀疏、上肾缺损、肾影增长、肾盂分离;RDI的灵敏度、特异性、准确性分别为73.3％、93.2％、81.4％;RDI对合并输尿管囊肿检出率较好,并可检出部分输尿管扩张积水;利尿肾图显示尿路梗阻类型均为非机械性梗阻。临床病理分型为发育不良型,其上肾D/N值均小于30％,发育型均大于70％,积水型为30％～70％。对术后随访的病例,RDI在双肾形态和功能转归方面有肯定的判断。说明^(99)Tc^m-EC肾动态显像对肾重复畸形有较好的诊断价值可帮助判断重复上半肾功能,为临床术前选择手术方式提供重要依据可作为术后随访复查的主要检查手段。In order to observe and analyze the imaging characteristics of childhood duplex kidney and the change of its main functional index(D/N) in renal dynamic imaging (RDI) assessment and thereby to clarify the clinical significance, 23 hospitalized children with duplex kidney were examined with RDI assessment, in 14 of whom the pathological changes could be divided into 3 kinds of patterns: dysplasia, well-development and hydronephrosis. RDI semi-quantitative assessment of tracer uptake was routinely made using a ratio of radioactivity of upper part of duplex kidney in comparison with the lower part(ipsilateral, D/I) and with that in other upper part of kidney (contralateral, D/C). Then, the imaging characteristics of RDI was used to compare with the pathological alteration. The results showed that the imaging characteristics of upper part of duplex kidney could be demonstrated as the following 4 kinds patterns : decreased radio-distribution, radioactivity deficiency, kidney with long shape and renal pelvis septation. The rates of sensitivity, specificity and accuracy were separately 73. 3%,93. 2% and 81. 4%. Furthermore, not only ureterocele could be detected in 18 cases, but also hydroureterosis in some other cases: all of them were verified to be urinary functional obstruction but not mechanical obstruction through diuretic renogram assessment. According to the pathological classification, D/N of dysplasia was less than 30%(4 cases),D/N of well-development greater than 70% (4 cases) and D/N of hydronephrosis ranging 30-70%(6 cases). It is then concluded that RDI assessment is a sensitive, practical and reliable method in diagnosing duplex kidney in children, RDI is useful to evaluate the functions of upper part of kidney and thereby provides an important evidence for the choice of operation modelity and could be carried out as a main method of follow-up after operation.

关 键 词：肾重复畸形 放射性核素显像 病理 手术 儿童 

分 类 号：R726.9[医药卫生—儿科]