Grenier Nicolas, Mendichovszky Iosif, de Senneville Baudouin Denis, Roujol Sébastien, Desbarats Pascal, Pedersen Michael, Wells Kevin, Frokiaer Jorgen, Gordon Isky
Laboratoire d'Imagerie Moléculaire et Fonctionnelle, UMR-CNRS 5231 Université Victor Segalen-Bordeaux 2, Bordeaux, France.
Semin Nucl Med. 2008 Jan;38(1):47-55. doi: 10.1053/j.semnuclmed.2007.09.004.
Glomerular filtration rate (GFR) is the most useful quantitative index of renal function and is used clinically as the gold standard of renal dysfunction. Follow-up of patients with impaired renal function requires reliable measurements of GFR. Thus, serial GFR values estimated from magnetic resonance imaging (MRI) would be worthwhile if easy to obtain, accurate, and reproducible. Nuclear medicine-based techniques remain at present the reference method for quantification of GFR, but MRI should be able to compete in the near future. Several methods are available for measurement of GFR using MRI and freely filtered Gd-chelates: (1) measurement of the clearance of the agent using blood samplings; (2) measurement of the plasma clearance of the agent using signal intensity changes within abdominal organs; (3) measurement of the extraction fraction of the agent; and (4) monitoring of tracer intrarenal kinetics. A high heterogeneity of protocols (e.g., in acquisition mode, dose of contrast, postprocessing techniques) is noted in the literature, reflecting the number of technical challenges that will have to be solved before to reach a consensus, and the reported accuracy and reproducibility are insufficient for justifying their use in clinical practice now.
肾小球滤过率（GFR）是评估肾功能最有用的定量指标，临床上被用作肾功能不全的金标准。对肾功能受损患者进行随访需要可靠的GFR测量值。因此，如果通过磁共振成像（MRI）估算的连续GFR值易于获取、准确且可重复，那么将是很有价值的。基于核医学的技术目前仍是GFR定量的参考方法，但MRI在不久的将来应该能够与之竞争。使用MRI和可自由滤过的钆螯合物测量GFR有几种方法：（1）通过采血测量药物清除率；（2）利用腹部器官内信号强度变化测量药物的血浆清除率；（3）测量药物的提取分数；（4）监测示踪剂在肾内的动力学。文献中指出方案存在高度异质性（例如采集模式、造影剂剂量、后处理技术），这反映出在达成共识之前必须解决的技术挑战数量，而且目前报道的准确性和可重复性不足以证明其在临床实践中的应用合理性。
