Perkutanöz Nefrolitotomide Parankim Kalınlığının BT ve Tc-99m DMSA Sintigrafisi ile Karşılaştırılmas

Abstract

Amaç: Perkutanöz nefrolitotomi PNL büyük ve komplike renal callus tedavisinde kullanılan cerrahi yöntemlerdendir. Hemoraji PNL'nin en önemli komplikasyonlarından biri olarak bildirilmektedir. Gelişen hemorajinin böbrek parankim kalınlığı ile ilişkili olabileceğini bildiren yayınlar bulunmaktadır. Çalışmamızın amacı PNL öncesi bilgisayarlı tomografi BT ve Tc-99m DMSA ile ölçülen böbrek boyutları ve parankim kalınlıklarının karşılaştırılması ve aralarında korelasyon olup olmadığının saptanmasıdır. Metaryal ve metod: Çalışmaya PNL öncesi abdomen tomografileri ve Tc-99m DMSA ile renal kortikal sintigrafileri çekilmiş 16 hasta dahil edildi. Hastaların böbrek boyutları, üst, orta ve alt pollerden böbrek parankim kalınlıkları ile ortalama parankim kalınlıkları hesaplandı. Bulgular: Ortalama parankim kalınlığı BT'de sağ böbrek için 18.68±5.41 mm, sol böbrek için 17.62± 4.55 mm olarak hesaplandı. DMSA sintigrafisinde ise ortalama parankim kalınlığı sağ böbrek için 15,27±3.30 mm, sol böbrek için 16.27± 3.89 mm olarak hesaplandı. Ortalama böbrek boyutları BT'de sağ için 99.49 ± 18.92 x 46.53 ± 12 mm, sol için 95.40± 11.91x45.58± 11.23 mm olarak hesaplanırken, sintigrafide sağ için 106.66 ± 18.48x 47.36 ± 11.52 mm, sol için 104.37±18.28x 46.26±12.94 mm olarak hesaplandı. Sonuçta DMSA sintigrafisi ile BT'den ölçülen parankim kalınlığı ve böbrek boyut ölçümleri arasında anlamlı korelasyon görüldü p

Keywords

• Böbrek,Tc-99m DMSA,Bilgisayarlı tomografi

The Comprassion of Parenchymal Thickness with CT and DMSA Scintigraphy in Percutaneous Nephrolithotomy

Abstract

Background: Percutaneous nephrolithotomy PNL is one of the surgical methods used in the treatment of large and complex renal callus. Hemorrhage has been reported as one of the major complications of PNL. There are publications reporting that composed hemorrhage may be associated with renal parenchymal thickness. The aim of this study is to compare the sizes and parenchymal thickness of kidneys measured by computed tomography CT and Tc-99m DMSA scintigraphy before PNL and determine whether there is a correlation between them. Methods: Sixteen patients who performed abdominal CT scan and Tc-99m DMSA renal cortical scintigraphy before PNL, were included to study. The patients' kidney sizes, parenchymal thicknesses from upper, middle and lower poles and mean parenchymal thicknesses were calculated. Results: The mean parenchymal thickness was calculated as 18.68±5.41 mm for right kidney and 17.62± 4.55 mm for left kidney on CTscan. On DMSAscintigraphy, the mean parenchymal thickness was calculated as 15,27±3.30 mm for right kidney and 16.27± 3.89 mm for left kidney. While the mean kidney sizes were calculated as 99.49 ± 18.92 x 46.53 ± 12 mm for right and 95.40± 11.91x45.58± 11.23 in left on CTscan, they were calculated as 106.66 ± 18.48x 47.36 ± 11.52 mm for right and 104.37±18.28x 46.26±12.94 for left on scintigraphy. As a result, a significant correlation was seen between parenchymal thicknesses and kidney sizes measured by DMSAscintigraphy and CTscan p

Keywords

• Kidney, Tc-99m DMSA, Computed tomography.

References

1. ) Chatham JR, Dykes TE, Kennon WG, Schwartz BF. Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography.Urology. 2002; 59(4):522-5
2. ) Kukreja R, Desai M, Patel S, Bapat S. Factors a f f e c t i n g b l o o d l o s s d u r i n g p e r c u t a n e o u s nephrolithotomy: prospective study. J Endourol. 2004; (8) : 715-22.
3. ) Kaplon DM, Lasser MS, Sigman M, Haleblian GE, Pareek G. Renal parenchyma thickness: a rapid estimation of renal function on computed tomography. Int Braz J Urol. 2009;35(1):3-8.
4. ) Lin E, Connolly LP, Zurakowski D, DiCanzio J, Drubach L, Mitchell K, Tetrault T, Laffin SP, Treves ST. Reproducibility of renal length measurements with mTc-DMSA SPECT. J Nucl Med. 2000;41(10):1632
5. ) Demirtaş A, Caniklioğlu M, Kula M, Sofikerim M, Akınsal EC, Ergül MA, Baydilli N, Ekemekçioğlu O. Assessment of the effects of access count in percutaneous nephrolithotomy on renal functions by technetium-99m-dimercaptosuccinic Acid scintigraphy. ISRN Urol. 2013;8(5);83-91.
6. ) Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F et al. Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol. ; 148(1) : 177-80. ) El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I et al. Postpercutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol. 2007; 177(2) : 576-9.
7. ) Rice HE, Frush DP, Farmer D et al Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg 2007; 42(4):603–7.
8. ) Sargent MA, Wilson BPM. Observer variability in the sonographic measurement of renal length in childhood. Clin Radiol. 1992;46(5):344–7.

9. ) Carrico CWT, Zerin JM. Sonographic measurement of renal length in children: does the position of the patient matter? Pediatr Radiol. 1996;26(8):553–5.
10. ) Dhar M, Denstedt JD Imaging in diagnosis, treatment, and follow-up of stone patients. Adv Chronic Kidney Dis 2009; 16(1):39–47
11. ) Brenner D, Elliston C, Hall E et al . Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001 ;176(2):289–96
12. ) Turk C, Knoll T, Petrik A et al. EAU guidelines on urolithiasis. Eur Assoc Urol 2013:1–100
13. ) Ng CF, Chan LW, Wong KT, Cheng CW, Yu SC, Wong WS. Prediction of differential creatinine clearance in chronically obstructed kidneys by non-contrast helical computerized tomography. Int Braz J Urol. 2004;30(2):102
14. ) Wallin L, Thorne J, Bajc M. Kidney size estimation in piglets using dimercaptosuccinic acid (DMSA) scintigraphy. Clin Physiol. 1997;17(6):591–7.
15. ) Rossleigh MA, Farnsworth RH, Leighton DM, Yong JLC, Rose M, Christian CL. Technetium-99m dimercaptosuccinic acid scintigraphy studies of renal cortical scarring and renal length. J Nucl Med. ;39(7):1280–85.
16. ) Ferrer FA, McKenna PH, Bauer MB, Miller SF. Accuracy of renal ultrasound for predicting actual renal size. J Urol. 1997;157(6):2278–81.
17. ) Cao X, Zurakowski D, Diamond DA, Treves ST. Automatic measurement of renal volume in children using mTc dimercaptosuccinic acid SPECT: normal ranges with body weight. Clin Nucl Med. 2012;37(4):356-61.