Chen C C, Hoffer P B, Vahjen G, Gottschalk A, Koster K, Zubal I G, Setaro J F, Roer D A, Black H R
Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, CT 06510.
Radiology. 1990 Aug;176(2):365-70. doi: 10.1148/radiology.176.2.2195592.
Fifty patients with suspected renal artery stenosis (RAS) were studied with renal scintigraphy before and after administration of captopril. Twenty-three patients had RAS (greater than or equal to 75% RAS or greater than or equal to 50% RAS with poststenotic dilatation) and 27 had normal renal arteries at angiography. Angiotensin-converting enzyme inhibitors were discontinued 24 hours prior to renal scintigraphy; all other medications were continued. Each patient was evaluated with a simplified captopril renal scintigraphic protocol: renal imaging after administration of 12 mCi (444 MBq) of technetium-99m diethylenetriaminepentaacetic acid (DTPA), a 3-hour wait, oral administration of 50 mg of captopril, a 1-hour wait, and another scintigram obtained after administration of 12 mCi (444 MBq) of Tc-99m DTPA. Times of peak renal activity (Tmax) were determined from renal time-activity curves, and glomerular filtration rates (GFRs) were calculated with the Gates technique. A Tmax greater than or equal to 11 minutes after injection or a GFR ratio (larger GFR/smaller GFR) greater than 1.5 enabled detection of RAS with 91% sensitivity, 93% specificity, and 92% accuracy. Renal scintigraphy without captopril had only 43%-68% sensitivity in detecting RAS, depending on the criteria used.
对50例疑似肾动脉狭窄（RAS）患者在服用卡托普利前后进行了肾闪烁扫描研究。23例患者存在RAS（肾动脉狭窄≥75%或肾动脉狭窄≥50%且伴有狭窄后扩张），27例患者血管造影显示肾动脉正常。在肾闪烁扫描前24小时停用血管紧张素转换酶抑制剂；其他所有药物继续服用。采用简化的卡托普利肾闪烁扫描方案对每位患者进行评估：静脉注射12毫居里（444兆贝可）的锝-99m二乙三胺五乙酸（DTPA）后进行肾脏显像，等待3小时，口服50毫克卡托普利，再等待1小时，然后静脉注射12毫居里（444兆贝可）的锝-99m DTPA后再次进行闪烁扫描。从肾脏时间-活性曲线确定肾脏峰值活性时间（Tmax），并采用Gates技术计算肾小球滤过率（GFR）。注射后Tmax≥11分钟或GFR比值（较大GFR/较小GFR）＞1.5能够检测出RAS，敏感性为91%，特异性为93%，准确性为92%。不使用卡托普利的肾闪烁扫描在检测RAS时，根据所采用的标准，敏感性仅为43%-68%。
