锝 99m-L,L-乙二硫代氨酸比锝 99m 二乙三胺五乙酸更有效地排除肾盂积水患者的梗阻。

Technetium-99m-L,L-ethylenedicysteine is more effective than technetium-99m diethylenetriamine penta-acetic acid for excluding obstruction in patients with pyelocalicinal dilation.

机构信息

Division of Nuclear Medicine, Department of Radiology, State University of Campinas, Campinas, São Paulo, Brazil.

出版信息

Urology. 2010 Aug;76(2):283-8. doi: 10.1016/j.urology.2009.12.032. Epub 2010 Mar 5.

DOI:10.1016/j.urology.2009.12.032

PMID:20206974

Abstract

OBJECTIVE

To evaluate the utility of diuretic dynamic renal scintigraphy (DDRS) with technetium-99m-L,L-ethylenedicysteine ((99m)Tc-EC) in patients with indeterminate or possible false-positive results for urinary obstruction by technetium-99m diethylenetriamine penta-acetic acid ((99m)Tc-DTPA) DDRS.

METHODS

A total of 92 patients (63 male; mean age, 16.6 +/- 21.25 years) were studied, with a total of 103 kidneys presenting indeterminate (20/103) or possible false-positive results for obstruction attributable to reduced renal function or severe kidney dilation (83/103) by (99m)Tc-DTPA DDRS (<60% of radiopharmaceutical excreted in 20 minutes-half-time clearance [T(1/2)] >15 minutes). Patients were reimaged after intravenous injection of (99m)Tc-EC, with dynamic images before and after furosemide administration using the same acquisition parameters applied in the previous (99m)Tc-DTPA study. Time interval between (99m)Tc-DTPA and (99m)Tc-EC renograms was 2-64 days. The percentage of excreted material 20 minutes after furosemide was calculated using both radiopharmaceuticals, and were statistically compared using the paired samples t test.

RESULTS

The excretion after furosemide injection was 25.3% +/- 18.2% for (99m)Tc-DTPA and 41.2% +/- 26.1% for (99m)Tc-EC, with a statistically significant difference between both radiopharmaceuticals (P <.0001). Using (99m)Tc-EC obstruction was excluded in 36 of 103 kidneys, which excreted >60%. A total of 10 of 83 kidneys (12.0%) with an obstructive pattern by (99m)Tc-DTPA study turned out to be indeterminate by (99m)Tc-EC DDRS. There was an agreement between (99m)Tc-EC and (99m)Tc-DTPA studies in 54 of 83 kidneys with obstructive (65.1%) and in 3 of 20 (15.0%) with indeterminate patterns.

CONCLUSIONS

(99m)Tc-EC was more effective than (99m)Tc-DTPA for excluding obstruction, presenting less false-positive and indeterminate results. (99m)Tc-EC can substitute (99m)Tc-DTPA to evaluate patients with urinary tract dilation.

摘要

目的

评估使用放射性核素 99m-L,L-乙二胺二半胱氨酸（99mTc-EC）行利尿剂动态肾闪烁扫描（DDRS）对 99mTc-二乙三胺五乙酸（99mTc-DTPA）DDRS 诊断尿路梗阻呈不确定或可能假阳性结果的患者的应用价值。

方法

共有 92 例患者（63 例男性；平均年龄 16.6±21.25 岁）参与研究，其中 103 个肾脏的 99mTc-DTPA DDRS 检查结果呈不确定（20/103）或可能假阳性（83/103），其原因是肾功能降低或严重肾扩张导致放射性药物排泄减少（20 分钟时放射性药物排泄半排期[T1/2]＞15 分钟，＜60%放射性药物排出）。患者在静脉注射 99mTc-EC 后再次进行扫描，使用与之前 99mTc-DTPA 研究相同的获取参数，在给予呋塞米前后进行动态图像采集。99mTc-DTPA 和 99mTc-EC 肾图之间的时间间隔为 2-64 天。使用两种放射性药物计算呋塞米后 20 分钟的排泄百分比，并使用配对样本 t 检验进行统计学比较。

结果

呋塞米注射后，99mTc-DTPA 的排泄率为 25.3%±18.2%，99mTc-EC 的排泄率为 41.2%±26.1%，两种放射性药物之间存在统计学差异（P＜.0001）。使用 99mTc-EC 后，103 个肾脏中有 36 个（36/103，34.9%）排泄＞60%，可排除梗阻。83 个（83/103，80.6%）99mTc-DTPA 检查呈梗阻性模式的肾脏中，有 10 个（10/83，12.0%）用 99mTc-EC DDRS 检查结果为不确定。83 个（83/103，80.6%）梗阻性肾脏和 20 个（20/103，19.4%）不确定性肾脏中，99mTc-EC 与 99mTc-DTPA 检查结果一致的分别有 54 个（54/83，65.1%）和 3 个（3/20，15.0%）。