肾动态显像测量肾功能时一侧肾脏感兴趣区的不同勾画对另一侧肾脏肾小球滤过率的影响

摘要

Objective To explore the effects of different outlining methods of the region of interest (ROI) for one kidney on glomerular filtration rate (GFR) of contralateral kidney.Methods The data of 270 patients with renal diseases who received dynamic renal imaging for detecting GFR were enrolled.The data was divided into two groups.In the first group,bilateral kidneys didn't had hydronephrosis and occupying lesion,and the GFR of the left kidney was observed under the condition of altering the ROI size of the right kidney and keeping the left renal ROI and background ROI of two kidneys unchanged.In the second group,one kidney had hydronephrosis and the contralateral kidney didn't had hydronephrosis and occupying lesion,keeping the ROI of kidney without hydronephrosis and background ROI of two kidneys unchanged,holonephros ROI and cortex ROI of the kidney with hydronephrosis were outlined,respectively,and the difference in the GFR of the kidney without hydronephrosis were compared between the two ROI outlining methods.According to the GFR measured by the standard ROI outlining method,the renal functions in the left kidney or the kidney without hydronephrosis were divided into 5 stages.Results The analysis of variance with repeated measurements revealed that the different ROI outlining methods of the right kidney were the effect factors of the GFR of the left kidney (F=462.2,P=0.000),and that the outlining of right rena ROI and the staging of the left renal function presented the interation on the GFR of the left kidney (F=2.64,P=0.001).The smaller the right renal ROI,the more significant the relative decrease of the left renal GFR.The differences in the GFR of the kidney without hydronephrosis between holonephros ROI and cortex ROI for the kidney with hydronephrosis were statistically significant in all stages (t=7.15-19.17,P=0.000).Conclusion Gates algorithm has the shortcoming that the GFR of one kidney could be affected by differently outlining of contralateral renal ROI.Outlining the renal ROI according to a decided standard is significant for ensuring the accuracy,repeatability and comparability of the renal GFR.%目的:探讨一侧肾脏感兴趣区(ROI)的不同勾画对另一侧肾脏肾小球滤过率(GFR)的影响.方法:选择行肾动态显像GFR测定的270例肾脏疾病患者的资料.将资料分为两组:第1组,双侧肾脏均无肾积水且无占位性病变,保持左肾ROI与双肾本底ROI不变,改变右肾ROI大小,观察左肾GFR的变化;第2组,一侧肾脏积水且另一侧肾脏无积水且无占位性病变,保持未积水肾脏ROI与双肾本底ROI不变,分别勾画积水肾脏全肾ROI与皮质ROI大小,比较两种勾画方式情况下来积水肾脏GFR的差异.按照标准的ROI勾画法测量的GFR大小,将患者左肾功能或未积水肾脏的功能分为5期.结果:(1)重复测量数据的方差分析显示,右肾ROI的不同勾画是左肾GFR结果的影响因素(F=462.2,p=0.000),且右肾ROI的勾画与左肾功能的分期对左肾GFR的结果存在交互影响(F=2.64,P=0.001).(2)右肾ROI越小,则左肾GFR的相对下降幅度越大.(3)各分期中,积水肾脏勾画全肾ROI与勾画皮质ROI时未积水肾脏的GFR结果之间差异均具有统计学意义(t=7.15～19.17,P=0.000).结论:Gates算法存在一侧肾脏GFR受对侧肾脏ROI不同勾画法影响的缺点,以确定的标准勾画肾脏ROI对保证肾脏GFR结果的准确性、重复性与可比性具有重要意义.