{"title":"肾实质体积分析能代替核肾扫描在肾部分切除热缺血前后诊断肾功能分裂吗？","authors":"Yixin Huang, Ming Gao, Yanjun Wang, Rongliang Zheng, Shaohan Yin, Huiming Liu, Xiangpeng Zou, Xin Luo, Longbin Xiong, Zhaohui Zhou, Yulu Peng, Fangjian Zhou, Hui Han, Shengjie Guo, Pei Dong, Wen Dong, Zhiling Zhang","doi":"10.1016/j.urolonc.2024.12.271","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The assessment of split renal function (SRF) before and after partial nephrectomy (PN) is crucial. While nuclear renal scan (NRS) is a traditional method for evaluating SRF, its extensive use is hindered by concerns regarding radioactivity. Parenchymal volume analysis (PVA) has been employed to assess SRF for kidney donors. Nonetheless, the efficacy of PVA in evaluating SRF in kidneys with renal masses before and after PN with warm ischemia remains uncertain.</p><p><strong>Aim: </strong>The current study probed into the potential of PVA as a substitute for NRS in assessing SRF before and after PN with warm ischemia.</p><p><strong>Methods: </strong>This study included 318 patients who underwent unilateral PN with warm ischemia at Sun Yat-Sen University Cancer Center (SYSUCC) and had a functional contralateral kidney. All patients underwent PVA and NRS assessments both pre-PN and at 1-12 months post-PN. PVA was analyzed using Mimics software in the venous phase. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. The correlation between ipsilateral eGFR values derived from SRF assessed via PVA and NRS was examined using Pearson correlation. Concordance between different methods of SRF estimation was analyzed using the Friedman test, Bland-Altman plots, and Kendall's consistency coefficient. Similar study was conducted on a comparable cohort from Sun Yat-Sen Memorial Hospital.</p><p><strong>Results: </strong>The median tumor size was 3.5cm, and the median warm ischemia time was 25min. Preoperatively, ipsilateral SRF values based on PVA were notably consistent with those derived from NRS (49.4% vs 50.0%, P = .501). A strong correlation was observed between preoperative ipsilateral eGFR based on SRF from PVA and NRS (r = 0.89, P < .0001). Bland-Altman plots indicated minimal bias (-0.36%) between PVA and NRS in assessing SRF. However, post-PN, the median ipsilateral SRF based on PVA was slightly higher than that based on NRS (45.6% vs. 43.6%, P < .0001). Although there was still a strong correlation between post-PN ipsilateral eGFR based on SRF from PVA and NRS (r = 0.87, P < .0001), Bland-Altman plots revealed a non-negligible bias between the 2 methods (2.19 %). External study supported our findings.</p><p><strong>Conclusions: </strong>PVA shows promise as a substitute for NRS in assessing SRF before PN with warm ischemia. However, this substitution may result in an overestimation of ipsilateral renal function in the post-PN phase.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Can parenchymal volume analysis replace nuclear renal scans for split renal function before and after partial nephrectomy with warm ischemia?\",\"authors\":\"Yixin Huang, Ming Gao, Yanjun Wang, Rongliang Zheng, Shaohan Yin, Huiming Liu, Xiangpeng Zou, Xin Luo, Longbin Xiong, Zhaohui Zhou, Yulu Peng, Fangjian Zhou, Hui Han, Shengjie Guo, Pei Dong, Wen Dong, Zhiling Zhang\",\"doi\":\"10.1016/j.urolonc.2024.12.271\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The assessment of split renal function (SRF) before and after partial nephrectomy (PN) is crucial. While nuclear renal scan (NRS) is a traditional method for evaluating SRF, its extensive use is hindered by concerns regarding radioactivity. Parenchymal volume analysis (PVA) has been employed to assess SRF for kidney donors. Nonetheless, the efficacy of PVA in evaluating SRF in kidneys with renal masses before and after PN with warm ischemia remains uncertain.</p><p><strong>Aim: </strong>The current study probed into the potential of PVA as a substitute for NRS in assessing SRF before and after PN with warm ischemia.</p><p><strong>Methods: </strong>This study included 318 patients who underwent unilateral PN with warm ischemia at Sun Yat-Sen University Cancer Center (SYSUCC) and had a functional contralateral kidney. All patients underwent PVA and NRS assessments both pre-PN and at 1-12 months post-PN. PVA was analyzed using Mimics software in the venous phase. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. The correlation between ipsilateral eGFR values derived from SRF assessed via PVA and NRS was examined using Pearson correlation. Concordance between different methods of SRF estimation was analyzed using the Friedman test, Bland-Altman plots, and Kendall's consistency coefficient. Similar study was conducted on a comparable cohort from Sun Yat-Sen Memorial Hospital.</p><p><strong>Results: </strong>The median tumor size was 3.5cm, and the median warm ischemia time was 25min. Preoperatively, ipsilateral SRF values based on PVA were notably consistent with those derived from NRS (49.4% vs 50.0%, P = .501). A strong correlation was observed between preoperative ipsilateral eGFR based on SRF from PVA and NRS (r = 0.89, P < .0001). Bland-Altman plots indicated minimal bias (-0.36%) between PVA and NRS in assessing SRF. However, post-PN, the median ipsilateral SRF based on PVA was slightly higher than that based on NRS (45.6% vs. 43.6%, P < .0001). Although there was still a strong correlation between post-PN ipsilateral eGFR based on SRF from PVA and NRS (r = 0.87, P < .0001), Bland-Altman plots revealed a non-negligible bias between the 2 methods (2.19 %). External study supported our findings.</p><p><strong>Conclusions: </strong>PVA shows promise as a substitute for NRS in assessing SRF before PN with warm ischemia. However, this substitution may result in an overestimation of ipsilateral renal function in the post-PN phase.</p>\",\"PeriodicalId\":23408,\"journal\":{\"name\":\"Urologic Oncology-seminars and Original Investigations\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-01-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urologic Oncology-seminars and Original Investigations\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.urolonc.2024.12.271\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologic Oncology-seminars and Original Investigations","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urolonc.2024.12.271","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：评估肾部分切除术（PN）前后的分裂肾功能（SRF）至关重要。虽然核肾扫描（NRS）是评估SRF的传统方法，但其广泛使用受到放射性问题的阻碍。肾实质体积分析（PVA）已被用于评估肾供者的SRF。尽管如此，PVA在肾包块伴热缺血肾移植前后的SRF评估中的有效性仍不确定。目的：探讨PVA替代NRS评价热缺血PN前后SRF的潜力。方法：本研究纳入318例在中山大学肿瘤中心（SYSUCC）行单侧PN伴热缺血且对侧肾脏功能正常的患者。所有患者在pn前和pn后1-12个月均进行了PVA和NRS评估。应用Mimics软件分析静脉期PVA。估计的肾小球滤过率（eGFR）使用慢性肾脏疾病流行病学合作（CKD-EPI） 2021方程计算。通过PVA和NRS评估SRF得出的同侧eGFR值之间的相关性使用Pearson相关性进行检验。采用Friedman检验、Bland-Altman图和Kendall一致性系数分析不同SRF估计方法之间的一致性。在孙中山纪念医院进行了类似的研究。结果：中位肿瘤大小为3.5cm，中位热缺血时间为25min。术前，基于PVA的同侧SRF值与NRS的结果明显一致（49.4% vs 50.0%, P = .501）。术前基于PVA SRF的同侧eGFR与NRS有很强的相关性（r = 0.89,P < 0.0001）。Bland-Altman图显示PVA和NRS在评估SRF时偏差最小（-0.36%）。然而，在pn后，基于PVA的同侧SRF中位数略高于基于NRS的SRF中位数（45.6%比43.6%,P < 0.0001）。尽管基于PVA SRF和NRS的pn后同侧eGFR之间仍然存在很强的相关性（r = 0.87,P < 0.0001），但Bland-Altman图显示两种方法之间存在不可忽略的偏差（2.19 %）。外部研究支持我们的发现。结论：PVA有希望替代NRS评估热缺血PN前的SRF。然而，这种替代可能会导致对pn期后同侧肾功能的高估。
Can parenchymal volume analysis replace nuclear renal scans for split renal function before and after partial nephrectomy with warm ischemia?
Background: The assessment of split renal function (SRF) before and after partial nephrectomy (PN) is crucial. While nuclear renal scan (NRS) is a traditional method for evaluating SRF, its extensive use is hindered by concerns regarding radioactivity. Parenchymal volume analysis (PVA) has been employed to assess SRF for kidney donors. Nonetheless, the efficacy of PVA in evaluating SRF in kidneys with renal masses before and after PN with warm ischemia remains uncertain.
Aim: The current study probed into the potential of PVA as a substitute for NRS in assessing SRF before and after PN with warm ischemia.
Methods: This study included 318 patients who underwent unilateral PN with warm ischemia at Sun Yat-Sen University Cancer Center (SYSUCC) and had a functional contralateral kidney. All patients underwent PVA and NRS assessments both pre-PN and at 1-12 months post-PN. PVA was analyzed using Mimics software in the venous phase. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. The correlation between ipsilateral eGFR values derived from SRF assessed via PVA and NRS was examined using Pearson correlation. Concordance between different methods of SRF estimation was analyzed using the Friedman test, Bland-Altman plots, and Kendall's consistency coefficient. Similar study was conducted on a comparable cohort from Sun Yat-Sen Memorial Hospital.
Results: The median tumor size was 3.5cm, and the median warm ischemia time was 25min. Preoperatively, ipsilateral SRF values based on PVA were notably consistent with those derived from NRS (49.4% vs 50.0%, P = .501). A strong correlation was observed between preoperative ipsilateral eGFR based on SRF from PVA and NRS (r = 0.89, P < .0001). Bland-Altman plots indicated minimal bias (-0.36%) between PVA and NRS in assessing SRF. However, post-PN, the median ipsilateral SRF based on PVA was slightly higher than that based on NRS (45.6% vs. 43.6%, P < .0001). Although there was still a strong correlation between post-PN ipsilateral eGFR based on SRF from PVA and NRS (r = 0.87, P < .0001), Bland-Altman plots revealed a non-negligible bias between the 2 methods (2.19 %). External study supported our findings.
Conclusions: PVA shows promise as a substitute for NRS in assessing SRF before PN with warm ischemia. However, this substitution may result in an overestimation of ipsilateral renal function in the post-PN phase.
期刊介绍：
Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
