Cichocki Paweł, Filipczak Krzysztof, Adamczewski Zbigniew, Kuśmierek Jacek, Płachcińska Anna
Department of Nuclear Medicine, Medical University of Lodz, 92-216 Łódź, Poland.
Department of Quality Control and Radiation Protection, Medical University of Lodz, 92-216 Łódź, Poland.
J Clin Med. 2021 Feb 2;10(3):529. doi: 10.3390/jcm10030529.
This study evaluates the usefulness of parameters allowing assessment of renal function in absolute values in dynamic renal scintigraphy (DRS) with Tc-ethylenedicysteine (Tc-EC) uptake constant (K), mean transit time (MTT), and parenchymal transit time (PTT) in the diagnosis of obstructive uro/nephropathy. The study included 226 people: 20 healthy volunteers, for whom normative values of assessed parameters were determined, and 206 patients. Reproducibility of results obtained by two independent operators, specificity, correlation with estimated GFR (eGFR), and Cohen's kappa were used to evaluate reliability of assessed parameters. Normative values were as follows: K ≥ 1.6, MTT ≤ 250 s, and PTT ≤ 225 s. Reproducibility of determination of K (r = 0.99) and MTT (r = 0.98) was significantly higher than that of PTT (r = 0.95) ( = 0.001). Specificity was 100% for K, 81% for MTT, and 91% for PTT. Correlation of eGFR with K (r = 0.89) was significantly higher than with PTT (r = 0.53) and with split function (SF) (r = 0.66) ( < 0.0001). Cohen's kappa was κ = 0.89 for K, κ = 0.88 for MTT, and κ = 0.77 for PTT. In a group of patients where standard DRS parameters are unreliable (bilateral obstructive uro/nephropathy or single functioning kidney), the use of K (the most effective among assessed parameters) changed the classification of 23/79 kidneys (29%). K enables reproducible assessment of absolute, individual kidney function without modifying routine DRS protocol. Diagnostic value of MTT and PTT is limited.
本研究评估了在使用锝-乙二巯基丁二酸（Tc-EC）摄取常数（K）、平均通过时间（MTT）和实质通过时间（PTT）的动态肾闪烁显像（DRS）中，以绝对值评估肾功能的参数在诊断梗阻性尿路/肾病中的有用性。该研究纳入了226人：20名健康志愿者，确定了所评估参数的正常参考值，以及206名患者。通过两名独立操作人员获得的结果的可重复性、特异性、与估计肾小球滤过率（eGFR）的相关性以及科恩kappa系数用于评估所评估参数的可靠性。正常参考值如下：K≥1.6，MTT≤250秒，PTT≤225秒。K（r = 0.99）和MTT（r = 0.98）测定的可重复性显著高于PTT（r = 0.95）（P = 0.001）。K的特异性为100%，MTT为81%，PTT为91%。eGFR与K的相关性（r = 0.89）显著高于与PTT（r = 0.53）以及与分肾功能（SF）的相关性（r = 0.66）（P < 0.0001）。K的科恩kappa系数为κ = 0.89，MTT为κ = 0.88，PTT为κ = 0.77。在一组标准DRS参数不可靠的患者（双侧梗阻性尿路/肾病或单肾有功能）中，使用K（在所评估参数中最有效）改变了79个肾脏中23个（29%）的分类。K能够在不改变常规DRS方案的情况下，对个体肾脏的绝对功能进行可重复评估。MTT和PTT的诊断价值有限。
