Brenner Michele, Bonta Dacian, Eslamy Hedieh, Ziessman Harvey A
Russell H. Morgan Department of Radiology, Division of Nuclear Medicine, Johns Hopkins University and Johns Hopkins Outpatient Center, 601 N Caroline St., JHOC Rm. 3231, Baltimore, MD 21287, USA.
AJR Am J Roentgenol. 2009 Aug;193(2):333-7. doi: 10.2214/AJR.08.1788.
Renal cortical scintigraphy with (99m)Tc dimer captosuccinic acid (DMSA) is the standard method to detect acute pyelonephritis and cortical scarring. Different acquisition methods have been used: planar parallel-hole or pinhole collimation and single photon emission tomography (SPECT). Publications support the superiority of each; few comparative studies have been reported, with mixed results. We have compared planar parallel-hole cortical scintigraphy and dual-head SPECT for detection of cortical defects.
Forty patients (37 children, 3 adults; 9 male, 31 female) were imaged 3 hours after injection of (99m)Tc-DMSA with dual-head SPECT and planar imaging (posterior, left, and right posterior oblique views with a parallel-hole collimator). For each patient, planar and SPECT images were evaluated at different sittings, in random order, by three independent observers. Twelve cortical segments were scored as normal or reduced uptake. The linear correlation coefficient for the number of abnormal segments detected between readers, techniques, and segments was calculated.
No significant difference was seen in the average number of abnormal segments detected by planar versus SPECT imaging; 2.1 for planar imaging and 2.2 for SPECT (p = 0.84, two-tailed). For all observers, the average correlation coefficient for SPECT alone, planar imaging alone, and between techniques (SPECT vs planar imaging) was high (r = 0.93-0.94). Applying nonparametric Spearman's rank analysis, the average correlation remained high (r = 0.70-0.75). Correlation between readers, techniques, and segments for methods and readers was also good (r = 0.69-0.77).
(99m)Tc-DMSA renal cortical imaging using dual-head SPECT offers no statistically significant diagnostic advantage over planar imaging for detection of cortical defects.
用锝-99m二巯基丁二酸（DMSA）进行肾皮质闪烁扫描是检测急性肾盂肾炎和皮质瘢痕的标准方法。已采用不同的采集方法：平面平行孔或针孔准直以及单光子发射断层扫描（SPECT）。有文献支持每种方法的优越性；但很少有比较研究报道，结果也不一致。我们比较了平面平行孔皮质闪烁扫描和双头SPECT对皮质缺损的检测。
40例患者（37例儿童，3例成人；9例男性，31例女性）在注射锝-99m-DMSA 3小时后，用双头SPECT和平面成像（后位、左侧和右侧后斜位，使用平行孔准直器）进行成像。对于每位患者，平面和SPECT图像由三名独立观察者在不同时间、随机顺序下进行评估。12个皮质节段被评为摄取正常或减低。计算读者、技术和节段之间检测到的异常节段数的线性相关系数。
平面成像与SPECT成像检测到的异常节段平均数无显著差异；平面成像为2.1，SPECT为2.2（p = 0.84，双侧）。对于所有观察者，单独SPECT、单独平面成像以及技术之间（SPECT与平面成像）的平均相关系数都很高（r = 0.93 - 0.94）。应用非参数Spearman秩分析，平均相关性仍然很高（r = 0.70 - 0.75）。方法与读者之间读者、技术和节段的相关性也很好（r = 0.69 - 0.77）。
使用双头SPECT进行锝-99m-DMSA肾皮质成像在检测皮质缺损方面，与平面成像相比无统计学上显著的诊断优势。
