CT肾脏影像学参数与 99mTc-DTPA肾动态显像法测定肾小球滤过率之间的关系  

Relationship between CT renal imaging parameters and glomerular filtration rate measured by 99mTc-DTPA renal dynamic imaging

作　　者：郑蒙蒙 朱一辰[1] 田野[1] Zheng Mengmeng;Zhu Yichen;Tian Ye(Department of Urology,Bejing Friendship Hospital,Capital Medical University,Institute of Urology,Bejing Municipal Health Commission,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科、北京市卫生健康委员会泌尿外科研究所,北京100050

出　　处：《国际外科学杂志》2025年第3期181-188,F0003,共9页International Journal of Surgery

基　　金：北京市医院管理局科研培育计划(PX2023002)。

摘　　要：目的:探讨3D-slicer软件测量CT肾脏影像学参数与99mTc-DTPA肾动态显像法测定肾小球滤过率(GFR)之间的关系。方法:回顾性分析2015年1月—2021年8月首都医科大学附属北京友谊医院收治的177例患者(包括65例亲属肾移植供者、60例梗阻性肾积水患者和52例肾肿瘤患者)的病例资料。检测所有患者的GFR,基于3D-slicer软件平台对泌尿系增强CT进行三维影像重建后测量肾皮质、实质体积及平均CT值等参数,并对共计189个单肾(包括健康肾65例、积水肾72例、肿瘤肾52例)的上述指标进行分析。使用的统计学分析方法包括独立样本t检验、单因素方差分析、Pearson相关性分析和受试者操作特征(ROC)曲线分析。结果:相较于健康肾,积水肾及肿瘤肾皮质和实质体积显著减小(P<0.001)、GFR显著降低(P<0.001)。189例肾脏参数中,除肾髓质体积(r=0.146,P=0.531)以外,肾皮质体积(r=0.784,P<0.001)、肾实质体积(r=0.698,P<0.001)均与GFR显著相关。单因素方差分析结果显示,肾功能不同分组间,肾皮质体积(F=142.62,P<0.001)、肾实质体积(F=92.92,P<0.001)、肾皮质平均CT值(F=12.68,P<0.001)、肾实质平均CT值(F=19.68,P<0.001)及肾髓质体积(F=3.26,P=0.041)差异均具有统计学意义。各亚组间,肾皮质体积和肾实质体积差异均具有统计学意义(P<0.001)。相较其他参数指标,肾皮质体积在诊断区分不同程度肾功能分组之间的诊断效能较高,取肾皮质体积分别为77.91、45.46 mL时,诊断区分肾功能正常与肾功能轻度受损组肾脏(AUC=0.830,95%CI:0.761~0.889,P<0.001),肾功能轻度受损与重度受损肾脏之间(AUC=0.894,95%CI:0.787~0.952,P<0.001)的灵敏度和特异性较高。结论:3D-slicer软件测量肾脏影像学参数在评估患者肾功能中具有一定的临床价值,其中肾皮质体积在区分不同程度肾功能分组之间的诊断效能较好,值得临床推广应用。Objective:To explore the relationship between CT renal imaging parameters measured by 3D-slicer software and glomerular filtration rate(GFR)measured by 99mTc-DTPA renal dynamic imaging.Methods:A retrospective analysis was conducted on the clinical data of 177 patients(65 renal transplant donors,60 patients with obstructive nephropathy,and 52 patients with renal tumors)admitted to Beijing Friendship Hospital,Capital Medical University from January 2015 to August 2021.GFR was measured for all patients.After three-dimensional imaging reconstruction of the urinary system enhanced CT using the 3D-slicer software platform,renal cortical volume,parenchymal volume,and average CT values were measured.A total of 189 kidneys(65 healthy kidneys,72 hydronephrotic kidneys,and 52 tumor kidneys)were analyzed for the above parameters.The statistical analysis methods used independent sample t-test,one-way analysis of variance(ANOVA),Pearson correlation analysis,and receiver operating characteristics(ROC)curve analysis.Results:Compared with healthy kidneys,renal cortex volume and parenchyma volume in hydronephrotic and tumor kidneys were significantly reduced(P<0.001),and GFR was significantly lower(P<0.001).Among the 189 renal parameters,except for renal medulla volume(r=0.146,P=0.531),renal cortex volume(r=0.784,P<0.001)and renal parenchyma volume(r=0.698,P<0.001)were significantly correlated with GFR.The results of one-way ANOVA showed significant differences between the groups in terms of renal cortex volume(F=142.62,P<0.001),renal parenchyma volume(F=92.92,P<0.001),average CT value of the renal cortex(F=12.68,P<0.001),average CT value of the renal parenchyma(F=19.68,P<0.001),and renal medulla volume(F=3.26,P=0.041).Significant differences were observed between the subgroups for both renal cortex and parenchyma volumes(P<0.001).Compared with other parameters,renal cortex volume showed higher diagnostic performance in distinguishing different levels of renal function.When the renal cortex volume was set to 77.91 mL and 45.46 mL,

关 键 词：肾肿瘤 肾积水 肾功能不全 图像重建 

分 类 号：R737.11[医药卫生—肿瘤]