| Part Ⅰ Analysis of frequentely impact factors using 99mTc-DTPA renal dynamic imaging to measure glomerular filtration rateObjective: To enhance success ratio and diagnostic accuracy of the 99mTc-DTPA renal dynamic imaging, we analyzed the frequentely impact factors and characteristics in routine.Methods:A retrospective analysis of the unsuccessful renal dynamic imaging of 38 cases (20 female cases,18 male cases) and one male healthy volunteer over the past 15 months. The study concluded radioactive counts of syringes, radioactive leakage at injection site, shape of the renogram curve, renal radioactive percentage (%DOSE), and total glomerular filtration rate (TGFR) of two times imaging.Results:A total of 18 cases (18/38) were found radioactive leakage at injection site,The renogram curve showed that the maximal counts of the curves was lower and the excretory phase of the renogram curve was prolonged,%DOSE and TGFR significantly decreased (P=0.0002 and P=0.0003);7 cases (7/38) occurred frustrated injection due to vein rupture;5cases(5/38) have higher radioactive counts in empty syringes, and no significant difference was found in TGFR;8 cases (8/38) were the failure of imaging because of inconsistent doses,body movement and other factors;The volunteer underwent two times renal dynamic imaging in interval of three days,the imaging were respectively performed after given 500ml water 5 minutes and 30 minutes. The renogram curve showed lower maximal counts, elevated excretory phase and poor TGFR.Conclusion:Any one error in the process of 99mTc-DTPA renal dynamic imaging may be caused the failure of imaging.It is important to understand the frequentely impact factors and characteristics to ensure the accuracy of the results.Part II Research on calculation method of the kidney depthObjective:To establish and evaluate the calculation method in order to obtain the accurate depth of the kidney.Methods:A group(219 cases) and B group(105 sases) were selected, and their sex, age, height and weight were recorded. The CT scan was performed to measure the kidney depth of each patient. A multiple linear stepwise regression analysis was carried out to determine the relative importance of each of several variables in order to develop a new regression equation for estimating the kidney depth. A group was used to derive a new regressive formula and the B group was used to verify the formula. Coefficient of determination R2 was used to compare the kidney depth calculated according to two formulas. Another Synchronized research: A total number of 123 patients who measure GFR using Gates method were enrolled. The kidney depth was calculated using Tonnesen formula and BMI was also calculated and classificated by World Health Organization (WHO)’s standard. With informed consent, CT scan was performed to measure the kidney depth of each patient. Paired-samples T test was used to compare the kidney depth calculated using Tonnesen formula and kidney depth measured in CT scan images.Results:①There was significant difference in left and right kidney depth in A group(t=2.244,P=0.026),which was found lower R2 in comparision of Tonnesen formula estimation and CT measurement(R2=0.658/0.668).②The depth regression equations deduced from this study were as followed:left kidney depth (cm)CTDL= 2.440+9.829xWdH+0.008xAge,right kidney depth (cm)CTDR=2.994+9.854×WdH (WdH:kg/cm).③The new equations was more accurate than Tonnesen formula(R2= 0.750/0.792;0.0.664/0.682).④In normal BMI range group, kidney depth calculated using Tonnesen formula and measured in CT scan images showed no statistical significant difference(left kidney depth comparisont=1.88,p=0.064; right kidney depth comparison t=1.69, P=0.097).Conclusion:The new equation is more accurate than Tonnesen formula. The Tonnesen formula is suitable for Chinese people whose BMI is in normal range.PartⅢ Establishment of normal reference intervals for GFR of the health children by 99mTc-DTPA renal dynamic imagingObjective: Glomerular filtration rate (GFR) is an important criterion to evaluate renal function.The aim of this study was to measure reference GFR intervals for Chinese children by means of 99mTc-DTPA renal dynamic imaging.Methods:Ninety-nine children (aged 8weeks～12years) with normal renal function underwent 99mTc-DTPA renal dynamic imaging to measure GFR using Gate’s method, and all cases were divided into fives groups by age.Results:①ccording to the method reported by Gate’s,the normal reference intervals of GFR as follows:8weeks～1years,GFR50～90ml/min;1～2years,GFR 67 ～ 91ml/min;2～3years,GFR75～95ml/min;3～10years,GFR 72～96ml/min;10～ 12years,GFR72～100ml/min.②The GFR was no gender difference in 2～12years group(P=0.0791).Conclusion: The data provided by this study is of value for evaluating the renal function of Chinese children objectively and quantitatively.PartIV Evaluation of the precision of kidney depth determination using Tonnesen formula in health children and its influence on GFRObjective: To study the precision of kidney depth calaculated by Tonnesen formula in health children and its influence on GFR.Methods:Ninety-nine children (aged 8weeks-12years) with normal renal function were divided into five groups by age and underwent 99mTc-DTPA renal dynamic imaging to measure GFR using Gate’s method,and were performed to measure directly the kidney depth of each case by lateral static views to replace Tonnesen formula. The Corrected GFR (cGFR) was obtained from the method.Results:①Kidney depth calculated using Tonnesen formula and measured in lateral views showed no statistical significant difference(p=0.05) except 10-12years group(P=0.0416/0.0247,a=0.01).②According to the method reported, the GFR as followed: 8weeks～1years,GFR 70±10 ml/min, cGFR 84±10 ml/min; 1～2years, GFR 79±6 ml/min, cGFR 94±7 ml/min; 2～3years, GFR85±5 ml/min, c GFR 98±4 ml/min; 3-10years, GFR 84±6 ml/min, c GFR 102±6ml/min; 10～12years, GFR86±7 ml/min, cGFR 105±6 ml/min. 1～3years GFR 82±6 ml/min, c GFR96±6 ml/min; 3～12yearsGFR 85±6 ml/min, cGFR 102±6 ml/min; 2～12years GFR 85±6 ml/min, cGFR100±6 ml/min. ③here were significantly different between GFR and cGFR in our every group(p<0.05).Conclusion:The kidney depth calculated using Tonnesen formula was suitable for older children;but statistical different was showed between GFR and cGFR in this group. As a result,kindey depth was not only fator influencing GFR. |
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