功能磁共振尿路造影对儿童肾积水单侧肾功能的评估价值

摘要

Objective To assess the value of functional magnetic resonance urography (fMRU)for the unilateral renal function in children with hydronephrosis.Methods Fourteen children with congenital hydronephrosis (unilateral hydronephrosis in 1 2 cases,bilateral hydronephrosis in 2 cases)examined by fMRU in Beijing Children′s Hospital,Capital Medical University,were enrolled.In 7 patients of them,diuretic renal scintigraphy (DRS)was per-formed within 1 0 days before fMRU examination.The following parameters in fMRU,as renal parenchymal volume,volu-metric differential renal function (vDRF),Patlak,Patlak differential renal function (pDRF),index of glomerular filtra-tion rate (GFR)and differential renal function based on index of GFR (gDRF),were calculated and analyzed.Statisti-cal analysis was performed by using SPSS 1 3.0.Results In 7 cases whose fMRU and DRS were examined,the indexes of GFR obtained from fMRU and GFR from DRS were well correlated (r =0.892,P <0.001 )in 1 4 kidneys.The gDRF determined by 2 methods on the left kidneys[the average was(46.80 ±1 9.20)% and(45.1 8 ±20.29)%,respective-ly]had no significant difference (t =0.051 6,P =0.624),which was also highly correlated (r =0.91 2,P =0.004). In 1 2 cases with unilateral hydronephrosis,vDRF,pDRF,index of GFR and gDRF in hydronephrotic side[(43.54 ± 9.61 )%,(42.80 ±1 0.83)%,(38.56 ±29.23)mL/min,(38.37 ±1 3.61 )%]were all less than those in the con-tralateral side[(56.46 ±9.61 )%,(57.1 9 ±1 0.83)%,(57.02 ±26.22)mL/min,(61 .63 ±1 3.61 )%](t =2.326, 2.300,2.422,2.960;P =0.040,0.042,0.034,0.01 3).However,there was no statistical difference in both renal pa-renchymal volume and Patlak between the hydronephrotic and the contralateral side kidneys(t =1 .765,1 .450;P =0.1 05,0.1 75).Conclusions fMRU is a very valuable examination method in evaluating single kidney function in children with congenital hydronephrosis,and able to demonstrate that gDRF,indexes of GFR,vDRF and pDRF decrease in the hydronephrotic kidney.%目的：研究在儿童肾积水中功能磁共振尿路造影（fMRU）对单侧肾脏功能的评估价值。方法收集首都医科大学附属北京儿童医院成功完成 fMRU 检查的肾积水患儿14例（单侧肾积水12例、双侧肾积水2例），其中7例同时进行了核医学利尿性肾动态显像（DRS）。fMRU 所得主要功能参数为单肾体积、单肾patlak 数（滤过率／mL）、单肾肾小球滤过率（GFR）指数，以及基于体积、patlak 数及 GFR 的3种分肾功能（vDRF、pDRF 和 gDRF）。DRS 所得参数为 GFR、gDRF。使用 SPSS 13．0软件进行统计分析。结果在行 fMRU与 DRS 2种检查的7例14个肾脏，前者所得单肾 GFR 指数与后者所得 GFR 高度相关（r ＝0．892，P ＜0．001）；2种方法所得的 gDRF （均取左侧）分别为（46．80±19．20）％、（45．18±20．29）％，差异无统计学意义（t ＝0．0516，P ＝0．624），且高度相关（r ＝0．912，P ＝0．004）。12例积水侧肾脏 vDRF、pDRF、GFR 指数及 gDRF [（43．54±9．61）％、（42．80±10．83）％、（38．56±29．23）mL／min、（38．37±13．61）％]均较健侧小[（56．46±9．61）％、（57．19±10．83）％、（57．02±26．22）mL／min、（61．63±13．61）％]（t ＝2．326、2．300、2．422、2．960， P ＝0．040、0．042、0．034、0．013）；12例积水侧肾体积、patlak 数虽较健侧小，但差异无统计学意义（t ＝1．765、1．450，P ＝0．105、0．175）。结论在儿童肾积水，fMRU 是评估单肾功能非常有价值的检查方法，可显示积水肾脏 vDRF、pDRF、GFR 指数及 gDRF 降低，以 gDRF 改变明显。