Barth K H, White R I, Marshall F F
J Urol. 1981 Feb;125(2):161-3. doi: 10.1016/s0022-5347(17)54947-2.
Arteriovenous shunting was quantitated with 20 plus or minus 10 mu 99mtechnetium human albumin microspheres in 12 patients with angiographically hypervascular renal cell carcinomas. Arteriovenous shunting was diagnosed angiographically when the renal vein was opacified during the arterial phase. With use of an angiographic catheter 2 to 3 mCi. 99mtechnetium human albumin microspheres were first injected into the renal artery directly supplying the tumor. Thereafter, 0.5 to 1 mCi. microspheres were injected into the inferior vena cava. Scintillation counts over the right lung were obtained immediately after each injection. The ratio between the 2 counts established the rate of tumor shunting after correction for dose difference and decay. Nine patients without angiographic evidence of arteriovenous shunting had mean shunt rates of 15 per cent, whereas 3 patients with angiographically visible shunting had significantly higher shunt rates of 57 per cent (p less than 0.001). It is concluded that angiography discovers only massive arteriovenous shunting in patients with renal cell carcinoma, whereas a fair degree of arteriovenous shunting may go undetected. The significance of minimal or moderate arteriovenous shunting in patients with renal cell carcinoma needs further investigation. The microsphere quantitation method can be applied routinely to angiography.
对12例经血管造影显示为高血供肾细胞癌的患者，使用20±10微居里的99m锝标记人白蛋白微球来定量动静脉分流情况。当在动脉期肾静脉显影时，通过血管造影诊断动静脉分流。使用血管造影导管，首先将2至3毫居里的99m锝标记人白蛋白微球直接注入供应肿瘤的肾动脉。此后，将0.5至1毫居里的微球注入下腔静脉。每次注射后立即获取右肺的闪烁计数。经剂量差异和衰变校正后，这两个计数之间的比率确定了肿瘤分流率。9例无血管造影动静脉分流证据的患者，其平均分流率为15%，而3例血管造影可见分流的患者，其分流率显著更高，为57%（p<0.001）。结论是，血管造影仅能发现肾细胞癌患者中的大量动静脉分流，而相当程度的动静脉分流可能未被检测到。肾细胞癌患者中轻度或中度动静脉分流的意义需要进一步研究。微球定量方法可常规应用于血管造影。
