摘要
目的探讨^99Tc^m-二巯基丁二酸(DMSA)肾SPECT/CT显像对成人上尿路感染的诊断价值。方法回顾性分析2017年9月至2019年12月间北京医院109例临床疑诊上尿路感染患者[男14例,女95例,年龄23~85(60.0±14.1)岁]的^99Tc^m-DMSA肾SPECT/CT显像及临床资料,以临床最终诊断作为诊断标准,分析^99Tc^m-DMSA肾SPECT/CT显像的诊断效能,并与SPECT显像结果比较;另分析上尿路感染的SPECT/CT影像表现。采用χ^2检验或Fisher确切概率法比较不同诊断方法间的差异。结果109例患者中^99Tc^m-DMSA肾SPECT/CT显像诊断上尿路感染91例,其诊断上尿路感染的灵敏度、特异性、阳性预测值、阴性预测值及准确性分别为100%(86/86)、78.26%(18/23)、94.51%(86/91)、18/18、95.41%(104/109);同机低剂量CT的应用使SPECT/CT显像的诊断特异性明显高于SPECT显像[52.17%(12/23),P=0.014],并有5.81%(5/86)的患者借助于同机CT发现了上尿路感染的病因。29.41%(10/34)的慢性肾盂肾炎患者SPECT/CT显像可见典型肾瘢痕征象;剔除典型肾瘢痕患者后,急性、慢性肾盂肾炎患者肾放射性减低或缺损区≤2个者分别为11.54%(6/52)和37.50%(9/24),差异有统计学意义(χ^2=6.987,P=0.008)。结论^99Tc^m-DMSA肾SPECT/CT显像对成人上尿路感染的诊断具有良好的临床应用价值。与^99Tc^m-DMSA肾SPECT显像相比,SPECT/CT显像能有效提高特异性,探查尿路梗阻、结石等上尿路感染病因。
Objective To explore the diagnostic value of ^99Tc^m-dimercaptosuccinic acid(DMSA)renal SPECT/CT imaging in adult upper urinary tract infection.Methods From September 2017 to December 2019,^99Tc^m-DMSA renal SPECT/CT imaging and clinical data of 109 patients(14 males,95 females;age:23-85(60.0±14.1)years)suspected of upper urinary tract infection from Beijing Hospital were retrospectively analyzed.Final clinical diagnosis was regarded as the diagnostic standard.The diagnostic efficacy of ^99Tc^m-DMSA renal SPECT/CT imaging was analyzed and compared with that of ^99Tc^m-DMSA renal SPECT imaging.The imaging features of SPECT/CT imaging in upper urinary tract infection were analyzed.The differences between the diagnostic methods were analyzed by usingχ^2 test or Fisher′s exact test.Results Of 109 patients,91 were diagnosed as upper urinary tract infection by ^99Tc^m-DMSA renal SPECT/CT imaging,with the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 100%(86/86),78.26%(18/23),94.51%(86/91),18/18 and 95.41%(104/109),respectively.With the application of low-dose CT,the diagnostic specificity of SPECT/CT was significantly higher than that of SPECT(52.17%(12/23);P=0.014),and the causes of upper urinary tract infection were found in 5.81%(5/86)of patients with the help of CT.There were 10(29.41%,10/34)patients with chronic pyelonephritis had typical signs of renal scar on SPECT/CT imaging.Excluding the patients with typical renal scar,11.54%(6/52)and 37.50%(9/24)of patients with acute and chronic pyelonephritis had decrease or defect focus≤2(χ^2=6.987,P=0.008).Conclusions ^99Tc^m-DMSA renal SPECT/CT has good clinical value in the diagnosis of adult upper urinary tract infection.Compared with ^99Tc^m-DMSA renal SPECT,^99Tc^m-DMSA renal SPECT/CT can effectively improve the diagnostic specificity and explore the causes of upper urinary tract infection such as urinary tract obstruction and stones.
作者
陈聪霞
王海涛
陈敏
姚稚明
郭悦
李旭
Chen Congxia;Wang Haitao;Chen Min;Yao Zhiming;Guo Yue;Li Xu(Peking University Fifth School of Clinical Medicine,Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nephrology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华核医学与分子影像杂志》
CAS
北大核心
2020年第7期394-398,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
