Gupta Sandeep K, Lewis Guy, Rogers Kerry M, Attia John, Rostron Kirk, O'Neill Leanne, Skillen Annah, Viswanathan Suresh
Department of Nuclear Medicine and PET, John Hunter Hospital Newcastle, New South Wales, Australia.
Department of Medicine, John Hunter Hospital Newcastle, New South Wales, Australia ; Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, University of Newcastle Newcastle, New South Wales, Australia.
Am J Nucl Med Mol Imaging. 2014 Apr 25;4(3):213-24. eCollection 2014.
Various (99m)Tc DTPA scintigraphic quantitative parameters for renal graft function assessment have been recommended, but none is universally accepted. In this study, 439 dynamic renal transplant scintigraphies (DRTS) were retrospectively analysed. In the first set of studies, four observers analysed the 47 random DRTS and interobserver agreement of eleven derived parameters was assessed. In the other set of studies, 181 instances of DRTS, performed on 127 recipients with renal biopsies within five days of each other were selected for correlation with pathology. Hilson's Perfusion index (HI), ΔP, P:Pl, P:U & T10 were selected for this analysis. The pathologies were categorized into renal vascular compromise (RVC; n = 20), acute tubular necrosis (ATN; n = 40), vascular rejection (VR; n = 34), interstitial rejection (IR; n = 33), normal (NOR; n = 36) and unclassified pathologies (n = 18). A majority of the parameters showed good Intraclass correlation (ICC). HI differentiated well between grafts with RVC and the remainder of the study cohort, (p < 0.0001; AUC = 0.84); at a cut-off > 278, it had 84% sensitivity and 78% specificity (Likelihood ratio = 3.8). At < 278, it had 98% 'negative' predictive value for RVC. HI also showed reasonable association with VR (p = 0.02; AUC = 0.62) and IR (p = 0.009; AUC = 0.65). However, significant overlap of HI values between various subgroups was noted. Other parameters had good ICC but were not effective in differentiating graft pathologies. Of the measured parameters, only HI proved to be useful for the pathological assessment, particularly in the identification of vascular compromise. This parameter, however, has lower specificity in differentiating the other pathologies.
已经推荐了多种用于评估肾移植功能的（99m）锝二乙三胺五乙酸闪烁扫描定量参数，但没有一个被普遍接受。在本研究中，对439例动态肾移植闪烁扫描（DRTS）进行了回顾性分析。在第一组研究中，四名观察者分析了47例随机DRTS，并评估了11个衍生参数的观察者间一致性。在另一组研究中，选择了181例在127名接受者身上进行的DRTS，这些接受者在彼此五天内进行了肾活检，以与病理结果进行相关性分析。为此分析选择了希尔森灌注指数（HI）、ΔP、P:Pl、P:U和T10。病理情况分为肾血管损害（RVC；n = 20）、急性肾小管坏死（ATN；n = 40）、血管排斥（VR；n = 34）、间质排斥（IR；n = 33）、正常（NOR；n = 36）和未分类病理（n = 18）。大多数参数显示出良好的组内相关性（ICC）。HI能够很好地区分有RVC的移植物与研究队列的其余部分，（p < 0.0001；AUC = 0.84）；在临界值> 278时，其敏感性为84%，特异性为78%（似然比 = 3.8）。在< 278时，其对RVC的“阴性”预测值为98%。HI与VR（p = 0.02；AUC = 0.62）和IR（p = 0.009；AUC = 0.65）也显示出合理的相关性。然而，注意到不同亚组之间HI值有明显重叠。其他参数有良好的ICC，但在区分移植物病理方面无效。在所测量的参数中，只有HI被证明对病理评估有用，特别是在识别血管损害方面。然而，该参数在区分其他病理方面特异性较低。
