Clinical Application Of Radionuclide Renal Imaging

1. Clinical value of serum C- response protein levels in acute pyelonephritis estimated by ⁹⁹Tc^m-DMSA renal scanObjective: To evaluate the diagnostic value of serum C-response protein (CRP) levels in acute pyelonephritis with ⁹⁹Tc^m-DMSA renal scan.Methods: Serum CRP levels and DMSA scintigraphy were measured for 80 women admitted for suspected febrile UTI (first episode). Make a comparative study with CRP levels and imaging results.Results The mean CRP level was significantly higher in acute pyelonephritis than in UTI without renal lesions (15.7±9.8mg/L vs 4.3±2.5 mg/L, P=0.000). CRP levels and results of ⁹⁹Tc^m-DMSA renal scan had moderate goodness of fit(K=0.61,P=0.000). For the prediction of acute pyelonephritis, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CRP measurements were 66.0%,95.7%,80.0%,94.6% and 71.4% respectively. And there was a significant correlation between serum CRP levels and the severity of renal lesions.Conclusions: Serum CRP levels may be useful for early diagnosis of acute pyelonephritis and determination of the severity of renal parenchymal involvement.2. To analysis related factors of reduced glomerular filtration rate in renal cell carcinoma patientsObjective: To investigate related factors of reduced glomerular filtration rate in renal cell carcinoma (RCC) patients.Methods: There were 98 cases of RCC patients. ⁹⁹Tc^m-DTPA renal dynamic imaging was performed for determining glomerular filtration rate (GFR) before surgery. According to with or without renal dysfunction, 98 cases were divided into two groups to do univariate analysis. Factors associated with GFR were dealt by linear correlation analysis and multiple regression analysis. All data were analyzed by t-test orχ²-text.Results: The age of GFR reduction group (GFR <60 ml/min) were higher than GFR normal group (t =-3.524,p<0.01),and then RCC patients with hypertension had higher incidence of GFR decline (χ² =3.902,p<0.05). Linear correlation analysis showed that age,creatinine(Cr)and uric acid (UA)was negative correlation with GFR(P<0.05),hemoglobin(Hb) was positive correlation with GFR(P<0.05). According to multiple regression analysis, age,Cr and UA entered the regression equation(F=15.81,P=0.000),so they were main factors of GFR decline in RCC patients.Conclusions: GFR decline of RCC patients is the result of multiple factors,in which age and hypertension account for most.3. The clinical significance of glomerular filtration rate measured by ⁹⁹Tc^m-diethylentriamine pentaacetic acid renal dynamic imaging in renal cell carcinoma patients before surgeryObjective: To investigate the clinical significance of glomerular filtration rate (GFR) measured by ⁹⁹Tc^m-diethylentriamine pentaacetic acid (⁹⁹Tc^m-DTPA) renal dynamic imaging in renal cell carcinoma patients before surgery.Methods: There were 98 cases of RCC patients,88 patients undergoing radical nephrectomy (RN) and 10 patients undergoing nephron-sparing surgery (NSS). ⁹⁹Tc^m-DTPA renal dynamic imaging were performed for determining glomerular filtration rate (GFR) before surgery. Make a comparison of GFR between RCC group and control group (normal kidney donors). Make a comparison of GFR between RN group and NSS group. Make a comparison between GFR and serum creatinine in determining preoperative renal dysfunction of RCC patients. Follow-up was made in some patients three months after surgery. Make a comparison of uninjured kidney's GFR and renal function before and after surgery. All data were analyzed by t-test orχ²-text.Results: Compared with contral group, total GFR of RCC patients was lower,but there was no significant difference (76.7±20.4 ml/min vs 80.6±17.4 ml/min, t= 0.789 ,p>0.05). 18.4% of RCC patients had preoperative renal dysfunction(total GFR <60 ml/min),but only 3 cases performed abnormal serum creatinine(>133μmol/L).There was no significant difference in GFR of neoplastic kindeys between NSS group and RN group(34.1±11.7ml/min vs 38.1±11.9 ml/min,t= -1.014,p>0.05).GFR of contralateral kidneys was lower in NSS group than RN group(32.7±10.3ml/min vs 39.7±10.1ml/min,t=-2.067,p<0.05). The percentage of preoperative renal dysfunction(total GFR <60 ml/min) in NSS group was significantly higher than in RN group(50.0% vs 14.8%,χ²=7.432,p<0.01).Patients with normal GFR of uninjured kidney before surgery had no significant change in GFR of uninjured kidney three months after surgery. Also, they had normal renal function.Conclusions: GFR can provide the accurate information of both kidneys and single kidney before surgery. Thus it is important for treatment decisions and may anticipate prognosis after operation.