Singal R K, Lee T Y, Razvi H A, Mosalei H, Denstedt J D, Chun S S, Bennett J, Romano W, Toll M
Division of Urology, St. Joseph's Health Centre Lawson Research Institute, University of Western Ontario, London, Canada.
J Endourol. 1997 Feb;11(1):5-13. doi: 10.1089/end.1997.11.5.
The development of a reliable, minimally invasive method of distinguishing physiologically significant renal obstruction from dilation without obstruction would have important clinical implications. As it is well known that renal blood flow decreases over time in the presence of obstruction, we investigated the ability of color flow Doppler ultrasonography and dynamic contrast-enhanced CT scanning to detect changes in blood flow in unilaterally obstructed porcine kidneys. In the initial phase of this study, the effect of acute unilateral obstruction were studied in nine pigs. The resistive index (RI) was measured with Doppler ultrasonography, and renal blood flow was quantitated with dynamic CT using tracer kinetic principles and deconvolution. The RI measurements were unable to distinguish between the obstructed kidneys and their controls. Dynamic CT scanning demonstrated a greater fall in blood flow in the obstructed kidney, and this change was significantly different from baseline. The same findings were supported by radiolabelled microsphere blood-flow measurement. In the chronic portion of the study, after surgical creation of a partial ureteric obstruction, the kidneys were studied by both techniques at 1, 2, and 3 weeks. Again, RI was unable to demonstrate any difference between obstructed and unobstructed kidneys, while CT showed a progressive fall in blood flow in each successive week that was statistically significant. Dynamic contrast-enhanced CT scanning is a promising diagnostic tool that might be used to distinguish a functionally significant renal obstruction from nonobstructive dilation. Further clinical studies to validate this technique are warranted.
开发一种可靠的、微创的方法来区分具有生理意义的肾梗阻与无梗阻性扩张具有重要的临床意义。众所周知，在存在梗阻的情况下，肾血流量会随时间减少，我们研究了彩色多普勒超声和动态对比增强CT扫描检测单侧梗阻猪肾血流变化的能力。在本研究的初始阶段，对9头猪的急性单侧梗阻效应进行了研究。用多普勒超声测量阻力指数（RI），并用动态CT利用示踪动力学原理和去卷积法定量肾血流量。RI测量无法区分梗阻肾与其对照。动态CT扫描显示梗阻肾的血流下降幅度更大，且这种变化与基线有显著差异。放射性微球血流测量也支持了相同的结果。在研究的慢性阶段，在手术造成部分输尿管梗阻后，在第1、2和3周用这两种技术对肾脏进行研究。同样，RI无法显示梗阻肾与未梗阻肾之间的任何差异，而CT显示在连续的每一周血流都有逐渐下降，且具有统计学意义。动态对比增强CT扫描是一种有前景的诊断工具，可用于区分功能性显著的肾梗阻与非梗阻性扩张。有必要进行进一步的临床研究以验证该技术。
