The clinical value of 99mTc-DTPA renal dynamic imaging in evaluating AKI in early adult PNS patients / 中国现代医生

@#Objective To explore the clinical value of 99mTc-diethylenetriaminepentaacetic acid(DTPA)renal dynamic imaging in evaluating renal tubulointerstitial injury in early adult primary nephrotic syndrome(PNS)patients.Methods A total of 42 early adult PNS patients were selected as case group,and the diagnostic efficacy of 99mTc-DTPA renal dynamic imaging quantitative indicators and biochemical indicators of serum creatinine(SCr),blood urea nitrogen(BUN),blood uric acid(UA),blood retinol-binding protein(RBP),and blood β2-microglobulin(β2-MG)levels in renal tubulointerstitial injury was analyzed based on pathological results with or without renal interstitial injury as the standard.Results ①The total glomerular filtration rate(GFR),left kidney GFR and right kidney GFR were negatively correlated with blood SCr,BUN and β2-MG levels of patients in case group.②The diagnostic efficiency of total GFR in diagnosis of tubulointerstitial injury in early adult PNS patients is better than that of blood SCr,BUN and β2-MG,total GFR combined with time to peak(Tp),half discharge time(T1/2)and 20 minute residual rate(R20/p)can improve the diagnostic efficiency.Conclusion 99mTc-DTPA renal dynamic imaging is helpful in early diagnosis of tubulointerstitial injury in early adult PNS patients.

99mTc-DTPA Renal Dynamic Imaging for Evaluating the Function of Duplex Kidneys in Adult Patients

Background: This study aimed to explore technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) renal dynamicimaging to evaluate duplex kidney function in adult patients.Subjects and Methods: We retrospectively analyzed the clinical data of 25 patients with duplex kidneys who underwent 99mTc-DTPA renal dynamic imaging between June 2011 and March 2023 at our hospital. Patients in the duplex kidney group (n = 25)were divided into renogram normal (n = 9) and abnormal (n = 16) groups according to the imaging data. Additionally, normalpatients were selected as the control group (n = 25). After imaging, the region of interest of the kidneys was delineated, andrenography was performed. Renography can provide renal function parameters, including glomerular filtration rate (GFR),Tmax, T1/2, renal clearance, and the GFR ratio of the duplex renal segment (upper renal moiety).Results: Compared with the control group, the serum creatinine level in the duplex kidney group was higher (p = 0.025), GFRwas lower (p = 0.001), and patients with impaired renal function were mainly in the abnormal renography group (p = 0.001). Inthe duplex kidney group, the GFR (p = 0.026) and renal clearance (p = 0.006) of the affected kidneys were lower than those of thecontralateral kidneys, and Tmax (p = 0.025) was higher than that of the contralateral kidneys. There were no differences in renalfunction indicators of duplex renal segments with different GFR ratios. However, when the GFR ratio exceeded 50%, the renalfunction tended to decline.Conclusions: 99mTc-DTPA renal dynamic imaging was found useful to evaluate the total renal function, split renal function,and upper urinary tract patency in patients with duplex kidneys. Patients with abnormal renography results had worse renalfunction, and those with poor renal clearance in the affected renal moiety required surgical treatment. (AU)

Renal function damage in children with duplex kidneys.

PURPOSE: To evaluate renal function damage in children with duplex kidneys. METHODS: A total of 355 duplex kidneys, 110 urinary tract infection (UTI) kidneys without abnormalities, and 104 kidneys with primary unilateral vesicoureteral reflux (VUR) were reviewed. Clinical data including age at diagnosis, body weight, history of UTI, ureteroceles, ectopic ureteral opening, VUR grade, serum creatinine level, cystatin C level, renal scarring, split renal function in dimercaptosuccinic acid scans, and effective renal plasma flow (ERPF) were analyzed. RESULTS: Duplex kidneys had a higher grade of VUR and renal scarring. Split renal function in unilateral duplex kidneys (45.58 ± 12.85%) was much lower than that in contralateral duplex kidneys (56.33 ± 11.90%) and controls (50.00 ± 11.38%) (P < 0.001 and P = 0.014, respectively). Both left and right split renal functions in bilateral duplex kidneys were similar to those ipsilateral to the controls (P = 0.906 and P = 0.932, respectively). However, the total ERPFs in the left, right, and bilateral duplex kidneys were significantly lower than that in the control group (P = 0.003, P = 0.001, and P = 0.003, respectively). The total ERPFs in the left and right unilateral duplex kidneys were similar. ERPF in unilateral duplex kidneys (106.70 ± 48.05 mL/min/m2) was significantly lower than that in contralateral duplex kidneys (150.18 ± 49.01 mL/min/m2) or those ipsilateral to controls (145.98 ± 41.16 mL/min/m2) (P < 0.001 and P < 0.001, respectively). CONCLUSION: Duplex kidneys are usually accompanied by a higher grade of VUR, more severe renal scarring, and renal function impairment. Split renal function in duplex kidneys often declines significantly. Notably, the evaluation of split renal function in bilateral duplex kidneys should be performed cautiously.

99mTc-DTPA Renal Dynamic Imaging for Evaluating the Function of Duplex Kidneys in Adult Patients.

BACKGROUND: This study aimed to explore technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) renal dynamic imaging to evaluate duplex kidney function in adult patients. SUBJECTS AND METHODS: We retrospectively analyzed the clinical data of 25 patients with duplex kidneys who underwent 99mTc-DTPA renal dynamic imaging between June 2011 and March 2023 at our hospital. Patients in the duplex kidney group (n = 25) were divided into renogram normal (n = 9) and abnormal (n = 16) groups according to the imaging data. Additionally, normal patients were selected as the control group (n = 25). After imaging, the region of interest of the kidneys was delineated, and renography was performed. Renography can provide renal function parameters, including glomerular filtration rate (GFR), Tmax, T1/2, renal clearance, and the GFR ratio of the duplex renal segment (upper renal moiety). RESULTS: Compared with the control group, the serum creatinine level in the duplex kidney group was higher (p = 0.025), GFR was lower (p = 0.001), and patients with impaired renal function were mainly in the abnormal renography group (p = 0.001). In the duplex kidney group, the GFR (p = 0.026) and renal clearance (p = 0.006) of the affected kidneys were lower than those of the contralateral kidneys, and Tmax (p = 0.025) was higher than that of the contralateral kidneys. There were no differences in renal function indicators of duplex renal segments with different GFR ratios. However, when the GFR ratio exceeded 50%, the renal function tended to decline. CONCLUSIONS: 99mTc-DTPA renal dynamic imaging was found useful to evaluate the total renal function, split renal function, and upper urinary tract patency in patients with duplex kidneys. Patients with abnormal renography results had worse renal function, and those with poor renal clearance in the affected renal moiety required surgical treatment.

Establishment of a formula for the estimation of kidney depth in adults and its effect on glomerular filtration rate assessment.

Background: Gates' analysis method for kidney depth (KD) calculation is the only way to determine the glomerular filtration rate (GFR) of the kidney in clinical practice, which posits that the influence of KD on the GFR is more important than other factors. Computed tomography (CT) measurement of the donor KD can improve the accuracy of GFR measurement by Gates' method but will also increase the radiation exposure of kidney transplantation donors. Thus, it is particularly important to establish an accurate empirical formula for KD measurement that is more consistent with the real KD. Methods: In total, 326 potential renal transplantation donors were enrolled in this study. Among these, 167 donors were assigned to the training set to estimate the regression formula of KD measured by CT. The remaining 159 donors were included in the validation set to verify the regression formula. The KD measured by CT and its corresponding GFR was taken as the reference standard. The performances of formulas were then compared. Results: There was no significant statistical difference between the CT-measured KD and the current fitting, Li Q, and Xue JJ formulas (P>0.05). However, significant differences were observed between the KDs calculated using the Taylor, Ma G, and Uchiyama formulas and the CT-measured reference standard KD (P<0.05). Furthermore, there was no notable difference in the GFRL and GFRR corresponding to the CT-measured KD with that of the fitting, Ma G, and Xue JJ formulas (P>0.05). There were also marked differences in the GFRR corresponding to the Li Q's formula (P<0.05), and in the GFR between other estimation methods and the CT measurement (P<0.05). Conclusions: The fitting formula established in this study can play a more important role if an accurate measurement method of the body thickness at the level of the hilum on the body surface can be found.

A novel rotation method with variable-angle anterior probe for correcting the depth of the kidney to optimize renal dynamic imaging.

PURPOSE: We aimed to investigate the effect and significance of the rotation method with variable-angle anterior probe corrected for the depth of two kidneys on the determination of glomerular filtration rate (GFR) in total and single kidneys by the renal dynamic imaging Gates method. METHODS: Seventy-two patients who underwent dynamic renal imaging by the rotation method and abdominal CT in our hospital were collected in the present study. CT scanning, rotation method, Tonnesen's formula, and Li-Qian's formula were compared in terms of the depth of two kidneys, the depth difference between the two kidneys, and the total renal and single GFR obtained by substituting the renal depth values into Gates' formula. RESULTS: ①The depth of kidneys and GFR: Compared to CT, Tonnesen's formula significantly underestimated the depth of both kidneys and the total and single renal GFR (P < 0.05). No significant differences were found in the depth of both kidneys and the total and single renal GFR between Li-Qian's formula and the rotation method (P > 0.05), with a strong agreement and with the least bias in the values measured by the rotation method. ②Renal depth difference: Compared to CT, Tonnesen's formula and Li-Qian's formula underestimated the difference in depth between the two kidneys (P < 0.05). None of the differences were statistically significant based on the rotation method (P > 0.05). The depth difference was positively correlated with the resulting changes in single renal function (|R(CT)-R(Li-Qian)|) and (|R(Rotation)-R(Li-Qian)|) (r = 0.881, 0.641, P < 0.001). As the depth difference increased, Li-Qian's formula could not visualize changes in single renal function accurately. In contrast, the accuracy of the rotation method in assessing single renal function remains unaffected. CONCLUSION: The rotation method obtains an accurate depth and depth difference between the two kidneys without additional CT radiation, enhancing the accuracy of the Gates method for determining total and single renal GFR. Trial registration Medical Ethics Committee of First Hospital of Shanxi Medical University, 2021BAL0146. Registered 12 January 2021.

Inferences of SPECT renal dynamic imaging injection quality based on lung and abdominal aorta imaging features.

OBJECTIVE: To analyze the characteristics of blood flow perfusion images at different injection levels to establish an evaluation standard for renal dynamic imaging injection quality and reduce misdiagnosis. METHODS: Data from 140 single-photon emission computed tomography renal dynamic imaging, collected in our hospital, were retrospectively analyzed. The scans were divided into four groups according to the injection quality: total leakage of the imaging agent (group A), partial leakage (group B), poor bolus injection quality (group C), and good bolus injection quality (group D). The time of appearance and regression of the pulmonary blood perfusion phase, the peak time in the abdominal aorta, and the ratio between peak count and actual drug injection count were analyzed. The renal dynamic imaging was repeated in low-quality examinations, and the comparison between the two exams provided the misdiagnosis rate caused by inadequate injections. RESULTS: The images of the lungs and abdominal aorta in group A were blurred and indistinguishable; thus, these exams were unreliable. Both appearance and fading time of the bilateral lung shadows were significantly different between groups B, C, and D (p = 0.002 and p = 0.003, respectively). The peak time and peak counting ratio in the abdominal aorta were also significantly different between these groups (p = 0.002 and p < 0.001, respectively). The misdiagnosis rates of renal dynamic imaging in groups A, B, and C due to the different injection levels were significantly different at 94.29%, 77.14%, and 18.29%, respectively. CONCLUSIONS: The times of appearance and regression of the lung shadows and the peak time and peak count ratio in the abdominal aorta in the dynamic renal imaging perfusion phase can help assess the imaging agent injection quality and identify the need for a repeated examination. Improving the imaging agent injection quality can effectively reduce the renal function misdiagnosis rate.

[Renal functional compensation after unilateral radical nephrectomy of renal cell carcinoma].

OBJECTIVE: To investigate factors influencing renal functional compensation(RFC) of the preserved kidney after radical nephrectomy (RN). METHODS: A total of 286 patients treated with RN in Peking University People's Hospital were retrospectively analyzed. Preoperative body mass index (BMI), systolic blood pressure (SBP), history of smoking, history of chronic diseases and other basic information, as well as preoperative blood biochemistry, urine routine, imaging examination results were recorded. All the patients underwent 99mtechnetium-diethylenetriamine pentaacetic acid (99mTc-DTPA) renal scans before operation. The surgical method, pathology and blood creatinine values from 1 month to 60 months after RN were recorded. Preoperative and postoperative estimated glomerular filtration rate (eGFR) was calculated by the chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Renal functional compensation was defined as percent change in eGFR of the preserved kidney after RN compared with the preoperative eGFR. Univariate and multivariate regression analyses were used to identify predictive factors of RFC. RESULTS: Median age was 61 years and 65.4% of the patients were male. Early stage (T1 or T2) tumors were found in 83.6% of the cases. 18.5% of the patients had preoperative diabetes mellitus, 39.5% had hypertension, 19.2% had a history of smoking, and 27.6% were found to have renal cyst on the contralateral side. In the study, 226 cases underwent laparoscopic radical nephrectomy and 60 cases underwent open radical nephrectomy. Renal clear cell carcinoma was the most common pathological type, accounting for 88.5%. The median tumor maximum diameter was 4.5 cm (0.7-13.5 cm). Median renal function compensation was 27% one month after radical nephrectomy. Functional stability was then observed to 5 years. The results of univariate analysis showed that age, gender, preoperative blood uric acid, preoperative urine protein, contralateral renal cyst, and percentage of split renal function of contralateral kidney were correlated with RFC (P < 0.05). Among them, UA level and split renal function of contralateral kidney were strongly negatively correlated with RFC. The results of multivariate linear regression analysis showed age (P < 0.001), blood uric acid (P < 0.001), urine protein (P=0.002), preoperative eGFR (P < 0.001) and the split renal function of contralateral kidney (P < 0.001) were independent predictors of RFC. CONCLUSION: The basic examinations, such as blood biochemistry, urine routine and renal scan before RN are of great significance in predicting the compen-satory ability of the preserved kidney after RN, which is supposed to be taken into consideration when making clinical decision.

Renal functional compensation after unilateral radical nephrectomy of renal cell carcinoma / 北京大学学报(医学版)

OBJECTIVE@#To investigate factors influencing renal functional compensation(RFC) of the preserved kidney after radical nephrectomy (RN).@*METHODS@#A total of 286 patients treated with RN in Peking University People's Hospital were retrospectively analyzed. Preoperative body mass index (BMI), systolic blood pressure (SBP), history of smoking, history of chronic diseases and other basic information, as well as preoperative blood biochemistry, urine routine, imaging examination results were recorded. All the patients underwent 99mtechnetium-diethylenetriamine pentaacetic acid (99mTc-DTPA) renal scans before operation. The surgical method, pathology and blood creatinine values from 1 month to 60 months after RN were recorded. Preoperative and postoperative estimated glomerular filtration rate (eGFR) was calculated by the chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Renal functional compensation was defined as percent change in eGFR of the preserved kidney after RN compared with the preoperative eGFR. Univariate and multivariate regression analyses were used to identify predictive factors of RFC.@*RESULTS@#Median age was 61 years and 65.4% of the patients were male. Early stage (T1 or T2) tumors were found in 83.6% of the cases. 18.5% of the patients had preoperative diabetes mellitus, 39.5% had hypertension, 19.2% had a history of smoking, and 27.6% were found to have renal cyst on the contralateral side. In the study, 226 cases underwent laparoscopic radical nephrectomy and 60 cases underwent open radical nephrectomy. Renal clear cell carcinoma was the most common pathological type, accounting for 88.5%. The median tumor maximum diameter was 4.5 cm (0.7-13.5 cm). Median renal function compensation was 27% one month after radical nephrectomy. Functional stability was then observed to 5 years. The results of univariate analysis showed that age, gender, preoperative blood uric acid, preoperative urine protein, contralateral renal cyst, and percentage of split renal function of contralateral kidney were correlated with RFC (P < 0.05). Among them, UA level and split renal function of contralateral kidney were strongly negatively correlated with RFC. The results of multivariate linear regression analysis showed age (P < 0.001), blood uric acid (P < 0.001), urine protein (P=0.002), preoperative eGFR (P < 0.001) and the split renal function of contralateral kidney (P < 0.001) were independent predictors of RFC.@*CONCLUSION@#The basic examinations, such as blood biochemistry, urine routine and renal scan before RN are of great significance in predicting the compen-satory ability of the preserved kidney after RN, which is supposed to be taken into consideration when making clinical decision.

Relationship between Vesicoureteral Reflux and Glomerular Filtration Rate in Children.

Vesicoureteral reflux (VUR) is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare. We recruited 35 primary VUR patients with recurrent urinary tract infection (UTI) and 10 non-VUR patients with recurrent UTI. Contrast-enhanced voiding urosonography (ceVUS) was performed for VUR grading, and renal dynamic imaging was used for evaluating glomerular filtration rate (GFR, mL/min). Standardized GFR (sGFR), namely GFR/BSA (mL·min-1·m-2), was calculated based on the body surface area (BSA). Total sGFR (tsGFR, mL·min-1·m-2) was obtained from the sum of sGFR on the left and right sides of all the children. The risk of renal regurgitation was equal in the unilateral reflux group. The sGFR of children with grade IV (45.74±18.05 mL·min-1·m-2) and grade V (49.67±23.63 mL·min-1·m-2) reflux was significantly lower than that in children with grade III (77.69 ±22.21 mL·min-1·m-2). The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group, which was higher than that in the control group and level II, IV and V of reflux group respectively. In VUR group of the same grade, sGFR decreased with the age at diagnosis. In unilateral grade V reflux group, the tsGFR was lower than that in the unilateral grade III reflux group (133.51±48.21 vs. 186.87±53.49 mL·min-1·m-2). The patients with VUR of unilateral grade II were significantly older than those with VUR of unilateral grades III and IV. This study indicates that severe VUR is significantly associated with decreased renal function. Therefore, VUR should be diagnosed early and managed individually.

Validation of the full-age spectrum equation in the approximation of glomerular filtration rate in Chinese patients with chronic kidney disease.

Introduction: To investigate the validity of the full age spectrum (FAS) equation in determining the glomerular filtration rate (GFR) in Chinese patients with chronic kidney disease (CKD) and to compare the performance of FAS equation and the technetium-99m-diethylene triamine pentaacetic acid (Tc-99m-DTPA) renal dynamic imaging method. Methods: The GFR was determined by three methods in the same day: (a) Tc-99m-DTPA dual plasma sample clearance method (mGFR); (b) FAS equation (eGFR1); (c) Tc-99m-DTPA renal dynamic imaging method (eGFR2). The mGFR was used as the reference standard. The Bland-Altman method, concordance correlation coefficient and regression equation were applied to evaluate the validity of the estimated glomerular filtration rate (eGFR). The bias, precision and accuracy were analyzed to compare the performances of eGFR1 and eGFR2. Results: A total of 162 subjects were enrolled in this study. The eGFR1 was correlated well with mGFR (concordance correlation coefficient was 0.896, p < 0.0001) and the regression equation was mGFR = -0.374 + 1.029eGFR1 (p < 0001). The Bland-Altman analysis proved good agreement between the eGFR1 and mGFR. In comparison with eGFR2, the eGFR1 showed better performance on bias (-1.22 vs. 8.92, p < 0001), precision (15.69 vs. 18.36, p = 0.047) and 30% accuracy (75.31% vs. 59.26%, p = 0.0009) in all participants. Conclusions: The FAS equation is valid in determining the glomerular filtration rate in Chinese patients with chronic kidney disease. The Tc-99m-DTPA renal dynamic imaging method is less accurate than the FAS equation and cannot be employed as the reference method in assessing the performance of FAS equation.

Comparative evaluation of technetium-99m-diethylenetriaminepentaacetic acid renal dynamic imaging versus the Modification of Diet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equation for the estimation of GFR.

PURPOSE: We compared the performance of technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) renal dynamic imaging (RDI), the MDRD equation, and the CKD EPI equation to estimate glomerular filtration rate (GFR). METHODS: A total of 551 subjects, including CKD patients and healthy individuals, were enrolled in this study. Dual plasma sample clearance method of 99mTc-DTPA was used as the true value for GFR (tGFR). RDI and the MDRD and CKD EPI equations for estimating GFR were compared and evaluated. RESULTS: Data indicate that RDI and the MDRD equation underestimated GFR and CKD EPI overestimated GFR. RDI was associated with significantly higher bias than the MDRD and CKD EPI equations. The regression coefficient, diagnostic precision, and consistency of RDI were significantly lower than either equation. RDI and the MDRD equation underestimated GFR to a greater degree in subjects with tGFR ≥ 90 ml/min/1.73 m2 compared with the results obtained from all subjects. In the tGFR60-89 ml/min/1.73 m2 group, the precision of RDI was significantly lower than that of both equations. In the tGFR30-59 ml/min/1.73 m2 group, RDI had the least bias, the most precision, and significantly higher accuracy compared with either equation. In tGFR < 30 ml/min/1.73 m2, the three methods had similar performance and were not significantly different. CONCLUSIONS: RDI significantly underestimates GFR and performs no better than MDRD and CKD EPI equations for GFR estimation; thus, it should not be recommended as a reference standard against which other GFR measurement methods are assessed. However, RDI better estimates GFR than either equation for individuals in the tGFR30-59 ml/min/1.73 m2 group and thus may be helpful to distinguish stage 3a and 3b CKD.

The diagnostic value of nuclide renal dynamic imaging in early renaldamage in elderly essential hyperten-sion / 实用医学杂志

Objective To investigate the diagnostic value of 99mTc-DTPA nuclide renal dynamic imaging in early renal damage in elderly essential hypertension(EH). Methods Among the elderly patients with essential hypertension who were enrolled in our hospital. 86 patients were enrolled as the study subjects. They were divided into two groups according to the results of 24-hour urinary microalbuminuria(MA):MA negative(A) group and MA posistive(B) group.Meanwhile,20 elderly healthy persons were selected as the control group. 99mTc-DTPA re-nal dynamic imaging was performed in all subjects to detect couple glomerular filtration rate(GFR),the peak time(TP),half emptying time(T1/2) and ration of 20 min and peak phase kidney radioactivity count(T20/P%).At the same time,MA,serum cystatin C(Cys-C),surem creatinine(SCr) and blood urea nitrogen(BUN) were de-tected and compared with three groups. Rusults(1)The positive rate of early renal damage with 99mTc-DTPA nu-clide renal dynamic imaging method was significantly higher than those of two later methods(P < 0.01).(2)The levels of GFR,TP,T1/2,and T20/P% in group A were significantly higher than those in the control group and those in group B significantly higher than those in group A(P<0.05).(3)The levels of MA and Cys-C in group A was sig-nificantly higher than that of the control group,and those in group B significantly higher than that of group A(P<0.05).In comparisons of SCr and BUN among the three groups,the results had no significant difference. Conclu-sion 99mTc-DTPA nuclide renal dynamic imaging can early detect the renal damage in elderly EH patients,and it has better clinical value.

Preliminary study of renal function evaluated by the volume of hydronephrosis with 64 slice CT scan / 实用放射学杂志

Objective To explore the value of hydronephrosis volume measured by 64 slice CT scan, evaluating renal function in patients with obstructive hydronephrosis.Methods The patients performed with both single photon emission computed tomography(SPECT) renal dynamic imaging and 64 slice CT scan in three days were chosen, 176 cases included finally.The images of renal dynamic imaging were divided into normal renal function group, mild renal impairment group, moderate renal impairment group and severe renal impairment group according to glomerular filtration rate (GFR) measured by SPECT.At the same time, CT three-dimensional reconstruction technique has been used to measure the volume of hydronephrosis, compare the differences of hydronephrosis volume among these groups, and future analyze the correlation of hydronephrosis volume with renal GFR value.Results The hydronephrosis volume of the four groups were respectively (31.47±3.81) cm3,(83.43±7.81) cm3,(208.53±15.47) cm3 and (577.31±61.32) cm3.There was statistical significance among these groups (P<0.01),except between normal renal function group and mild renal impairment group.The volume of hydronephrosis showed positive correlations with renal GFR (r=-0.614).Conclusion The volume of hydronephrosis measured by 64 slice CT has positive correlation with GFR measured by SPECT, which could reflect renal function to some extent.

The effect of image processing from the renal dynamic imaging on the data of glomerular filtration rate / 中国医学装备

Objective:To analyze the difference of glomerular filtration rate (GFR) among image processing of the renal dynamic imaging through various methods.Methods: The renal dynamic imaging was processed through various methods, and using the image post-processing software. Using SPSS statistic system to analyze the data.Results: The methods of image processing had impacts on GFR. (1)The difference of GFR data obtained from images which were processed by different operators were not statistically significant. (2) The difference of GFR data obtained from images which image processing repeatedly by the same operator were not statistically significant. (3)GFR data measured based on background detecting regions of interest (ROI) (manually defined or auto-defined ROI) placed in different positions of kidney image had statistical significant. (4) The difference of GFR data were measured by manually defined and auto-defined background ROI had statistical significant.Conclusion: Choosing the proper image processing way, combining clinical appearance and detection, and gaining real data help to ensure the accuracy of imaging diagnostic reports.

Research of radiation dose rate around patients underwent renal dynamic imaging of SPECT with 99Tcm-DTPA / 中国医学装备

Objective:To study the radiation dose rate around patients underwent renal dynamic imaging of SPECT with 99Tcm-DTPA, so as to provide the basis for ensuring the radiation safety of the surrounding environment and the general public.Methods: 109 patients who underwent renal dynamic imaging were enrolled in this study, and the radiation dose rates of different time and different distance after 99Tcm-DTPA was injected patients were measured. And then, the changes of dose rate following time and distance were analyzed. Results: At the 0.5h, 1h, 2h, 3h, 6h, and 7h after radiopharmaceuticals were injected patients underwent renal dynamic imaging, the radiation dose rates were 0.76-8.86 μSv/h, 0.68-7.27 μSv/h, 0.57-4.52 μSv/h, 0.56-3.90 μSv/h, 0.23-2.07 μSv/h and 0.21-1.05 μSv/h, respectively, between 0.5 m and 4 m away from patients. At 24h after radiopharmaceuticals were injected, all of radiation dose rates at different distances around patients were same with background values.Conclusion: The radiation dose rates around patients underwent renal dynamic imaging will rapidly decrease with the increasing of time and distance. At 24h after radiopharmaceuticals were injected, all of radiation dose rates at different distances away from patients were same with background values.

Glomerular filtration rate measured by (99m) Tc-DTPA renal dynamic imaging is significantly lower than that estimated by the CKD-EPI equation in horseshoe kidney patients.

AIM: Gate's glomerular filtration rate (gGFR) measured by (99m) Tc-DTPA renal dynamic imaging and estimated GFR (eGFR) estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation are two indexes used to evaluate renal function. However, little is known about whether gGFR can be used to accurately assess renal function in horseshoe kidney (HSK) patients with renal fusion anomalies. METHODS: Nineteen HSK patients (HSK group) diagnosed by renal imaging and 38 CKD patients with "normal kidney shape" (non-HSK group) matched to the HSK patients in terms of gender, age and biochemical indicators at Chinese PLA General Hospital were enrolled in this study. Gender, age, serum total protein (TP), albumin (ALB), blood urea nitrogen (BUN), serum creatinine (Scr), gGFR and eGFR were recorded and analyzed using χ(2) test, t-test, and Wilcoxon test which was presented as median(IQR). RESULTS: (1) There were no significant differences in gender, age, TP, ALB, BUN, Scr, or eGFR between these two groups. (2) In HSK patients, the renogram showed abnormal renal axis with the lower poles orientated medially. The timed uptake curve showed that the isotope excretion in the HSK group was slower than that in the non-HSK group. (3) For all HSK patients, gGFR was significantly lower than eGFR (range -12.52 mL/min per 1.73m(2) to -93.18 mL/min per 1.73m(2) ). There was no significant difference in eGFR between the HSK [96.42 (36.02) mL/min per 1.73 m(2) ] and non-HSK groups [94.46 (33.00) mL/min per 1.73 m(2) ]. The gGFR of the HSK group [41.18 (16.60) mL/min per 1.73m(2) ] was much lower than that of the non-HSK group [86.42(26.40) mL/min per 1.73m(2) , P < 0.001] and the eGFR of the HSK group (P < 0.001). The gGFR and eGFR of the non-HSK group were not significantly different. CONCLUSION: gGFR measured by (99m) Tc-DTPA renal dynamic imaging is significantly lower than eGFR estimated by the CKD-EPI equation, which indicates that isotope renogram cannot accurately evaluate the GFR of HSK patients.

A new quantitative method for estimating glomerular filtration rate and its clinical value.

BACKGROUND AND AIM: The estimation of the glomerular filtration rate (GFR) is essential for the renal function. However, all estimation methods for GFR have advantages and disadvantages. The aim of this study was to develop a new quantitative method for estimating GFR and evaluate its clinical value. METHODS: The new GFR was estimated by quantifying the accumulation of Tc-99m DTPA in the dual kidneys and bladder during a gamma camera renogram study in 116 patients with chronic kidney disease. GFR was determined by this new method (nGFR), Gates' gamma camera technique (gGFR), a two-plasma sampling method (tGFR) and creatinine-based clearance as estimated by Cockcroft-Gault (cGFR) and abbreviated MDRD (aGFR) formulae. The correlation analysis, Bland-Altman analysis and receiver-operating characteristic (ROC) plots were carried out among above methods. RESULTS: The nGFR value has significant correlation with tGRF (r = 0·827, P<0·01). The nGFR had the best overall performances with a lowest bias deviation (3·1 ml min(-1) /1·73 m(2) ), better precision (53·0 ml min(-1) /1·73 m(2) ), narrowest interquartile range (13·5 ml min(-1) /1·73 m(2) ) and best accuracy (68·1%) within 30% of the tGFR, compared with those of gGFR, cGFR and aGFR. The new method had the similar maximum accuracy with the Gates' method and creatinine clearance as estimated by Cockcroft-Gault and abbreviated modification of diet in renal disease (MDRD) method. The new method had better repeatability characteristic compared with the Gates' method. CONCLUSIONS: The new method for estimating GFR had the better performances compared with the Gates' method and creatinine clearance as estimated by Cockcroft-Gault and MDRD method.

Functional and morphological outcome after pyeloplasty for children with unilateral hydronephrosis / 中华泌尿外科杂志

Objective To analyze the factors associated with the outcome of pyeloplasty in term of renal function and morphology improvement in children with unilateral ureteropelvic junction obstruction,in order to provide clinical evidence for the treatment of hydronephrosis in children.Methods Clinical data of 174 children who underwent unilateral dismembered pyeloplasty from January 2009 to June 2014 were retrospectively studied.Differential changes in renal function and renal morphology after pyeloplasty were assessed by serial renal scan and ultrasound.On the basis of preoperative split DRF,these patients were divided into three groups:group Ⅰ with DRF ≥40％ (n =99),group Ⅱ with DRF 30％-40％ (n =29) and group Ⅲwith DRF ＜ 30％ (n =46).According to their age at surgery,the children were divided into four groups,including group A aged 1-3 months (n =52),group B aged 3 months-3 years (n =44),groupCaged3-6years (n =37),and group D aged more than 6 years (n =41).Results Inall 174 children,postoperative complication occurred in 7 cases,including urinary tract infection in 6 cases and renal atrophy in 1 case.A significant improvement of both function and morphology was confirmed in most patients (P ＜ 0.01).Patients in group Ⅰ showed stable renal function after operation(DRF 48.46％ ±4.80％ vs.50.78％ ± 5.45％,P ＜ 0.01),of them who underwent pyeloplasty at 1-3 months of age showed the best obvious recovery of renal morphology.Renal function of patients in group Ⅱ recovered obviously and most of them reached to the initial values (DRF 35.18％ ± 2.95％ vs.43.91％ ± 6.89％,P ＜ 0.01).While renal function of patients in group Ⅲ recovered significantly after surgery,most of them failed to restore the initial values(DRF 20.70％ ± 6.90％ vs.33.78％ ± 12.49％,P ＜ 0.01),and among them,the aged 1-3 months group possessed the best recovery.Moreover,the morphological improvement was similar to the functional improvement.The time for hydronephrosis recovered to less than Grade 2 of Society for Fetal Urology(SFU)was 6,24 and over 24 months respectively in group Ⅰ,Ⅱ and Ⅲll,and the renal morphology gradually improved with the increasing duration of follow-up.Conclusions The renal function and morphology of most patients improved significantly after pyeloplasty.Recovery of renal function and morphology after surgery was significantly correlated with the preoperative DRF.Early surgical intervention may improve the function and morphology recovery of the involved renal unit.

Influence of different injection techniques on the quality of bolus in 99mTc-DTPA renal dynamic imaging / 中国实用护理杂志

Objective To explore the influence of different injection techniques on the quality of bolus in 99mTc-DTPA renal dynamic imaging.Methods 395 patients accepted 99mTc-DTPA renal dynamic imaging were retrospectively analyzed.All patients were divided into three groups according to injection techniques:direct injection group (187 cases),intravenous route injection group (84 cases)and venous indwelling needle injection group (124 cases).The three groups were injected by each technique.Areas of interest (ROI) were drawn on abdominal aorta by Xeleris workstation in blood flow perfusion imaging.The time-radioactivity curves of ROI were got.The patients whose ROI curve formed a peak was successfully injected,and did not formed was unsuccessfully injected.The number of patients in three groups who were successfully or unsuccessfully injected was respectively calculated.The data of three groups was taken Chisquare test by SPSS17.0 software.Results 174 patients of the direct injection group,46 of the intravenous route injection group and 115 of the venous indwelling needle injection group were injected successfully.The successful rate respectively was 93.0％,54.8％ and 92.7％.The successful rate of the direct injection group and venous indwelling needle injection group were higher than intravenous route injection group.The difference had statistical significance.The successful rate of the direct injection group and venous indwelling needle injection group hadn't statistical significance.Conclusions The successful rates of the direct injection group and venous indwelling needle injection group were similar.The venous indwelling needle injection technique can be chosen.The successful rate of the intravenous route injection group was lower than the other two groups.The intravenous route injection technique should be chosen prudently.