论文部分内容阅读
目的:初步探讨99Tcm-DTPA肾脏动态显像在肾脏单发占位性病变诊断和治疗中的应用价值。方法:回顾性收集2010年1月—2015年1月61例肾脏占位患者,多数接受增强CT和B超检查,所有患者接受99Tcm-DTPA肾脏动态显像和血生化检查,半定量评价肾脏占位、灌注指数(perfusion index,PI)和肾小球滤过率(glomerular filtration rate,GFR)。32例肾脏恶性肿瘤和2例良性肿瘤患者在术后6个月再次行99mTc-DTPA肾脏动态显像。结果 :99Tcm-DTPA肾脏动态显像诊断肾脏恶性肿瘤的灵敏度、准确性分别为37.5%、63.9%,明显低于增强CT;对长径大于4 cm者,肾脏动态显像诊断灵敏度、特异性和准确性分别为66.7%、85.7%和75.0%,如果以占位与健侧肾PI比值(T1/K1)≤1、功能相占位病灶与对侧(或邻近)对称肾组织GFR之比(T2/K2)接近0作为肾恶性肿瘤的诊断标准,其诊断灵敏度提高到83.3%。肾脏动态显像占位对侧肾中重度受损时,结合患肾情况选择保守手术,术后6个月肾PI降低,GFR增加,否则多在术后出现肾功能不全,部分患者需要透析治疗。结论:99Tcm-DTPA肾脏动态显像提供肾脏占位PI和单肾PI、GFR,对肾恶性肿瘤的诊断、手术方式选择和预后评价提供了重要数据支持。
Objective: To investigate the value of 99Tcm-DTPA renal dynamic imaging in the diagnosis and treatment of single-occupying lesions of the kidney. Methods: Sixty-one patients with renal masses from January 2010 to January 2015 were retrospectively collected. Most patients underwent enhanced CT and B-ultrasound. All patients underwent 99Tcm-DTPA renal dynamic imaging and blood biochemical tests. Semi-quantitative evaluation of kidney Bit, perfusion index (PI) and glomerular filtration rate (GFR). Thirty-two patients with renal malignancy and two patients with benign tumor underwent 99mTc-DTPA renal dynamic imaging at 6 months after operation. Results: The sensitivity and accuracy of 99Tcm-DTPA renal dynamic imaging in the diagnosis of renal malignant tumors were 37.5% and 63.9%, respectively, which were significantly lower than that of enhanced CT. The diagnostic sensitivity, specificity and Accuracy was 66.7%, 85.7% and 75.0%, respectively. If the ratio of occupying position to contralateral kidney PI (T1 / K1) ≤1, the ratio of functional GFR to the contralateral (or adjacent) T2 / K2) approaching 0 as the diagnostic criteria of renal malignancy, the diagnostic sensitivity increased to 83.3%. Kidney dynamic imaging of the contralateral kidney moderate to severe damage, combined with the selection of patients with kidney surgery conservative surgery, 6 months after the reduction of renal PI, GFR increased, or more postoperative renal insufficiency, some patients need dialysis treatment . Conclusion: The 99Tcm-DTPA renal dynamic imaging provides the data of renal occupancy PI and single kidney PI, GFR, diagnosis of renal malignancies, choice of surgical procedures and prognosis.