Ramaswamy Krishna, Marien Tracy, Mass Alon, Stifelman Michael, Shah Ojas
New York University School of Medicine, New York, NY 10016, USA.
Can J Urol. 2013 Aug;20(4):6833-9.
To determine whether a simplified approach to estimate renal function based on preoperative computerized tomography (CT) imaging correlates with nuclear renography (NR) following surgical treatment of ureteropelvic junction obstruction (UPJO).
We reviewed the charts of 47 patients who underwent robotic assisted laparoscopic pyeloplasty (RALP) for UPJO who had performed preoperative and postoperative NR and preoperative CT imaging. Twenty patients satisfied our inclusion criteria. We calculated differential renal function by measuring parenchymal thickness at the upper pole, midpole and lower pole regions of the kidney on the preoperative CT. Distances were measured from the edge of the collecting system to the capsule at the midpoint of the kidney in the coronal plane. After parenchymal thickness measurements were calculated bilaterally, a differential parenchymal thickness was obtained, and the ratio of parenchymal area was compared to the observed function on NR. Measurements were taken by three blinded observers and compared to preop and postop differential renal function as measured by NR to assess if preoperative CT renal parenchymal thickness correlates well with differential function of the affected and contralateral kidneys.
Estimated renal function was predicted with excellent accuracy and minimal interobserver variability. Pearson correlation coefficients for Observers 1, 2 and 3 were 0.89, 0.88 and 0.91, respectively when compared to the postoperative differential function on NR. The interclass correlation coefficient between the three observers was 0.957, which indicates an almost perfect correlation and reproducibility of the formula.
Estimating differential renal function based on renal parenchymal thickness on preoperative CT imaging correlates very well with observed postoperative differential renal function on NR following RALP.
确定基于术前计算机断层扫描（CT）成像的简化肾功能评估方法与输尿管肾盂连接部梗阻（UPJO）手术治疗后的核素肾图（NR）是否相关。
我们回顾了47例行机器人辅助腹腔镜肾盂成形术（RALP）治疗UPJO患者的病历，这些患者术前和术后均进行了NR检查及术前CT成像。20例患者符合我们的纳入标准。我们通过测量术前CT上肾脏上极、中极和下极区域的实质厚度来计算分肾功能。在冠状面从肾集合系统边缘到肾中点包膜处测量距离。双侧计算实质厚度后，得出分实质厚度，并将实质面积比与NR观察到的功能进行比较。由三名不知情的观察者进行测量，并与NR测量的术前和术后分肾功能进行比较，以评估术前CT肾实质厚度是否与患侧和对侧肾脏的分肾功能密切相关。
估计的肾功能预测准确率高，观察者间变异性小。与NR术后分肾功能相比，观察者1、2和3的Pearson相关系数分别为0.89、0.88和0.91。三名观察者之间的组内相关系数为0.957，这表明该公式具有几乎完美的相关性和可重复性。
基于术前CT成像的肾实质厚度估计分肾功能与RALP术后NR观察到的术后分肾功能密切相关。
