| To detect the cases changes of glomerular filtration rate ( GFR) by 99Tcm -DTPA radio nuclide renal dynamic imaging with upper urinary tract obstruction using two different ROI: the whole renal ROI and the renal parenchymal ROI, while urinary microalbumin ( MA1b) were detected and the relationship between them were studied to evaluate the role of radio nuclide imaging of GFR using two different ROI about assessing the obstructive renal function.Methods1. Clinical data30 cases with unilateral upper urinary tract obstruction were divided into 3 groups according to the results of intravenous pyelography (IVP) or the ultrasonic imaging: slight hydrone phrosis (n = 10) , moderate hydronephrosis (n = 8 ) , and severe hydronephrosis ( n = 12). The levels of the blood BUN, Scr and routine uronoscopy were all in normal ranges before treatment. The IVP and the radionulide renal dynamic imaging were at least 3 days intervals. The suffering kidney urine were from the cystoscope, intraureteral cannula and pyelostomy.2. DeterminationThe radioimmunoassay method was used in order to detect the level of microalbumin (MAlb). GFR was obtained by 99Tcm -DTPA renal dynamic functional imaging strictly followed the standar of nuclear medicine diagnosis and therapy.3. Gate's method.Project the ROI on the 2 -3min renal image after acquisition. The wholerenal ROI: drawing a closed curve including the complete renal pelvis around the outside rim of the renal cortex. The renal parenchymal ROI: drawing a closed curve excluding the renal pelvis detentioned the radioactive tracer. The background ROI: drawing a crescent ROI two pixels far from the renal cortex out lower the kidney.4. Calculation the suffering kidney GFR using the computer programme according to Gatefc method.5. Analysis data.Comparisons between the two groups were performed with one - way analysis of variance, comparisons with in a group using two ROI were made by means of paired t test. The correlation between the levels of GFR and MAlb was assessed by linear regression analysis. Probability values less than 0.05 were considered significant.ResultsWhen whole renal ROI, with the severity of the hydronephrosis GFR in the severe group (16.58 ±3.45m]/min) was significantly decreased compared with the slight group (38. 20 ±5. 35ml/min) and the moderate group(34. 75 ±5. 85ml/min) , P <0.01; There was no significantly decreasing between the moderate and severe groups ( P > 0.05 ).When the parenchymal ROI, with the severity of the hydronephrosis, GFR was significantly decreased in the slight group (32.10 ±5.01ml/min) , moderate group (21. 62 ± 3. 93ml/min) , and severe group (13. 17 ±3. 46ml/min) compared with each other( P <0.01).While with the severity of the hydronephrosis, the urinary MAlb were significantly elevated in the slight group (11. 16 ±3. 55mg/L) , moderate group (25.11 ±7.27mg/L) and severe group(55. 17 ±8. 66mg/L) compared with each other, P<0.01.When the whole renal ROI, the GFR in the slight group(r = -0.77, P < 0.05 ) and severe group ( r = - 0. 71, p < 0. 01) were significantly correlated with the MAlb, while not in the moderate group( r = -0.48, p >0.05 ).When the renal parenchymal ROI, the GFR in the slight group(r = -0. 81, p<0.01) , moderate group (r= -0.71 ,p <0.05) and severe group (r = -0.73 ,p <0. 01) were all significantly correlated with the level of the MAlb.Conclusions99Tcm - DTP A renal dynamic functional imaging could detect the unilateral renal GFR thus reflect the early damage and the degree of the damage about the obstructional renal function. Also show the important clinical value as a safe non - invasive simple and intuitive method combined the formation and function together. While the method of drawing ROI may influence the result of GFR when processing the image, the GFR using renal parenchymal ROI is much more negatively correlated with the MAlb level. And may provide a more sensitive and corrective results to evaluate the obstructional renal function.
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