肾脏64层螺旋CT灌注成像对梗阻性肾积水患者患肾功能的评价
신장64층라선CT관주성상대경조성신적수환자환신공능적평개
64-slice spiral CT perfusion imaging in the single renal functional assessment for hydronephrotic kidney
  • 万方数据
    中华泌尿外科杂志 중화비뇨외과잡지
    CHINESE JOURNAL OF UROLOGY
    2010年 2期 84-87 ,共4页

    王云华%侯伟伟%刘瑞洪%何建军%支科

    왕운화%후위위%류서홍%하건군%지과

    体层摄影术%X线计算机%肾盂积水 體層攝影術%X線計算機%腎盂積水
    체층섭영술%X선계산궤%신우적수
    Tomgraphy%X-ray computed%Hydronephrosis
    目的 探讨64层螺旋CT灌注成像检查对梗阻性肾积水患者患肾功能的评估价值.方法 梗阻性肾积水患者36例行64层螺旋CT灌注扫描和肾动态显像(SPECT)测定单侧GFR.其中有肾积水表现者48侧(积水组),28例健康志愿者作为正常对照1组,比较2组各灌注参数值.根据GFR结果将36例患者72侧肾脏分为正常对照2组、肾功能轻度受损组、重度受损组,比较3组肾皮质和髓质血流灌注参数的差异;将各灌注参数与单侧肾脏GFR行Pearson相关性分析. 结果 ①36例患者CT灌注成像表现为双侧时间密度曲线(TDC)不对称,积水组肾皮质、髓质TDC斜率与峰高降低.积水肾皮质血流量(BF)为(203.2±44.9)ml·100 ml~(-1)·min~(-1),血容量(BV)为(27.6±3.9)ml/100 ml,表面通透性(PS)为(30.7±6.5)ml·100 ml~1·min~(-1),Patlak血容量(PBV)为(46.5±10.9)ml/100ml;肾髓质分别为(99.9±24.1)ml·100 ml~(-1)·min~(-1)、(18.3±4.3)ml/100 ml、(51.8±12.1)ml·100 ml~(-1)·min~(-1)、(21.3±3.0)ml/100 ml.与对照1组肾皮质的(301.6±68.8)ml·100 ml~(-1)·min~(-1)、(38.9±5.8)ml/100 ml、(42.9±10.9)ml·100 ml~(-1)·min~(-1)、(67.5±10.3)ml/100 ml及肾髓质的(157.8±34.6)ml·100 ml~(-1)·min~(-1)、(28.5±3.9)ml/100 ml、(75.6±22.7)ml·100 ml~(-1)·min~(-1)、(28.2±0.9)ml/100 ml比较,灌注参数值均下降,差异均有统计学意义(P值均<0.05).②对照2组肾皮髓质BF、BV、PS、PBV分别为(31 4.2±28.7)ml·100 ml~(-1)·min~(-1)、(39.7±2.2)ml/100 ml、(45.2±3.4)ml·100 ml~(-1)·min~1、(68.6±4.3)ml/100 ml和(161.2±10.4)ml·100 ml~(-1)·min~(-1)、(28.7±1.8)ml/100 ml、(80.1±6.7)ml·100 ml~(-1)·min~(-1)、(27.9±6.9)ml/100 ml;肾功能轻度受损组分别为(245.8±16.8)ml·100 ml~(-1)·min~(-1)、(30.5±3.2)ml/100ml、(34.7±5.7)ml·100 ml~(-1)·min、(54.9±7.2)ml/100 ml和(120.7±1 9.6)ml·100 ml~1·min~(-1)、(22.0±2.7)ml/100 ml、(61.9±10.5)ml·100 ml~(-1)·min~(-1)、(23.0±2.2)ml/100 ml;肾功能重度受损组分别为(170.1±29.0)ml·100 ml~(-1)·min~(-1)、(25.4±2.8)ml/100 ml、(27.5±5.2)ml·100 ml~(-1)·min~(-1)、(40.0±8.4)ml/100 m1和(83.7±11.5)ml·100 ml~(-1)·min~(-1)、(15.5±2.9)ml/100 ml、(44.0±5.8)ml·100 ml~(-1)·min~(-1)、(20.0±2.8)ml/100 ml.3组间肾皮髓质血流灌注参数比较差异均有统计学意义(P<0.05).③肾皮髓质各灌注参数与GFR有良好的相关性.其中肾皮质BF相关性最好,r=0.852. 结论 64层螺旋CT肾脏灌注成像可对积水肾肾皮髓质血流灌注状态与肾功能损害进行定量评估,对受损肾功能可进行分级诊断,测定的肾皮髓质各灌注参数值与GFR有良好的相关性.
    목적 탐토64층라선CT관주성상검사대경조성신적수환자환신공능적평고개치.방법 경조성신적수환자36례행64층라선CT관주소묘화신동태현상(SPECT)측정단측GFR.기중유신적수표현자48측(적수조),28례건강지원자작위정상대조1조,비교2조각관주삼수치.근거GFR결과장36례환자72측신장분위정상대조2조、신공능경도수손조、중도수손조,비교3조신피질화수질혈류관주삼수적차이;장각관주삼수여단측신장GFR행Pearson상관성분석. 결과 ①36례환자CT관주성상표현위쌍측시간밀도곡선(TDC)불대칭,적수조신피질、수질TDC사솔여봉고강저.적수신피질혈류량(BF)위(203.2±44.9)ml·100 ml~(-1)·min~(-1),혈용량(BV)위(27.6±3.9)ml/100 ml,표면통투성(PS)위(30.7±6.5)ml·100 ml~1·min~(-1),Patlak혈용량(PBV)위(46.5±10.9)ml/100ml;신수질분별위(99.9±24.1)ml·100 ml~(-1)·min~(-1)、(18.3±4.3)ml/100 ml、(51.8±12.1)ml·100 ml~(-1)·min~(-1)、(21.3±3.0)ml/100 ml.여대조1조신피질적(301.6±68.8)ml·100 ml~(-1)·min~(-1)、(38.9±5.8)ml/100 ml、(42.9±10.9)ml·100 ml~(-1)·min~(-1)、(67.5±10.3)ml/100 ml급신수질적(157.8±34.6)ml·100 ml~(-1)·min~(-1)、(28.5±3.9)ml/100 ml、(75.6±22.7)ml·100 ml~(-1)·min~(-1)、(28.2±0.9)ml/100 ml비교,관주삼수치균하강,차이균유통계학의의(P치균<0.05).②대조2조신피수질BF、BV、PS、PBV분별위(31 4.2±28.7)ml·100 ml~(-1)·min~(-1)、(39.7±2.2)ml/100 ml、(45.2±3.4)ml·100 ml~(-1)·min~1、(68.6±4.3)ml/100 ml화(161.2±10.4)ml·100 ml~(-1)·min~(-1)、(28.7±1.8)ml/100 ml、(80.1±6.7)ml·100 ml~(-1)·min~(-1)、(27.9±6.9)ml/100 ml;신공능경도수손조분별위(245.8±16.8)ml·100 ml~(-1)·min~(-1)、(30.5±3.2)ml/100ml、(34.7±5.7)ml·100 ml~(-1)·min、(54.9±7.2)ml/100 ml화(120.7±1 9.6)ml·100 ml~1·min~(-1)、(22.0±2.7)ml/100 ml、(61.9±10.5)ml·100 ml~(-1)·min~(-1)、(23.0±2.2)ml/100 ml;신공능중도수손조분별위(170.1±29.0)ml·100 ml~(-1)·min~(-1)、(25.4±2.8)ml/100 ml、(27.5±5.2)ml·100 ml~(-1)·min~(-1)、(40.0±8.4)ml/100 m1화(83.7±11.5)ml·100 ml~(-1)·min~(-1)、(15.5±2.9)ml/100 ml、(44.0±5.8)ml·100 ml~(-1)·min~(-1)、(20.0±2.8)ml/100 ml.3조간신피수질혈류관주삼수비교차이균유통계학의의(P<0.05).③신피수질각관주삼수여GFR유량호적상관성.기중신피질BF상관성최호,r=0.852. 결론 64층라선CT신장관주성상가대적수신신피수질혈류관주상태여신공능손해진행정량평고,대수손신공능가진행분급진단,측정적신피수질각관주삼수치여GFR유량호적상관성.
    Objective To evaluate the value of MSCT perfusion imaging in assessment of single renal function of hydronephrotic kidney.Methods 64-slice spiral CT perfusion was performed in 36 obstructive nephrohydrosis patients whose split renal glomerular filtration rate(GFR) was measured by SPECT renal dynamic imaging. ①The perfusion parameters of the renal cortex and renal medulla of the hydronephrotic kidney were compared with the normal kidney studied by contrast group. ②The 72 kidneys were divided into normal renal function, mild and severe renal impairment groups according to renal function. Differences between the groups respect to all the mean perfusion parameters of the renal cortex and renal medulla were assesses by ANOVA. ③Using Pearsons correlation test, the correlations between all the mean perfusion parameters of the renal cortex and renal medulla and renal GFR were examined.Results ① The time-density curves of bilateral normal renal cortex and medulla were not symmetric. The mean BF, BV, PS, PBV of renal cortex were (203. 2±44.9)ml·100 ml~(-1)·min~(-1), (27.6±3.9)ml/100 ml, (30.7±6.5)ml·100 ml~(-1)· min~(-1), (46.5±10. 9)ml/100 ml; and the mean BF, BV, PS, PBV of renal medulla were (99.9±24.1)ml·100 ml~(-1)·min~(-1) ,(18. 3±4.3)ml/100 ml, (51.8±12.1)ml · 100 ml~(-1)· min~(-1) , (21.3±3.0)ml/100 ml. The mean perfusion parameters of the cortex and medulla of obstructed kidney were lower compared to that of normal kidney. ②There were significant differences of all the perfusion parameters of the renal cortex and me-dulla between 3 groups (P<0. 05). ③The perfusion parameters of the renal cortex and medulla had positive linear correlation with GFR. The best correlation was the blood flow of the cortex of kidney. The correlation coefficient r=0.852. Conclusions 64-slice spiral CT perfusion imaging can quantita-tively evaluate the haemodynamic condition and functional lesion of the kidney, classify the impaired kidney function. The perfusion parameters of the renal cortex and medulla had positive linear correlation with GFR.
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