CT灌注成像和SPECT对兔膀胱输尿管反流模型致肾脏积水的肾功能评估  

The renal function study of CT perfusion and SPECT of hydronephrosis due to vesicoureteral refluxin the rabbit model

作　　者：冯磊 张潍平 彭芸 韩文文 杨洋 于静 林德富 刘勇 张祺丰 杨吉刚 

机构地区：[1]首都医科大学附属北京儿童医院外科 [2]首都医科大学附属北京儿童医院影像中心 [3]首都医科大学附属友谊医院放射科

出　　处：《临床小儿外科杂志》2015年第6期501-505,共5页Journal of Clinical Pediatric Surgery

基　　金：北京市教育委员会科技计划面上项目,项目号:KM201210025018;首都发展科研专项,项目号:首发2014-2-2093

摘　　要：目的探讨CT灌注成像及单光子发射计算机体层成像（SPECT）对兔膀胱输尿管反流模型所致积水肾脏肾功能的评估价值。方法将10周龄雄性新西兰兔40只随机分为两组，假手术组10只，打开膀胱后直接关闭伤口，模型组30只，打开膀胱后选择左输尿管内口，完全切开黏膜下输尿管及部分壁内段输尿管。术前两组行VCU检查，以排除先天性反流，术后1个月两组行VCU检查，验证反流模型是否成功。两组成功模型于术前、术后3个月、术后6个月分别行左肾CT灌注成像和SPECT检查，前者测得肾脏皮质及髓质的血容量（BV）、血流量（BF）、平均通过时间（MTT）及表面通透性（Ps），后者测得肾小球滤过率（GFR）、达峰时间（Tb）及半排时间（T1／2）等参数，以病理检查为佐证，进行CT灌注扫描和SPECT各项参数的统计学相关性分析。结果假手术组建模成功率为80％；模型组建模成功率为66．7％。术前两组BV、BF、MTT、PS、GFR、Tb及T1／2元显著性差异（P〉0．05）。术后3个月模型组BV、BF、PS及GFR较术前有不同程度下降，Tb及T1／2延长，MTT变化不显著；术后6个月模型组BV、BF、PS及GFR明显下降，鸭及T1／2较前延长，MTT无明显变化。BF、BV、PS与GFR有正相关（P〈0．05）；MTT与GFR元相关性。病理结果显示左侧积水肾脏体积缩小，肾盂、输尿管扩张，肾实质瘢痕表现为肾髓质纤维化的间质性肾炎。结论在输尿管反流模型中，CT灌注参数中的皮髓质血流量、血容量、表面通透性与SPECT测得的相应GFR有高度正相关，可作为肾功能状态的评定指标，具有一定的临床指导意义。Objetive To evaluate the value of CT perfusion imaging and SPECT in assessing renal function of hydronephrosis in animal models. Methods Forty New Zealand rabbits （ 10-week-old, Male） were used and randomly assigned to two groups ： sham-operated group, 10 rabbits were just opened and closed the anterior wall of the bladder longitudinally;experimental group,30 rabbits were used to establish an experimental model of left VUR using an unroofing surgical procedure. Voiding cystourethrograms were obtained before and one month after surgery, to identify whether the VUR was established successfully. CT perfusion and SPECT were performed on the two groups preoperative. Three months and six months after surgery, CT perfusion and SPECT were performed on both groups again, respectively. The former parameters including blood volme （BV） , blood flow （BF）, mean transit time （MTF）, permeability surface （PS）, and the latter including glomerular filtration rate （GFR）,peak time （Tb） and semi-scheduled time （T1/2）were assessed. The parameters were assessed and the statistical significance of differences was determined, in terms of pathologic diagnoses. Pathology result and statistical analyses were performed simultaneously on the GFR of SPECT and CT perfusion parameters. Results The success rate of animal model was 80% and 66.7% ,respectively. The results of CT perfusion and SPECT showed： the BV,BF.MTT,PS.GFR,Tb and TI/2 were no significant difference between the two groups （P 〉 0.05） ; three months after surgery, the parameters including BV, BF, PS and GFR were decreased ; Tb and T1/2 extended; MTT were no obviously variable in both groups（ P 〉 0.05）. six months after surgery, BV, BF, PS and GFR were decreased significantly; Tb and T1/2 extended markedly; MTY were no obviously variable in both groups as before（P 〉 0.05）. Conclusions CT perfusion parameters including BV,BF,PS in renal cortex and medulla had good positive correlation with GFR. We have shown that CT perfusion can

关 键 词：膀胱输尿管返流 体层摄影术 发射型计算机 单光子 模型 动物 肾 水肿 评价研究 

分 类 号：R-332[医药卫生] R726.9