Bih L I, Changlai S P, Ho C C, Lee S P
Department of Rehabilitation Medicine, Taichung Rehabilitation Hospital, Taiwan.
Arch Phys Med Rehabil. 1994 Sep;75(9):982-6.
The effectiveness of radioisotope renography with Technetium-99m (Tc-99m) mercaptoacetyltriglycine (MAG3) to provide possible routine urological follow-up was evaluated for the spinal cord injury (SCI) population. Sixty-six SCI patients were examined with radioisotope renography and renal ultrasonography. Excretory urography was done on 46 patients and voiding cystourethrography was done on 46 patients and voiding cystourethrography was done on 59 patients. The time-activity curve patterns of renography were classified into six groups. Curves A were normal. Curves B and C showed various excretion delay but normal effective renal plasma flow (ERPF). Curves D, E, and F showed definite decreased ERPF and excretion delay of different severity. The respective incidence of upper urinary tract complications were 12.0% (10/83) for A, 68.2% (15/22) for B, 100% (4/4) for C, 100% (8/8) for D, 100% (11/11) for E, and 100% (4/4) for F curves. The sensitivity of radioisotope renography was 83.9%, and the specificity was 92.0% in detecting the upper urinary tract complications. There was no adverse effect after 80 renography examinations on 66 SCI patients. As excretion delay occurred in the earlier stage of renal dysfunction, followed by decrease of ERPF, the abnormal time-activity curves can be sensitive indicators to subject SCI patients with early renal deterioration for further urodynamic and morphological studies. For patients with normal renograms, conventional uroradiological studies are not recommended because they are more invasive, cumbersome, and have more side effects as well as higher radiation exposure. We found that radioisotope renography with Tc-99m MAG3 is a safe, noninvasive, sensitive, and valuable urological screening test for SCI patients.
对脊髓损伤（SCI）患者群体评估了锝-99m（Tc-99m）巯基乙酰三甘氨酸（MAG3）放射性核素肾图用于可能的常规泌尿外科随访的有效性。66例SCI患者接受了放射性核素肾图和肾脏超声检查。46例患者进行了排泄性尿路造影，46例患者进行了排尿性膀胱尿道造影，59例患者进行了排尿性膀胱尿道造影。肾图的时间-活性曲线模式分为六组。A曲线正常。B曲线和C曲线显示出不同程度的排泄延迟，但有效肾血浆流量（ERPF）正常。D曲线、E曲线和F曲线显示ERPF明显降低且排泄延迟程度不同。上尿路并发症的各自发生率在A曲线为12.0%（10/83），B曲线为68.2%（15/22），C曲线为100%（4/4），D曲线为100%（8/8），E曲线为100%（11/11），F曲线为100%（4/4）。放射性核素肾图检测上尿路并发症的敏感性为83.9%，特异性为92.0%。对66例SCI患者进行80次肾图检查后未出现不良反应。由于排泄延迟发生在肾功能障碍的早期，随后是ERPF降低，异常的时间-活性曲线可作为敏感指标，提示SCI患者早期肾脏恶化，以便进一步进行尿动力学和形态学研究。对于肾图正常的患者，不建议进行传统的尿放射学检查，因为它们更具侵入性、操作繁琐、副作用更多且辐射暴露更高。我们发现，Tc-99m MAG3放射性核素肾图对SCI患者是一种安全、无创、敏感且有价值的泌尿外科筛查检查。
