Department of Diagnostic Radiology, Sapporo City General Hospital, Japan.
Ann Nucl Med. 2010 Apr;24(3):189-95. doi: 10.1007/s12149-010-0349-y. Epub 2010 Mar 9.
Split renal function (SRF) estimated from the posterior view of (99m)Tc-diethylenetriaminepentaacetic acid planar scintigraphy (DTPA/P) is not sufficiently accurate even after correction for kidney depth by computed tomography (CT). To obtain more accurate SRF using (99m)Tc-DTPA, dynamic SPECT method was carried out for the initial 5 min after bolus injection of (99m)Tc-DTPA (DTPA/SPECT). Also SRF was evaluated from the renal volume measured by CT. We compared the results with (99m)Tc-dimercaptosuccinic acid SPECT (DMSA/SPECT).
In 60 consecutive live kidney donors, 30 DTPA/P, 30 DTPA/SPECT, 60 (99m)Tc-DMSA/SPECT, and 60 CT studies were performed. In the DTPA/P studies, SRF was calculated from the posterior image recorded during 2-3-min postinjection with attenuation correction for kidney depth measured by CT. In the DTPA/SPECT studies, SPECT images were acquired continuously for 5 min with a dual-headed gamma camera. In (99m)Tc-DMSA scintigraphy, DMSA/SPECT images were acquired 3-h postinjection. The SRF on both SPECT studies was calculated from the total counts of each kidney. In the DTPA/SPECT study, SRF was evaluated on the three images summed for 1 min: 1-2 min (DTPA/SPECT1-2), 2-3 min (DTPA/SPECT2-3), and 1-3 min (DTPA/SPECT1-3). In the CT examination, to assess the global renal volume, the axial images in the excretory phase were chosen. Renal contours were identified on each image, and the areas (cm(2)) of these regions were summed and multiplied by the slice thickness (10 mm) to yield global renal volume (ml). Right renal function from DTPA/P, DTPA/SPECT, and CT were compared with that from DMSA/SPECT as a reference.
Correlation coefficients of the right renal function between DMSA/SPECT and DTPA/P, DTPA/SPECT2-3, and CT were 0.663, 0.849 and 0.907, respectively (P < 0.0001). The differences between DMSA/SPECT and DTPA/P, DTPA/SPECT2-3 and CT were 2.42 +/- 3.878, 0.867 +/- 1.672, and -0.421 +/- 1.077% (mean +/- SD), respectively.
SRF derived from DTPA/SPECT showed a better correlation with DMSA/SPECT and significantly fewer errors (P < 0.05) than DTPA/P. A significant strong correlation was observed between SRF from DMSA/SPECT and CT, indicating the utility of CT renal volumetry for evaluating SRF.
即使通过计算机断层扫描（CT）对肾脏深度进行校正，从（99m）Tc-二乙三胺五乙酸平面闪烁显像（DTPA/P）的后视图估计的分肾功能（SRF）也不够准确。为了使用（99m）Tc-DTPA 获得更准确的 SRF，在静脉推注（99m）Tc-DTPA 后立即进行 5 分钟的（99m）Tc-DTPA 动态 SPECT 法（DTPA/SPECT）。还通过 CT 测量的肾体积评估了 SRF。我们将结果与（99m）Tc-二巯丁二酸 SPECT（DMSA/SPECT）进行了比较。
在 60 名连续的活体供肾者中，进行了 30 次 DTPA/P、30 次 DTPA/SPECT、60 次（99m）Tc-DMSA/SPECT 和 60 次 CT 检查。在 DTPA/P 研究中，SRF 是通过在注射后 2-3 分钟内从后向图像记录并使用 CT 测量的肾深度衰减校正来计算的。在 DTPA/SPECT 研究中，使用双探头伽马相机连续采集 5 分钟的 SPECT 图像。在（99m）Tc-DMSA 闪烁显像中，在注射后 3 小时进行 DMSA/SPECT 检查。两种 SPECT 研究的 SRF 均从每个肾脏的总计数中计算得出。在 DTPA/SPECT 研究中，评估了在 1 分钟内将三个图像求和的 SRF：1-2 分钟（DTPA/SPECT1-2）、2-3 分钟（DTPA/SPECT2-3）和 1-3 分钟（DTPA/SPECT1-3）。在 CT 检查中，为了评估整体肾功能，选择排泄期的轴向图像。在每个图像上识别肾轮廓，并将这些区域的面积（cm2）相加，再乘以切片厚度（10mm），即可得到整体肾体积（ml）。将 DTPA/P、DTPA/SPECT 和 CT 的右肾功能与作为参考的 DMSA/SPECT 进行比较。
DMSA/SPECT 与 DTPA/P、DTPA/SPECT2-3 和 CT 的右肾功能之间的相关系数分别为 0.663、0.849 和 0.907（P<0.0001）。DMSA/SPECT 与 DTPA/P、DTPA/SPECT2-3 和 CT 的差异分别为 2.42±3.878、0.867±1.672 和-0.421±1.077%（平均值±标准差）。
与 DTPA/P 相比，DTPA/SPECT 得出的 SRF 与 DMSA/SPECT 的相关性更好，误差更小（P<0.05）。DMSA/SPECT 和 CT 之间存在显著的强相关性，表明 CT 肾容积测量法可用于评估 SRF。
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