From the *Department of Nuclear Medicine, Mugla University Hospital; †Department of Pathology, Mugla University Hospital, Merkez, Mugla; and Departments of ‡Nuclear Medicine and §Nephrology, Ege University Medical Faculty, Bornova, Izmir, Turkey.
Clin Nucl Med. 2013 Dec;38(12):931-5. doi: 10.1097/RLU.0000000000000271.
We discuss whether resistance index (RI) and renal scintigraphy obtained within 48 hours after operation could predict the early graft dysfunction. We also aimed to assess the uses of scintigraphy and RI in diagnosis of acute rejection (AR) and acute tubular necrosis (ATN).
A total of 153 studies were performed in 109 patients. T½ of perfusion peak, perfusion curve grades, and accumulation index (R20/3) were used as scintigraphic parameters. Baseline studies obtained within 48 hours after transplantation were evaluated for prediction of early graft dysfunction. All data were then assessed for specific diagnosis.
Scintigraphic parameters were significantly higher in patients with delayed graft function (DGF) and slow graft function (SGF) than in patients with immediate graft function. These parameters in DGF were also considerably different from those in SGF. The mean RI was significantly high in DGF, but there was no difference between SGF and immediate graft function. In diagnostic groups, the mean values of all tests were significantly different between normal functioning grafts and pathological grafts (ATN + AR). There was no significant difference between AR and ATN. However, renal scintigraphy has higher sensitivity and specificity for AR as compared with RI of Doppler ultrasonography (US).
In predicting graft dysfunction and separating normal functioning graft from pathological graft (ATN + AR), renal scintigraphy provides more accurate information than Doppler US. Even though it is superior to Doppler US, renal scintigraphy also cannot reliably separate ATN from AR. The major advantage of renal scintigraphy is the early detection of reduced renal function.
我们探讨了术后 48 小时内获得的阻力指数（RI）和肾闪烁扫描能否预测早期移植物功能障碍。我们还旨在评估闪烁扫描和 RI 在诊断急性排斥反应（AR）和急性肾小管坏死（ATN）中的作用。
对 109 例患者的 153 项研究进行了分析。灌注峰值 T1/2、灌注曲线分级和积累指数（R20/3）被用作闪烁扫描参数。评估术后 48 小时内获得的基线研究以预测早期移植物功能障碍。然后评估所有数据以进行特定诊断。
在延迟移植物功能（DGF）和缓慢移植物功能（SGF）患者中，闪烁扫描参数明显高于立即移植物功能患者。DGF 患者的这些参数也与 SGF 患者的参数明显不同。DGF 患者的平均 RI 明显升高，但 SGF 与立即移植物功能之间无差异。在诊断组中，所有测试的平均值在正常功能移植物和病理移植物（ATN+AR）之间存在显著差异。AR 与 ATN 之间无显著差异。然而，与多普勒超声（US）的 RI 相比，肾闪烁扫描对 AR 的敏感性和特异性更高。
在预测移植物功能障碍和区分正常功能移植物与病理移植物（ATN+AR）方面，肾闪烁扫描比多普勒 US 提供更准确的信息。即使肾闪烁扫描优于多普勒 US，也不能可靠地区分 ATN 与 AR。肾闪烁扫描的主要优势在于早期发现肾功能降低。
