Buyukdereli Gulgun, Guney Isa Burak, Seydaoglu Gulsah
Department of Nuclear Medicine, Cukurova University Faculty of Medicine, Adana, Turkey.
Clin Nucl Med. 2005 Nov;30(11):721-4. doi: 10.1097/01.rlu.0000183614.76106.4d.
The aim of this study was to evaluate the effectiveness of diuretic injection for the measurement of differential renal function (DRF) with technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) scintigraphy in patients with a dilated pelvis.
A total of 46 patients who were referred for both technetium-99m-L,L-ethylenedicysteine (Tc-99m L,L-EC) and Tc-99m DMSA imaging and found to have a dilated collecting system on Tc-99m EC scintigraphy were studied. Four to 5 hours after intravenous injection of Tc-99m DMSA, imaging was performed in the supine position, and posterior, anterior, left and right lateral, and left and right posterior oblique views were taken. After this study, furosemide was administered intravenously and 30 minutes later, additional images in the anterior and posterior views were obtained.
The kidneys were evaluated into 2 groups. Group 1 comprised 12 kidneys that had an obstructive curve pattern on Tc-99m EC scans. Group 2 comprised 34 kidneys that had a nonobstructive dilated renogram curve pattern. DRF of the kidneys in each patient were calculated, and the values obtained from the standard and diuretic DMSA scans were compared with each other for all patients and each group. Considering all the patients, the values of mean DRF on both standard and diuretic DMSA images were 55.4%+/-21.2% and 55.4%+/-21.5%, respectively. There were no significant differences between DRF values of each kidney obtained by the 2 methods. When we compared the DRF values in groups 1 and 2, there were again no significant differences. In group 1, the values of mean DRF on standard and diuretic images were 51.7%+/-13.7% and 51.6%+/-13.9%, respectively, and in group 2, the values of mean DRF were 56.7%+/-23.4% and 56.7%+/-23.6%, respectively.
In view of our study, diuretic administration seems to be an unnecessary intervention because it has no effect on the accuracy of DRF measurements using DMSA scintigraphy in patients with a dilated collecting system whether it is obstructed or not.
本研究旨在评估利尿剂注射对使用锝-99m二巯基丁二酸（Tc-99m DMSA）闪烁扫描术测量肾盂扩张患者的分肾功能（DRF）的有效性。
共研究了46例同时接受锝-99m-L,L-乙二胺半胱氨酸（Tc-99m L,L-EC）和Tc-99m DMSA成像检查且在Tc-99m EC闪烁扫描术中发现有集合系统扩张的患者。静脉注射Tc-99m DMSA后4至5小时，患者取仰卧位进行成像，拍摄后位、前位、左右侧位以及左右后斜位图像。本研究结束后，静脉注射呋塞米，30分钟后，获取额外的前后位图像。
将肾脏分为两组。第1组包括12个在Tc-99m EC扫描中有梗阻曲线模式的肾脏。第2组包括34个有非梗阻性扩张肾图曲线模式的肾脏。计算每位患者肾脏的DRF，并将所有患者及每组患者从标准DMSA扫描和利尿剂DMSA扫描获得的值相互比较。考虑所有患者，标准DMSA图像和利尿剂DMSA图像上的平均DRF值分别为55.4%±21.2%和55.4%±21.5%。两种方法获得的每个肾脏的DRF值之间无显著差异。当我们比较第1组和第2组的DRF值时，同样无显著差异。在第1组中，标准图像和利尿剂图像上的平均DRF值分别为51.7%±13.7%和51.6%±13.9%，在第2组中，平均DRF值分别为56.7%±23.4%和56.7%±23.6%。
根据我们的研究，利尿剂给药似乎是不必要的干预措施，因为无论集合系统是否梗阻，它对使用DMSA闪烁扫描术测量肾盂扩张患者的DRF准确性均无影响。
