活体肾移植供体GFR评价的CT与SPECT对照研究

发布时间：2018-07-10 14:36

本文选题：肾小球滤过率 + 肾移植　；参考：《泰山医学院》2014年硕士论文

【摘要】：第一部分 CT增强扫描与SPECT测定活体肾移植供体GFR的对照研究目的研究螺旋CT多期增强扫描测定活体肾移植供体肾小球滤过率(GFR)的方法及其与SPECT测定GFR的对照研究。方法 60例成年活体亲属供肾者术前均行双肾螺旋CT多期增强扫描，扫描程序包括一期CT平扫和多期增强扫描(动脉期、静脉期及延迟期CTU扫描)，对比剂为碘普罗胺(100ml:37g I)，对比剂总量90ml，高压注射器注射速率4.0ml/s，根据Patlak方程分别计算双侧肾脏的肾小球滤过率(glomerular filtration rate，GFR)。作为参照，60例肾移植供体同时行SPECT99mTc-DTPA肾动态显像测定双肾GFR，将CT增强扫描测定的GFR与SPECT99mTc-DTPA肾动态显像所测定的GFR相对照，，进行直线回归与相关分析。结果 60例肾移植供体， CT增强扫描测得的左肾GFR和右肾GFR分别为(64.36±5.38)ml/min、(65.72±5.73)ml/min，总肾GFR为(129.48±10.49)ml/min；SPECT99mTc-DTPA肾动态显像测得的左肾GFR和右肾GFR分别为(41.74±5.49)ml/min、(43.36±6.31)ml/min，总肾GFR为(85.09±10.73)ml/min。相关性分析显示，两种方法所测得的GFR相关性良好，左肾GFR相关系数r=0.877，P0.01，直线回归方程为GFR(CT)=28.525+0.859×GFR(SPECT)，n=60；右肾GFR相关系数r=0.877，P0.01，直线回归方程为GFR(CT)=31.209+0.785×GFR(SPECT)，n=60；总肾GFR相关系数r=0.867，P0.01，直线回归方程为GFR(CT)=57.337+0.848×GFR(SPECT)，n=60。结论螺旋CT多期增强扫描能够较准确地测定活体肾移植供体单肾GFR及总肾GFR，应用螺旋CT多期增强扫描可以实现“一站式”完成肾移植供体术前肾脏功能和解剖结构的评价。第二部分 CT增强扫描测定活体肾移植供体GFR不同扫描方法的比较目的比较不同扫描方法对CT多期增强扫描测定活体肾移植供体GFR的影响。方法 30例成年活体亲属供肾者术前均行双肾螺旋CT多期增强扫描，扫描程序包括CT平扫和多期增强扫描(动脉期、早期静脉期、晚期静脉期及延迟期CTU扫描)。每例计算三次GFR,按不同计算方法分为三组： A组利用动脉期及早期静脉期扫描所得的两组数据计算GFR；B组利用动脉期及晚期静脉期扫描所得的两组数据计算GFR； C组利用动脉期、早期静脉期及晚期静脉期扫描所得的三组数据计算GFR。作为参照，30例供体同时行SPECT99mTc-DTPA肾动态显像测定双肾GFR，将CT增强扫描测得三组GFR与SPECT99mTc-DTPA肾动态显像所测定的GFR分别进行对照，进行直线回归与相关分析。结果 C组计算方法测定的GFR值与SPECT测定的GFR值的相关性最高，相关系数(左肾GFR相关系数r=0.906，右肾GFR相关系数r=0.905，总肾相关系数r=0.899)；B组次之，相关系数(左肾GFR相关系数r=0.890，右肾GFR相关系数r=0.891，总肾GFR相关系数r=0.889)；A组相关性最低，相关系数(左肾GFR相关系数r=0.875，右肾GFR相关系数r=0.875，总肾GFR相关系数r=0.864)。结论采用晚期静脉期扫描并且在动脉期和静脉期之间增加扫描次数，采集更多的数据绘制主动脉TDC，可以提高CT多期增强扫描测定活体肾移植供体GFR的准确性。
[Abstract]:Part one
Comparative study of CT enhanced scanning and SPECT in detecting GFR of living donor renal transplantation
objective
Objective to study the method of spiral CT multi-phase enhanced scanning for measuring glomerular filtration rate (GFR) in living donor renal transplant recipients and to compare with SPECT in detecting GFR.
Method
Double renal spiral CT multiphase enhanced scan was performed in 60 adult living relative donors before operation. The scanning program included CT plain and multiphase enhanced scan (arterial, venous and delayed CTU), contrast agent is 100ml:37g I, 90ml of contrast agent, 4.0ml/s of injection rate of high pressure syringe, and calculated by Patlak equation respectively. The glomerular filtration rate (glomerular filtration rate, GFR) in the lateral kidneys (GFR). As a reference, 60 renal transplantation donors were performed simultaneously with SPECT99mTc-DTPA renal dynamic imaging to determine the double renal GFR. The CT enhanced GFR was compared with GFR measured by the SPECT99mTc-DTPA renal dynamic imaging, and the linear regression and correlation analysis were performed.
Result
In 60 renal transplantation donors, the left kidney GFR and right kidney GFR were measured by CT enhanced scan (64.36 + 5.38) ml/min, (65.72 + 5.73) ml/min and total kidney GFR (129.48 + 10.49) ml/min, SPECT99mTc-DTPA renal dynamic imaging of left kidney GFR and right kidney GFR were (41.74 + 5.49) ml/min, (43.36 + 6.31) ml/min, and the total kidney was (85.09 + 10.73) related The relationship between the two methods showed that the correlation between the two methods was good, the GFR correlation coefficient r=0.877, P0.01, the linear regression equation were GFR (CT) =28.525+0.859 x GFR (SPECT), n=60, and the GFR correlation coefficient of the right kidney. The equation is GFR (CT) =57.337+0.848 x GFR (SPECT), n=60.
conclusion
The multi phase enhanced spiral CT scan can accurately determine the single kidney GFR and the total renal GFR of the donor kidney transplantation donor. The multi-phase spiral CT scan can be used to evaluate the renal function and anatomical structure of the renal transplantation donor.
The second part
Comparison of different scanning methods for CT enhanced GFR in living donor donors
objective
Objective to compare the effects of different scanning methods on the GFR of living donor renal transplantation by CT multi phase enhanced scanning.
Method
Double renal spiral CT multiphase enhanced scan was performed in 30 adult living relative donors before operation, including CT plain and multiphase enhanced scan (arterial, early venous, late venous and delayed CTU). Three GFR were calculated in three groups according to different methods: A group was obtained by arterial and early venous phase scan The two groups of data were calculated by GFR; group B was used to calculate GFR by two groups of data obtained by arterial and late venous phase scanning. Group C used three groups of data obtained by arterial phase, early venous phase and late venous phase to calculate GFR. as reference, and 30 donors simultaneously performed SPECT99mTc-DTPA renal dynamic imaging for the determination of double kidney GFR, and CT enhanced scan was used to measure three of the renal GFR. Group GFR was compared with GFR measured by SPECT99mTc-DTPA renal dynamic imaging. Linear regression and correlation analysis were performed.
Result
The correlation coefficient (GFR correlation coefficient r=0.906, GFR correlation coefficient r=0.905, total renal correlation coefficient r=0.899) was the highest for the GFR values measured in group C, and the correlation coefficient (GFR correlation coefficient of left kidney, right kidney correlation coefficient, total renal correlation coefficient); The lowest correlation coefficient (left renal GFR correlation coefficient r=0.875, right kidney GFR correlation coefficient r=0.875, total renal GFR correlation coefficient r=0.864).
conclusion
Using advanced venous phase scan and increasing the number of scanning times between arterial and venous phase and collecting more data to draw TDC of aorta can improve the accuracy of CT multiphase enhanced scan to determine the donor GFR of living kidney transplantation.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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