光谱CT碘定量评估肾肿瘤患者分肾功能  

Assessment of split renal function in patients with renal tumors by spectral detector computed tomography using iodine quantification

作　　者：李阳蕾 梁梦[2] 王鑫超 武志芳[2] LI Yanglei;LIANG Meng;WANG Xinchao;WU Zhifang(Department of Radiology,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Third Hospital of Shanxi Medical University,Tongji Shanxi Hospital,Taiyuan 030032,Shanxi Province,China;Department of Nuclear Medicine,The First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西白求恩医院(山西医学科学院),山西医科大学第三医院,同济山西医院放射科,山西太原030032 [2]山西医科大学第一医院核医学科,山西太原030001

出　　处：《肿瘤影像学》2024年第4期404-411,共8页Oncoradiology

摘　　要：目的:探究利用光谱计算机体层成像(computed tomography,CT)碘定量评估肾肿瘤患者分肾功能的潜在临床应用价值。方法:回顾并分析50例2周内先后行光谱CT肾脏多期增强及核素肾动态显像的肾肿瘤患者。光谱CT肾脏多期增强扫描采用标准的腹部3期增强方案。手动勾画光谱CT参数肾脏体积(volume,V)、平均CT值(Hounsfield unit,HU)、平均碘浓度值(iodine concentration,IC),并将平均IC与肾脏体积相乘得到碘对比剂累积量K值,同时使用简化的Patlak方程计算得到分肾CT清除率。根据99m锝-二亚乙基三胺五乙酸(^(99m)Tc-diethylene triaminepentaacetic acid,^(99m)Tc-DTPA)肾动态显像盖茨法肾小球滤过率(Gates glomerular filtration rate,Gates GFR)参考值,将100个肾脏分为分肾功能正常组(Gates GFR≥40 mL/min)、分肾功能受损组(Gates GFR<40 mL/min)两组。采用Kruskal-Wallis H检验比较两组间光谱CT各参数的差异,并将各参数与肾动态显像所得Gates GFR进行Spearman相关性分析。绘制受试者工作特征(receiver operating characteristic,ROC)曲线得出分肾CT清除率区分分肾功能正常和分肾功能受损的最佳诊断阈值。结果:光谱CT所得肾脏体积V、动脉期平均CT值HU(t1)、静脉期平均CT值HU(t2)、动脉期平均碘浓度值IC(t1)、静脉期平均碘浓度值IC(t2)、动脉期肾脏碘对比剂累积量K(t1)、静脉肾脏期碘对比剂累积量K(t2)及分肾CT清除率两组之间的差异均有统计学意义(Z/t=-4.459、2.815、-3.313、2.611、-3.609、-4.395、-5.637、-5.815,均P<0.05);并且上述各参数均与GFR相关(r=0.489、0.339、0.481、0.361、0.531、0.590、0.724、0.740,均P<0.001)。区分分肾功能正常与受损的碘定量分肾CT清除率界值为543 mg。结论:光谱CT各参数均可反映分肾功能,其中光谱CT碘定量分肾CT清除率与Gates GFR相关性最高并能区分肾功能是否受损,具有潜在的临床应用价值。Objective:To explore the potential clinical value of spectral detector computed tomography(SDCT)iodine quantification in assessing the split renal function impairment in patients with renal tumor.Methods:This retrospective study included 50 patients with renal tumors who underwent both multiphasic enhanced renal SDCT and renal dynamic imaging within two weeks.SDCT scans were performed using a normal enhanced abdominal protocol.Renal volumes(V),mean CT number(HU),and mean iodine concentration(IC)were delineated manually.The cumulative amount of iodine contrast media(K)was the product of IC and V.Clearance of single kidney was calculated using a simplified“two-point Patlak plot”.The patients’kidneys were divided into two groups according to^(99m)Tc-diethylene triamine pentaacetic acid(^(99m)Tc-DTPA)Gates glomerular filtration rate(Gates GFR):normal(Gates GFR≥40 mL/min),and impaired(Gates GFR<40 mL/min)group.SDCT parameters were compared between groups using Kruskal-Wallis H test.Correlation between SDCT parameters and Gates GFR was analyzed using Spearman’s coefficient Receiver operating characteristic(ROC)curve analysis was performed to determine optimal diagnostic threshold for clearance of single kidney to distinguish between normal and impaired renal function.Results:The V,mean HU of arterial phase-HU(t1),mean HU of parenchymal phase-HU(t2),mean IC of arterial phase-IC(t1),mean IC of parenchymal phase-IC(t2),K of arterial phase-K(t1),K of parenchymal phase-K(t2)and the clearance of single kidney between the groups were statistically significant(Z/t=-4.459,2.815,-3.313,2.611,-3.609,-4.395,-5.637,-5.815;P<0.05);and those parameters were related to Gates GFR(r=0.489,0.339,0.481,0.361,0.531,0.590,0.724,0.740;P<0.001).The cutoff value of clearance in distinguishing normal from impaired renal function was 543 mg.Conclusion:All parameters of SDCT could reflect split renal function,among which the clearance had the highest correlation with Gates GFR and could be used in diagnosis of impaired split renal funct

关 键 词：肾肿瘤 光谱CT 碘浓度 肾动态显像 分肾功能 

分 类 号：R737.11[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R445.5