儿童肾重复畸形^(99)Tc^m-EC肾动态显像  

A comparative study of ^(99)Tc^m-EC renal dynamic imaging with ultrasound、IVP and pathological observation in childhood duplex kidney

作　　者：李佳宁[1] 李劲松[1] 吴靖川[1] 王燕[2] 王国斌[2] 施海虹[1] 吴真[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,200092 [2]上海第二医科大学附属新华医院病理科,200092

出　　处：《中华核医学杂志》2001年第3期165-167,I001,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的　评价99Tcm 双半胱氨酸 (EC)肾动态显像 (RDI)在儿童肾重复畸形诊断中的意义以及对选择手术方式的价值。方法　对 2 0例肾重复畸形患儿行RDI、静脉肾盂造影 (IVP)、B超等检查 ,分析肾重复畸形的RDI影像特征 ,并对 3种检查结果进行比较。对 14例手术切除的上半肾作临床病理分型 :发育型、积水型、发育不良型。99Tcm EC肾动态显像处理 :把 2 4min内图像叠加成 1帧 / 2min连续影像 ,设置重复上半肾、同侧下半肾、对侧上半肾感兴趣区 ,获得其放射性计数率 (D、L、C) ,以D/L或D/C中较小者为重复上半肾功能指标 (D/N) ,并与病理分型比较。结果　肾重复畸形在RDI连续影像中有 4种表现 :上肾稀疏、上肾缺损、肾影增长、肾盂分离 ;RDI对合并输尿管囊肿检出率较高 ,并可检出部分输尿管扩张积水。RDI、B超、IVP对重复肾的检出率分别为 73.1%、5 7.7%、73 1% ,三者较为一致 (P >0 .0 5 ) ;RDI的灵敏度、特异性、准确性分别为 73.1%、92 .2 %、80 .0 %。发育不良型的上肾D/N值均小于 6 0 % ,发育型均大于 6 0 %。结论　肾重复畸形的99Tcm EC肾动态显像有较好的诊断价值 ,可为临床术前判断是否保留上肾提供重要依据。Objective To evaluate the values of 99 Tc m EC renal dynamic imaging(RDI) in the diagnosis and the choice of operation programs in childhood duplex kidney. Methods Twenty cases of duplex kidney were examined with ultrasound、IVP and RDI. All the results of three modalities were compared with each other. The characteristics of duplex kidney images were analyzed. Fourteen excised duplex kidneys were classified into 3 groups on the basis of pathological observation: dysplastic, fair developed and hydronephrotic. Semiquantitative RDI assessment of tracer uptake was made using a ratio of radioactivity in the upper part of the duplex kidney compared with the ipsilateral lower kidney (D/I) and with the upper part of contralateral kidney (D/C), the results were compared with the pathologic findings. Results The characteristics of RDI images were (1) decreasing of radiodistribution in the upper kidney, (2) radioactivity deficiency in the upper kidney, (3) kidney with a long shape, (4) renal pelvis septation. Not only ureterocele,but also hydroureterosis could be well detected in RDI. The sensitivity was 73.1%、57.7%、73.1% respectively with RDI、ultrasound and IVP. The positivity diagnosis rate of RDI was not significantly different compared with that of ultrasound or IVP ( P >0.05). The sensitivity、specificity and accuracy of RDI were 73.1%、92.2%、80.0%. Four cases were dysplastic, the D/N less than 60%; 4 cases were fair developed, the D/N more than 60%. Conclusions 99 Tc m EC renal dynamic imaging is a sensitive, practical and reliable method in diagnosing the duplex kidney. It provides an important evidence for the choice of operation programs.

关 键 词：肾畸形 放射性核素显像 ^99Tc^m-EC 肾动态显像 儿童 

分 类 号：R817[医药卫生—影像医学与核医学]