核医学课件：10肾图-1

1、RENOGRAPHY1、definition A renography is simply a time-activity curve using renogram equipment(肾图仪) after the bolus intravenous injection of a radiopharmaceutical（放射性药物）.It provides a graphic representation of the renal function(肾功能) and the conditions of upper urinary tract（上尿路情况）.It is a routine exa

2、mination.simple and convenientnon-invasiveprovides the function of each kidney2、radioactive tracerradioiodinated ortho iodiohippurate (sodium)131I-OIH99mTc-diethylenetriaminepenta acetic acid99mTc-DTPA99mTc-labeled agent mertiatide99m Tc-MAG33、principle 131I-OIH bolus intravenous injection secreted

3、by renal tubular epithelial cell (80%) renal pelvis ureter bladder 20% of 131I-OIH is filtrated by glomerulus.弹丸式注射肾小管上皮细胞肾盂输尿管膀胱肾小球滤过4、method4.preparation4.administration4.examination history-takinghydrated (drink water 300ml)urination（排尿）bolus injection 131I-OIH 185-370kBq(5-10Ci)Initiating(启动) th

4、e equipment at the same time of injectioninformation displayed about 15 to 20 min after injection5、normal renographyThe normal renogram consists of three phases.phase a : patent period phase b : aggregation period phase c : excretion period 示踪剂出现段示踪剂聚集段示踪剂排泄段5. phase aA steeply rising curve lasts ab

5、out 10 second after injection.5. 2. phase b A gradual rising curve following phase a. It occurs during minutes 2 through 4 and contains the peak of the curve. The slope and height reflex the rate and quantity of uptake of131I-OIH by renal tubular epithelial cell（肾小管上皮细胞）. It relates with effective r

6、enal plasma flow （肾有效血浆流量）and secretion function of renal tubules（肾小管分泌功能） 5. 3. c phase A decline curve after phase b. The downslope of the curve determined by urinary flow（尿流量） and the free movement of the urine in upper urinary tract（上尿路通畅）. It reflexes the quantity and rate of elimination of the

7、 tracer from the kidney. 6、semiquantitative indices（半定量指标）（半定量指标）time to peak activity （峰时）（峰时） Tb5min half-time excretion C1/28min difference of peak activity（峰值差）（峰值差） 30% difference in peak time （峰时差）（峰时差） 1min the time for half of the peak activity to be cleared from the kidney（半排时间）（半排时间）7、abno

8、rmal renography and its clinical applicationreasonprerenal(肾前性)：decrease of ERPFrenal(肾性)：impairement of renal functionpostrenal( 肾后性)：urinary obstruction renal tuberculosis（肾结核）, renal tumor 7. persistent rising（急剧上升型）（急剧上升型） curve analysisclinical applicationa: normalb: persistent risingc: no decl

9、ineurinary obstruction（尿路梗阻）（尿路梗阻） curve analysisa: normalb: straightlineno demarcation between b and cclinical applicationlong-standing urinary obstruction causing renal function damageurinary obstruction after renal function damage for a long longation at a high level（高水平延长型）（高水平延长型）7.par

10、abolic curve（抛物线型）（抛物线型） curve analysisa: normal/slight lowb: gradual risingc: gradual declineTp delayedclinical applicationacute incomplete obstruction of upper urinary tract hydronephrosis(肾盂积水)，renal ischemia（肾缺血）moderate impairment of renal longation at a low level（低水平延长型）（低水平延长型） c

11、urve analysisa: lowb: straightlineno demarcation between b and cclinical application significant renal damage chronic complete obstruction of upper urinary tract with bad hydronephrosis(慢性上尿路严重梗阻伴大量肾盂积水)acute renal failure （急性肾功衰） curve analysisa: lowno b and cgradual decline after phase a appearing

12、clinical applicationno function or poor functionrenal agenesis（肾缺损）nephrectomy（肾缺如）7.progressive decrease at a low level（低水平递降型）（低水平递降型）7.staircase decline（阶梯下降型）（阶梯下降型） curve analysisa: normalb: normalc: decline as irregular stairsclinical applicationspasm of upper urinary tractpainmental tension（精

13、神紧张）urinary tract infection（尿路感染）痉挛.unilateral small renogram（单侧小肾图）（单侧小肾图） curve analysisOne side : normalSuffering side: a near-normal shape but the peak activity obvious decreased clinical applicationsignificant difference of function between the two kidneysstenosis of renal artery at one side（单侧

14、肾动脉狭窄）（单侧肾动脉狭窄）congenital renal aplasia（先天性一肾发育不全）（先天性一肾发育不全）8、diuretic renography（利尿肾图）（利尿肾图） Diuretic renography is an important test to distinguish between obstructive hydronephrosis（机械性梗阻） and non-obstructive dilatation（非梗阻性尿路扩张）.8. principleobstructive hydronephrosis (anatomic)non-obstructive d

15、ilatation (functional)urinary stone（尿路结石）stenosis of urinary tract （尿路狭窄）tubatorsion （输尿管扭转）vesicoureteral reflux（膀胱输尿管返流）urinary tract infection（尿路感染）non-obstructive dilatationobstructive hydronephrosispyelectasispressure lowerthe rate of elimination of urine (agent) slowrising renogramusing a diureticpressure increasedphase c appearingrising renogramfunctionalanatomic肾盂扩张梗阻曲线利尿剂 method result8.2. method and resultfur