低剂量99Tcm-DTPA CZT SPECT/CT与常规剂量99Tcm-DTPA NaI SPECT/CT肾动态显像的一致性研究

Evaluation of consistency between low-dose 99Tcm-DTPA CZT SPECT/CT and conventional-dose 99Tcm-DTPA NaI SPECT/CT for dynamic renal imaging

    摘要
  • 摘要:
    目的 探究低剂量99Tcm-二亚乙基三胺五乙酸（DTPA）碲锌镉（CZT）SPECT/CT与常规剂量99Tcm-DTPA 碘化钠（NaI）SPECT/CT肾动态显像评估肾功能的一致性及可行性。
    方法 收集2024年5月至2025年5月在天津医科大学总医院接受370 MBq 99Tcm-DTPA CZT SPECT/CT（低剂量组）与555 MBq 99Tcm-DTPA NaI SPECT/CT（常规剂量组）2次肾动态显像的34例肾功能正常受检者的临床资料和影像资料进行前瞻性研究，其中男性14例、女性20例，年龄（45.8±14.2）岁，范围18~75岁。比较常规剂量组与低剂量组血清学指标（尿素、尿酸、肌酐、β2微球蛋白水平）和肾功能参数肾小球滤过率（GFR）、达峰时间（TTP）、半排时间和20 min残留率的差异。计量资料的组间比较采用配对t检验（方差齐）或Wilcoxon秩和检验；采用组内相关系数（ICC）评估2种显像方法测得的GFR的一致性；采用Pearson相关性分析和Bland-Altman法分别评估2种显像方法测得的双肾GFR的相关性和一致性。
    结果 常规剂量组与低剂量组患者相比，血清学指标（尿素、尿酸、肌酐、β2微球蛋白水平）检查结果差异无统计学意义（4.79±1.51） mmol/L对（5.03±1.26） mmol/L、（361.79±116.43） μmol/L对（340.94±102.74） μmol/L、73.00（61.50, 86.75） μmol/L对66.00（59.50, 90.25） μmol/L、1.52（1.22, 1.69） mg/L对1.23（1.07, 1.48） mg/L；t=−1.08、 1.13，Z=0.85、1.33；均P>0.05。左肾GFR（42.64±9.20） ml/min对（41.22±8.70） ml/min；t=1.54，P=0.132；右肾GFR（43.22±9.60） ml/min对（41.71±7.85） ml/min；t=1.35，P=0.185。左肾TTP 2.46（2.38, 3.46） min对2.45（2.38, 3.40） min；Z=0.21，P=0.840；右肾TTP 2.45（2.38, 4.39） min对2.45（2.38, 3.42） min；Z=0.61，P=0.553。左肾半排时间10.00（8.25, 13.00） min对11.00（9.00, 13.00） min；Z=−0.39，P=0.702；右肾半排时间12.50（10.00, 14.00） min对12.00（9.00, 13.00） min；Z=−0.27，P=0.786。左肾20 min残留率0.41（0.38, 0.46）%对 0.46（0.40, 0.48）%；Z=−2.44，P=0.023；右肾20 min残留率0.45（0.37, 0.47）%对 0.46（0.39, 0.49）%；Z=−2.25，P=0.031。综上，2种显像方法在评估肾功能参数GFR、TTP及半排时间方面差异均无统计学意义。常规剂量组与低剂量组GFR的ICC：左肾ICC=0.819、右肾ICC=0.725（均P<0.05）；Pearson相关性分析结果表明，左肾r=0.82、右肾r=0.74（均P<0.05），2种显像方法测得的双肾GFR呈中高度相关。Bland-Altman分析结果显示，左肾GFR 95%一致性界限（95%LoA）：−9.13~11.98，右肾GFR 95% LoA：−11.24~14.25，均在临床可接受范围内。
    结论 低剂量99Tcm-DTPA CZT SPECT/CT与常规剂量99Tcm-DTPA NaI SPECT/CT显像测得的血清学指标和肾功能参数具有良好的一致性。因此，在肾功能正常人群中，低剂量99Tcm-DTPA CZT SPECT/CT可满足临床肾功能评估需求，且具有降低辐射剂量的优势。

     

    Abstract:
    Objective To investigate the consistency and feasibility of low-dose 99Tcm-diethylene-triaminepentaacetic acid (DTPA) cadmium zinc telluride (CZT) SPECT/CT compared with conventional-dose 99Tcm-DTPA sodium iodide (NaI) SPECT/CT dynamic renal imaging in evaluating renal function.
    Methods A prospective study was conducted on 34 subjects with normal renal function (14 males and 20 females, mean age (45.8±14.2) years, ranging from 18 to 75 years) who underwent both 370 MBq 99Tcm-DTPA CZT SPECT/CT (low-dose group) and 555 MBq 99Tcm-DTPA NaI SPECT/CT (conventional-dose group) dynamic renal imaging at Tianjin Medical University General Hospital from May 2024 to May 2025. Clinical and imaging data were collected to compare serum biomarkers (urea, uric acid, creatinine, and β2-microglobulin levels) and renal functional parameters (glomerular filtration rate (GFR), time to peak (TTP), half-excretion time, and 20 min residual rate) between the two groups. Paired t-tests (equal variances assumed) or Wilcoxon rank-sum tests were used for intergroup comparisons of measurement data. Intraclass correlation coefficient (ICC) was employed to assess the consistency of GFR measurements between the two imaging methods. Pearson correlation analysis and Bland-Altman plots were utilized to evaluate the correlation and consistency of the bilateral renal GFR results obtained by the two methods.
    Results No statistically significant differences were observed in serum biomarkers (urea, uric acid, creatinine, and β2-microglobulin levels) between the conventional-dose and low-dose groups ((4.79±1.51) mmol/L vs. (5.03±1.26) mmol/L, (361.79±116.43) μmol/L vs. (340.94±102.74) μmol/L, 73.00 (61.50, 86.75) μmol/L vs. 66.00 (59.50, 90.25) μmol/L, 1.52 (1.22, 1.69) mg/L vs. 1.23 (1.07, 1.48) mg/L; t=−1.08, 1.13; Z=0.85, 1.33; all P>0.05). Left kidney GFR ((42.64±9.20) ml/min vs. (41.22±8.70) ml/min; t=1.54, P=0.132); right kidney GFR ((43.22±9.60) ml/min vs. (41.71±7.85) ml/min; t=1.35, P=0.185). Left kidney TTP (2.46 (2.38, 3.46) min vs. 2.45 (2.38, 3.40) min; Z=0.21, P=0.840); right kidney TTP (2.45 (2.38, 4.39) min vs. 2.45 (2.38, 3.42) min; Z=0.61, P=0.553). Left kidney half-excretion time (10.00 (8.25, 13.00) min vs. 11.00 (9.00, 13.00) min; Z=−0.39, P=0.702); right kidney half-excretion time (12.50 (10.00, 14.00) min vs. 12.00 (9.00, 13.00) min; Z=−0.27, P=0.786). Left kidney 20 min residual rate (0.41 (0.38, 0.46) % vs. 0.46 (0.40, 0.48) %; Z=−2.44, P=0.023); right kidney 20 min residual rate (0.45 (0.37, 0.47) % vs. 0.46 (0.39, 0.49) %; Z=−2.25, P=0.031). In summary, there was no statistical significance between the two imaging methods in assessing renal GFR, TTP and half-excretion time. ICC for GFR between the conventional-dose and low-dose groups: left kidney ICC=0.819, right kidney ICC=0.725 (both P<0.05). Pearson correlation analysis showed that left kidney r=0.82, right kidney r=0.74 (both P<0.05), the GFR of both kidneys measured by the two imaging methods showed moderate to high correlation. Bland-Altman analysis revealed 95% limits of agreement of −9.13–11.98 for left kidney GFR and −11.24–14.25 for right kidney GFR. These values are all within clinically acceptable ranges.
    Conclusion The serum biomakers and renal functional parameters measured by low-dose 99Tcm-DTPA CZT SPECT/CT and conventional-dose 99Tcm-DTPA NaI SPECT/CT imaging have good consistency. Therefore, low-dose 99Tcm-DTPA CZT SPECT/CT can meet the needs of clinical renal function assessment in people with normal renal function and has the advantage of reducing radiation dose.

     

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