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肾脏核医学的儿科应用

Pediatric applications of renal nuclear medicine.

作者信息

Piepsz Amy, Ham Hamphrey R

机构信息

Centre Hospitalo-Universitaire St Pierre, Department Radioisotopes, Brussels, Belgium.

出版信息

Semin Nucl Med. 2006 Jan;36(1):16-35. doi: 10.1053/j.semnuclmed.2005.08.002.

Abstract

This review should be regarded as an opinion based on personal experience, clinical and experimental studies, and many discussions with colleagues. It covers the main radionuclide procedures for nephro-urological diseases in children. Glomerular filtration rate can be accurately determined using simplified 2- or 1-blood sample plasma clearance methods. Minor controversies related to the technical aspects of these methods concern principally some correction factors, the quality control, and the normal values in children. However, the main problem is the reluctance of the clinician to apply these methods, despite the accuracy and precision that are higher than with the traditional chemical methods. Interesting indications are early detection of renal impairment, hyperfiltration status, and monitoring of nephrotoxic drugs. Cortical scintigraphy is accepted as a highly sensitive technique for the detection of regional lesions. It accurately reflects the histological changes, and the interobserver reproducibility in reporting is high. Potential technical pitfalls should be recognized, such as the normal variants and the difficulty in differentiating acute lesions from permanent ones or acquired lesions from congenital ones. Although dimercaptosuccinic acid scintigraphy seems to play a minor role in the traditional approach to urinary tract infection, recent studies suggest that this examination might influence the treatment of the acute phase, the indication for chemoprophylaxis and micturating cystography, and the duration of follow-up. New technical developments have been applied recently to the renogram: tracers more appropriate to the young child, early injection of furosemide, late postmicturition and gravity-assisted images and, finally, more objective parameters of renal drainage. Pitfalls mainly are related to the interpretation of drainage on images and curves. Dilated uropathies represent the main indication of the renogram, but the impact of this technique on the management of the child is, in a great number of cases, still a matter of intense controversy. Direct and indirect radionuclide cystography are interesting alternatives to the radiograph technique and should be integrated into the process of diagnosis and follow-up of vesicoureteral reflux.

摘要

本综述应被视为基于个人经验、临床和实验研究以及与同事的多次讨论而形成的观点。它涵盖了儿童肾泌尿系统疾病的主要放射性核素检查方法。使用简化的两样本或一样本血浆清除率方法能够准确测定肾小球滤过率。与这些方法技术方面相关的小争议主要涉及一些校正因子、质量控制以及儿童的正常值。然而,主要问题是尽管这些方法的准确性和精密度高于传统化学方法,但临床医生却不愿应用它们。有趣的应用包括早期发现肾功能损害、高滤过状态以及监测肾毒性药物。皮质闪烁扫描被认为是检测局部病变的高敏感技术。它能准确反映组织学变化,且观察者间报告的可重复性高。应认识到潜在的技术陷阱,如正常变异以及区分急性病变与永久性病变或后天性病变与先天性病变的困难。尽管二巯基丁二酸闪烁扫描在传统的尿路感染诊治方法中似乎作用较小,但近期研究表明,该项检查可能会影响急性期治疗、化学预防和排尿性膀胱尿道造影的指征以及随访时长。近期新技术已应用于肾图检查:更适合幼儿的示踪剂、速尿的早期注射、排尿后晚期及重力辅助图像,以及最终更客观的肾引流参数。陷阱主要与图像和曲线上引流情况的解读有关。肾盂输尿管扩张症是肾图检查的主要适应证,但在许多情况下,这项技术对儿童治疗管理的影响仍存在激烈争议。直接和间接放射性核素膀胱造影是X线照相技术的有趣替代方法,应纳入膀胱输尿管反流的诊断和随访过程。

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