螺旋 CT多期扫描在慢性上尿路梗阻患者分肾功能评估中的价值

摘要

目的：通过螺旋CT多期扫描对慢性尿路梗阻且血肌酐正常患者的分肾功能进行评估。方法前瞻性研究65例单侧或双侧慢性上尿路梗阻并且血肌酐正常的成年患者，60例为单侧梗阻，对侧肾正常，其余5例为双侧梗阻。所有患者均行螺旋CT多期扫描及99mTc-DTPA核素肾动态显像检查。 CT用来明确梗阻的原因，间接测定双肾的肾小球滤过率（ GFR），分析梗阻肾脏CT GFR和同位素GFR 之间的相关性。结果梗阻肾脏同位素GFR为（36．9±9．79）mL/min，CT GFR为（37．8±10．53）mL/min，梗阻肾脏同位素GFR与相应的CT GFR之间呈显著正相关（r＝0．74，P＜0．001），其同位素GFR与CT GFR差异没有显著性意义（P＝0．28）；正常肾脏的同位素GFR为（62．3±13．07）mL/min，CT GFR为（62．1±10．11）mL/min，正常肾脏的同位素GFR和CT GFR比较，同样呈显著正相关（r＝0．78，P＜0．001），其同位素GFR与CT GFR差异没有显著性意义（P＝0．75）。结论在梗阻肾脏及正常肾脏的功能评估中，螺旋CT多期扫描对于总肾功能和分肾功能的计算与核素肾动态显像一样准确。%Objective To evaluate contrast enhanced spiral computerized tomography ( CT) for differential renal functional assessment in the patients with chronic obstructive uropathy and normal serum creatinine .Methods We chose 65 patients with unilateral or bilateral chronic renal obstruction and normal serum creatinine in the prospective study .Sixty patients had unilateral obstruction and a normal contralateral kidney and the remaining five had bilateral obstruction .All patients under-went contrast enhanced spiral CT together with 99 Tcmercaptoacetyltriglycine renal scan .CT was used to identify the cause of obstruction and selectively determine the glomerular filtration rate ( GFR) of the differential kidneys .We analyzed the rela-tionship between isotope GFR and CT GFR in the obstructed kidneys .Results The isotope GFR of obstructed kidneys was (36.9 ±9.79) mL/min,and the CT GFR was (37.8 ±10.53) mL/min.Comparison between the isotope GFR of obstruc-ted kidneys with the corresponding CT GFR indicated a positive correlation (r=0.74,P<0.001).There was no statisti-cally significant difference between isotope GFR and CT GFR in the obstructed kidneys (P=0.28).The isotope GFR of healthy kidneys was (62.3 ±13.07) mL/min,and the CT GFR was (62.1 ±10.11) mL/min.Moreover, similar to the obstructed kidneys , comparison between isotope GFR and CT GFR of normal kidneys showed an excellent correlation ( r=0.78,P<0.001).There was no statistically significant difference between isotope GFR and CT GFR in the healthy kidneys (P=0.75).Conclusion Contrast enhanced spiral CT is as accurate as radioisotope renal scan for calculating the total and differential kidney function in the functional assessment of the obstructive and healthy kidneys .