Department of Radiology, NYU Langone Medical Center, New York, NY 10016, USA.
Invest Radiol. 2013 Oct;48(10):687-92. doi: 10.1097/RLI.0b013e3182909e7b.
To evaluate changes in single-kidney glomerular filtration rate (SK-GFR) using low-dose dynamic contrast-enhanced magnetic resonance (MR) renography (MRR) in patients undergoing partial nephrectomy for renal masses.
In this Health Information Patient Protection Act-compliant prospective study, 18 patients with renal masses underwent preoperative MR imaging at 1.5 T for renal mass evaluation and low-dose gadolinium-enhanced MRR. Magnetic resonance renography was repeated approximately 48 to 72 hours and 6 months after partial nephrectomy. Single-kidney glomerular filtration rate was calculated from the MRR images, and the right and left kidney values were summed for total MR-GFR. Postoperative changes in SK-GFR and MR-GFR were compared with changes in estimated glomerular filtration rate calculated using modification of diet in renal disease formula, renal lesion characteristics, ischemia type (warm vs cold), and ischemia time.
A decrease in the operated kidney SK-GFR was seen in 15 of the 18 patients, with a mean (SD) loss of 31% (23%), whereas estimated glomerular filtration rate decreased in 13 of the 18 patients with mean (SD) decrease of 19% (14%). Decrease in SK-GFR was greatest in the patients with warm ischemia time greater than 40 minutes and least in the patients with cold ischemia. In the immediate postoperative period, 6 of 7 patients (86%) with preoperative MR-GFR less than 60 mL/min per 1.73 m failed to demonstrate compensatory increase in SK-GFR in the nonoperated kidney, whereas 5 of 11 patients with baseline MR-GFR more than 60 mL/min per 1.73 m showed compensatory increase in nonoperated kidney SK-GFR.
Magnetic resonance renography can demonstrate functional loss in the operated kidney and compensatory increase in the function of the contralateral kidney, thus enabling evaluation of various surgical techniques on kidney function.
通过低剂量动态对比增强磁共振（MR）肾图（MRR）评估行部分肾切除术治疗肾肿瘤患者的单肾肾小球滤过率（SK-GFR）变化。
本研究符合健康保险携带和责任法案要求，为前瞻性研究，18 例肾肿瘤患者于术前 1.5T 行 MR 成像以评估肾肿瘤，并进行低剂量钆增强 MRR。部分肾切除术后约 48 至 72 小时及 6 个月时重复行 MRR。从 MRR 图像计算单肾肾小球滤过率，将左右肾值相加计算总 MR-GFR。术后 SK-GFR 和 MR-GFR 的变化与基于肾脏病饮食改良公式计算的肾小球滤过率、肾病变特征、缺血类型（热缺血与冷缺血）及缺血时间的变化进行比较。
18 例患者中 15 例手术侧 SK-GFR 下降，平均（标准差）损失 31%（23%），而 18 例患者中有 13 例估算肾小球滤过率下降，平均（标准差）下降 19%（14%）。热缺血时间大于 40 分钟患者的 SK-GFR 下降最大，冷缺血患者的下降最小。在术后即刻，7 例术前 MR-GFR 小于 60mL/min/1.73m2患者中，有 6 例（86%）未观察到对侧非手术侧肾滤过率的代偿性增加，而 11 例基线 MR-GFR 大于 60mL/min/1.73m2患者中有 5 例观察到非手术侧肾滤过率的代偿性增加。
MRR 可显示手术侧肾的功能丧失和对侧肾功能的代偿性增加，从而能够评估各种手术技术对肾功能的影响。
