摘要目的 探讨核素肾动态显像(99Tcm-DTPA)对肾脏占位病变性质评估的价值.方法 164例肾占位病例,术后均经病理证实,其中肾占位恶性病例119例,肾占位良性病例45例,分析应用99Tcm-DTPA、超声检查(US)、计算机辅助体层摄影术(CT)、磁共振成像( MRI)、静脉肾盂造影(IVP)及正电子发射型计算机断层扫描显像( PET-CT)等影像技术鉴别肾占位病变性质的特点.结果 几种常用影像学检查定性判断肾良、恶性占位病变的准确率如下:99Tcm-DTPA为84％、45 ％;US为72％、64 ％;CT为91％、92％；MRI为50％、67％；IVP为50％、17 ％;PET-CT诊断恶性占位准确率为67％.99Tcm-DTPA判断不同病理分期肾透明细胞癌阳性率差异具有统计学意义(x2=83.4,P＜0.01)；判断肾内良性病变中肾囊肿与肾血管平滑肌瘤的阳性率分别为85％(22/26)和80％( 12/15),差异无统计学意义(x2=0.0035,P＞ 0.05).对直径＞4 cm的病灶诊断符合率为68％(71/105),明显高于≤4 cm者的33％(20/59),差异具有统计学意义(x2=16.05,P＜ 0.05).结论 99Tcm-DTPA不仅能够定量评价肾脏功能,而且对判定肾占位病变的良恶性具有重要价值.

abstractsObjective To evaluate 99tcm-DTPA nuclear dynamic imaging in distinguishing the renal occupied disease.Methods A total of 164 in-patients with renal occupied disease who underwent surgery were included.According to the pathological diagnosis,119 patients had malignant tumors,and 45 patients had benign diseases.All patients’ imaging was retrospectively analyzed.Application of 99Tcm-DTPA nuclear dynamic imaging in renal occupied disease was compared with ultrasonography (US),computed tomography (CT),magnetic resonance imaging (MRI),intravenous pyelogram (IVP),and positron emission tomography (PET)-CT.Results The accuracy rates of different imaging methods in distinguishing between renal malignant and benign disease were 99Tcm-DTPA (84 ％,45 ％),US (72 ％,64 ％),CT ( 91％,92 ％),MRI (50 ％,67 ％),IVP (50 ％, 17 ％), respectively.The diagnostic accuracy rate of PET-CT for malignant tumors was 67 ％.The accuracy rates of 99Tcm-DTPA in distinguishing different phases of renal cell carcinoma were statistically significant (x 2 =83.4, P ＜ 0.01), while the accuracy rates in distinguishing renal cyst from renal angiomyolipoma were not statistically different.With the greater diameter, the diagnostic accordance rate is higher (x 2 =16.05,P ＜ 0.05).Conclusion 99Tcm-DTPA could be used not only to evaluate the renal function quantificationally,but also be helpful to distinguish renal malignant tumor from benign disease.