培訓(xùn)07核醫(yī)學(xué)泌尿系統(tǒng)8年制

1、中山大學(xué)附屬第三醫(yī)院 張勇,Urinary system,泌尿系統(tǒng),臨床醫(yī)學(xué)八年制核醫(yī)學(xué)教學(xué)課件,Kidney ureter bladder urethra,,Gross anatomy of kidney,,1 Filtration of glomeruli of kidney Produce crude urine NO blood cells and macromolecular prote

2、in2 Reabsorption and secretory action of kidney tubules,Urine production process,,Principle: After intravenous inject imaging agent which could be filtration by glomeruli and secrete from renal tubular epithelial cell，t

3、ime-acttivity curve of both kidney were automatically acquired by equipment,ⅠRadioactive nephrogram,,Normal nephrogram：a, b and c segmenta segment，reflect blood flow of kidneyb segment，reflect renal function and renal

4、blood flowc segment，reflect urinary flow and obstruction of urinary tract,Normal nephrogram：,,Abnormal nephrogram,,a Persistence ascend acute upper urinary tract obstructionb High level extended pattern nephrohydro

5、sis acompanyed impaired renal functionc Parabola pattern upper urinary tract drainage is not smooth, acompanyed nephrohydrosisd Low level extended pattern serious impaired renal functione Low level decrement nonfunc

6、tionf Echelon descend ureteral spasmg Unilateral small kidney URAC and congenital hypoplasia of kidney,Abnormal nephrogram and clinical significances,,Reflect biood flow of kidneyReflect renal functionReflect upp

7、er urinary tract drainage,ⅡNephro-dynamic imaging,,Principle After intravenous inject imaging agent ，renal information were acquired by dynamic collection using SPECT. We can dynamic observed the abdominal aorta, rena

8、l aorta, cortex renis, renal pelvis, kidney calices, ureter and bladder, and acquired quantitative index, including renal dynamic functional image, radioactive nephrogram , GFR and ERPF, et al.,,Glomerular filtration typ

9、e：acquired information of renal perfusion, renal function imaging and value of GFR . 99mTc-DTPARenal tubular secretion type： acquired information of renal tubular epithelial absorption, secretion and little part of glom

10、erular filtration. 99mTc-EC, 99mTc-MAG3, 131I-OIH,Imaging agents,,Normal renal dynamic images,,（1）Absent kidney image：Renal function or blood flow almost disappeared.（2）Kidney appeared or regression delayed：renal functi

11、on or renal perfusion impaired obviously.（3）Renal parenchymal image continued to exist：This may be due to the original urine formation was significantly reduced, or due to diffuse renal tubular lumen blockage.（4）i

12、mages of kidney calices, renal pelvis or ureter were enlarged and fade slowly：Urinary tract obstruction and dilatation.,Abnormal renal dynamic images,,Glomerular filtration (GFR)Effective Renal Plasma Flow (ERPF),Import

13、ant index of renal function,,Diuretic testCaptopril test,Interventional test,,Clinical significanceIdentification of simple urinary tract obstruction and mechanical obstruction of urinary tract,Diuretic test,,Right sid

14、e of the upper urinary tract dilation and diuretic renal dynamic imaging,,Right side of the mechanical obstruction of renal dynamic imaging,,⒈ single renal function evaluationRenal perfusion and renal parenchymal images

15、 were decreased, and appearance and regression of renal parenchymal were delayedGFR and /or ERPF ↓radioactive nephrogram: a segment decreased，b segment increase slowly and peak time delayed，c segment decreased slowly,C

16、linical application,慢性腎功能不全雙腎血流灌注差；功能動(dòng)態(tài)像可見(jiàn)雙腎顯影欠清晰，體積減小,以右腎明顯,,Diabetes,,Hypertension,,左腎積水,,Clinical application,⒉ Diagnosis and monitoring the efficacy of treatment of upper urinary tract obstruction The C segment of

17、 the radioactive nephrogram was significantly delayed or absent,,Clinical application,,Clinical application,uronephrosis,,Clinical application,⒊ Screening of unilateral renal vascular hypertensionCaptopril test can impr

18、ove the sensitivity and specificity of renal dynamic imaging for screening unilateral renal artery constriction.,,Clinical application,right renal artery constriction,右腎動(dòng)脈狹窄：上排為常規(guī)腎動(dòng)態(tài)顯像，發(fā)現(xiàn)右腎體積稍小，攝取功能輕度減低。下排為巰甲丙脯酸介入試驗(yàn)，顯示右

19、腎功能明顯受損。,,Clinical application,⒋ Monitoring after renal transplantation,移植腎功能良好,,移植腎動(dòng)脈閉塞,,,移植腎尿漏,,⒌ Judgement on the location, size and shape of the kidney,Clinical application,惡性腎腫瘤腎血流灌注顯像呈現(xiàn)血流灌注比正常腎組織早，灌注量多。腎動(dòng)態(tài)顯像呈

20、現(xiàn)全動(dòng)態(tài)過(guò)程固定的放射性空白區(qū)。,,,,,ⅢStatic Kidney Imaging,Principle：The imaging agents could be uptake and slowly clearing by normal function renal proximal tubule epithelial cells, and left in renal parenchyma to make kidney imaging

21、99mTc-DMSA 99mTc-GH,,1. Shape, position, size and position of kidney,horseshoe kidneys,polycytic kidney （99mTc-DMSA）雙腎放射性分布不均勻，可見(jiàn)多個(gè)放射性稀疏、缺損區(qū),,Nephropyelitis,2. Inflammatory lesion,腎盂腎炎： 上一排左側(cè)圖為左腎，可見(jiàn)上極放射性攝取

22、稀疏區(qū)，為腎盂腎炎影像特征。 下一排圖為治療后3月腎皮質(zhì)顯像，可見(jiàn)左腎上極放射性攝取較治療前明顯增加。,,Direct method and indirect method,ⅣReflux imaging of bladder and ureter,,（1）mild ：obvious imaging agents appeared in the lower ureter（2）moderate ：imaging agent app

23、eared in the upper urinary catheter（3）Serious ： imaging agent appeared in renal area,Interpretation of results,,Ⅴ Scrotal scintigraphy,Acute testicular torsion blood pool phase,,Delayed testicular torsion A, Blood flo