Tripathi Madhavi, Chandrashekar Narayana, Phom Hentok, Gupta Devender Kumar, Bajpai Minu, Bal Chandrashekhar, Malhotra Arun
Departments of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Ann Nucl Med. 2004 Dec;18(8):681-7. doi: 10.1007/BF02985962.
To evaluate the feasibility of modifying diuresis renography by the simultaneous administration of Tc-99m ethylenedicysteine and furosemide in the investigation of hydronephrosis and hydroureteronephrosis in infants and children. Parameters assessed were the diuretic response in normal kidneys and the ability of the F+0 study to differentiate between renal obstruction and nonobstruction.
One hundred and thirty-three children (93 males, 40 females; mean age 35.2 months) with sonographic diagnoses of hydronephrosis or hydroureteronephrosis underwent F+0 diuresis renography. Tc-99m ethylenedicysteine (3.7 MBq/kg body weight) and furosemide at an appropriate dose were administered intravenously at the start of the study. Posterior imaging of the kidneys and bladder was performed for 20 min followed by imaging after voiding. All patients were followed-up for 12 months, and the results of the initial F+0 diuresis renography were compared with the final diagnoses. Final diagnosis was based on the pediatric urologist's decision of either surgery or conservative management.
A renal unit was defined as a kidney and its ureter. There were 262 renal units with 4 patients having a solitary kidney. 90 normal and 172 abnormal renal units on sonography were assessed by F+0 diuresis renography. The furosemide clearance half time for the 90 normal renal units was 5.8 +/- 1.4 min. Of the 172 abnormal renal units, 100 were classified as nonobstructed and 72 as obstructed on diuresis renography. All 100 nonobstructed renal units were correctly classified with no false-negative studies; of the 72 renal units classified as obstructed, there were 43 true-positive studies and 29 false-positive studies. The sensitivity was 100%, specificity was 78% and accuracy was 83%.
Tc-99m ethylenedicysteine F+0 diuresis renography is a valid method for the investigation of hydronephrosis and hydroureteronephrosis in infants and children.
评估在婴幼儿和儿童肾积水及输尿管肾盂积水的检查中，同时给予锝-99m乙二巯基丁二酸和呋塞米来改良利尿肾图的可行性。评估的参数包括正常肾脏的利尿反应以及F+0检查区分肾梗阻与非梗阻的能力。
133例经超声诊断为肾积水或输尿管肾盂积水的儿童（男93例，女40例；平均年龄35.2个月）接受了F+0利尿肾图检查。研究开始时静脉注射锝-99m乙二巯基丁二酸（3.7 MBq/kg体重）和适当剂量的呋塞米。对肾脏和膀胱进行20分钟的后位成像，然后在排尿后成像。所有患者随访12个月，并将初始F+0利尿肾图的结果与最终诊断进行比较。最终诊断基于小儿泌尿科医生关于手术或保守治疗的决定。
一个肾单位定义为一个肾脏及其输尿管。共有262个肾单位，4例为单肾。通过F+0利尿肾图评估了超声检查显示的90个正常肾单位和172个异常肾单位。90个正常肾单位的呋塞米清除半衰期为5.8±1.4分钟。在172个异常肾单位中，利尿肾图检查将100个分类为非梗阻性，72个分类为梗阻性。所有100个非梗阻性肾单位均分类正确，无假阴性研究；在72个分类为梗阻性的肾单位中，有43个真阳性研究和29个假阳性研究。敏感性为100%，特异性为78%，准确性为83%。
锝-99m乙二巯基丁二酸F+0利尿肾图是婴幼儿和儿童肾积水及输尿管肾盂积水检查的一种有效方法。
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