PET [C] 乙酸盐也是一种用于评估肾脏功能的灌注示踪剂。
PET [C]acetate is also a perfusion tracer for kidney evaluation purposes.
机构信息
Department of Nephrology and Renal Functional Explorations, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; CarMeN: Cardiovasculaire, Métabolisme, Diabétologie & Nutrition-INSERM U1060/INRA U1397/Université Lyon1, France; CERMEP, MR-PET Center, Lyon, France.
Department of Nephrology and Renal Functional Explorations, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; CarMeN: Cardiovasculaire, Métabolisme, Diabétologie & Nutrition-INSERM U1060/INRA U1397/Université Lyon1, France; CERMEP, MR-PET Center, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
出版信息
Nucl Med Biol. 2019 Sep-Oct;76-77:10-14. doi: 10.1016/j.nucmedbio.2019.08.004. Epub 2019 Sep 11.
RATIONALE
Renal positron emission tomography (PET) functional imaging allows non-invasive and dynamic measurements of functional and metabolic parameters. [O]HO is used as a perfusion tracer, and [C]acetate as an oxidative metabolism in this purpose, requiring two injections to assess those fundamental parameters. Yet, in cardiac physiology study, the high first-pass myocardial extraction fraction of [C]acetate allowed to use its influx rate as a blood flow marker too. Since [C]acetate has been characterized by a 20-25% single pass renal extraction in dogs, it could be used as a potential tracer for renal perfusion. The aim of this study was to determine whether [C]acetate influx rate can be used as quantitative in vivo marker of kidney perfusion in human.
METHODS
In 10 healthy subjects, dynamic PET acquisitions were performed after [O]HO and [C]acetate injections spaced by a 15-minute interval. As previously validated, with compartmental modeling of kinetics, renal perfusion and oxidative metabolism were estimated respectively with influx rate of [O]HO and efflux rate of [C]acetate. Additionally, influx rate of [C]acetate was regressed to influx rate of [O]HO.
RESULTS
Renal time activity curves of [C]-acetate was best fitted with a mono compartmental model compared to a bi-compartmental model (p < 0.0001). [C]acetate influx rate was significantly correlated with perfusion quantified with [O]HO (r = 0.37, p < 0.001) at baseline. This regression allowed the computation of a renal [C]acetate extraction fraction (EF), and further the computation of renal blood flow from its influx rate.
CONCLUSION
In healthy subjects, over a wide range of renal perfusion, direct estimates of renal oxygen consumption as well as tissue perfusion can be obtained by PET with a single tracer [C]acetate. This approach needs to be validated in CKD patients, and would be of great interest to design clinical protocol aiming at evaluating ischemic nephropathies candidate to revascularization.
原理
肾脏正电子发射断层扫描（PET）功能成像允许非侵入性和动态测量功能和代谢参数。[O]HO 被用作灌注示踪剂，[C]乙酸盐在此目的中用作氧化代谢物，需要两次注射来评估这些基本参数。然而，在心脏生理学研究中，[C]乙酸盐的高首次通过心肌提取分数允许将其流入率用作血流标志物。由于在狗中，[C]乙酸盐的单次通过肾脏提取率为 20-25%，因此它可用作潜在的肾灌注示踪剂。本研究旨在确定[C]乙酸盐流入率是否可用于人体肾灌注的定量体内标志物。
方法
在 10 名健康受试者中，在[O]HO 和[C]乙酸盐注射之间间隔 15 分钟进行动态 PET 采集。如先前验证的那样，通过动力学的房室模型化，分别用[O]HO 的流入率和[C]乙酸盐的流出率来估计肾灌注和氧化代谢。此外，[C]乙酸盐的流入率与[O]HO 的流入率回归。
结果
与双房室模型相比，[C]-乙酸盐的肾时间活性曲线更适合单房室模型拟合（p<0.0001）。在基线时，[C]乙酸盐的流入率与用[O]HO 量化的灌注显著相关（r=0.37，p<0.001）。该回归允许计算肾[C]乙酸盐提取分数（EF），并进一步从其流入率计算肾血流量。
结论
在健康受试者中，在广泛的肾灌注范围内，通过 PET 用单一示踪剂[C]乙酸盐可以直接估计肾氧消耗以及组织灌注。这种方法需要在 CKD 患者中进行验证，并且对于设计旨在评估候选血管重建的缺血性肾病的临床方案将非常感兴趣。
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