Effects of renal ROI and depth calibrated by 99Tcm-DMSA renal imaging on GFR measurement of the injured-kidney in infants with congenital hydronephrosis
Objective To investigate the application value of 99Tcm-dimercaptosuccinic acid(DMSA)renal static imaging to correct renal ROI and renal depth in measurement of glomerular filtration rate(GFR)of the injured-kidney in infants with congenital hydronephrosis.Methods From January 2022 to November 2022,30 infants with congenital hydronephrosis(25 males,5 females,age 3.0(1.0,5.5)months)in Nu-clear Medicine Department of the Second Hospital of Shanxi Medical University were prospectively included.Sixty kidneys were divided into 3 groups according to the degree of hydronephrosis:normal group(7 left kidneys and 12 right kidneys),mild hydronephrosis group(10 left kidneys and 12 right kidneys)and mod-erate to severe hydronephrosis group(13 left kidneys and 6 right kidneys).The patients received 99Tcm-di-ethylenetriamine penta-acetic acid(DTPA)diuretic renal dynamic imaging and 99Tcm-DMSA renal static imaging within 3 days,and bilateral renal lateral acquisition was performed at the end of the imaging.The depths(cm)of kidneys measured based on the lateral image and Tonnesen's formula were compared.The single kidney GFR(ml·min-1·1.73 m-2)measured after the renal ROI corrected,or renal depth corrected,or re-nal ROI-depth corrected by renal static imaging(aGFRsingle,dGFRsingle,adGFRsingle)was compared with that measured by Gates method(gGFRsingle).The one-way analysis of variance,the least significant differ-ence-t test and Dunnett-t test were used for data analysis.Results In different hydronephrosis groups,renal depths measured by dynamic imaging,static imaging and Tonnesen formulas were significantly different(F values:38.07-59.63,t values:2.53-15.17,all P＜0.05).There were no significant differences in renal depth between the two kinds of imaging in the normal group(F values:34.89,54.30,both P＜0.05;t val-ues:0.65,1.60,both P＞0.05).aGFRsingle of all groups were smaller than gGFRsingle,but the values were similar,and were not significantly different in normal kidneys(F values:3.02,5.51,both P＜0.05;t val-ues:0.12,0.53,both P＞0.05),while those in abnormal kidneys(left kidneys:43.27±8.84 vs 46.19± 7.88,F=9.75,t=2.18,bothP＜0.05;right kidneys:39.87±10.25 vs 42.94±10.28,F=10.32,t=2.04,both P＜0.05)and in mild(48.58±10.94 vs 51.08±11.44,F=10.34,t=2.04,both P＜0.05),moderate to severe(34.41±8.84 vs 37.62±8.84,F=19.97,t=3.41,both P＜0.05)hydronephrosis groups were differ-ent.The dGFRsingle was significantly higher than gGFRsingle in 3(normal,mild,moderate to severe)hydro-nephrosis groups(t values:3.82,3.39,3.81,all P＜0.01).adGFRsingle was between aGFRsingle and dGFRsingle,and adGFRsingle were significantly different from gGFRsingle in normal right kidneys,in abnormal kidneys and in mild and moderate to severe hydronephrosis groups(t values:2.25-3.12,all P＜0.05).Conclusions Renal static imaging corrected ROI can improve the accuracy of GFR measurement of the affected kidney,especially for children with moderate and severe congenital hydronephrosis.However,the GFR corrected for renal depth or ROI-depth are significantly different from the true GFR.The lateral kidney depth measured by static imaging is more accurate than that measured by dynamic imaging.
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