Methoden zur quantitativen Clearancebestimmung

Zusammenfassung

Es gibt mehrere Prinzipien, nach denen Clearancebestimmungen durchgeführt werden können und unter diesen jeweils eine Reihe von unterschiedlichen Verfahren, die teilweise in Abhängigkeit vom verwendeten Radiopharmakon zur Anwendung kommen. Insbesondere für einfache und häufig in der klinischen Routine eingesetzte Methoden stehen eine Vielzahl verschiedener, empirisch gefundener Algorithmen zur Verfügung, über deren Wertigkeit und Genauigkeit sich die Experten selten einig sind und die länderabhängig in unterschiedlichem Ausmaß eingesetzt werden.
In der vorliegende Arbeit werden zum einen die physiologischen Grundlagen von Clearancebestimmungen erörtert sowie die vorwiegend eingesetzten Radiopharmaka vorgestellt, zum anderen die theoretischen Hintergründe der einzelnen Clearancebestimmungsverfahren dargelegt. Schwerpunktmäßig befasst sich der Artikel dabei mit der Modifikation der seit Anfang der 70-iger Jahre bekannten Single-Sample-Methode durch den Autor. Die resultierenden neuen Algorithmen sind inzwischen vor allem in Deutschland sehr verbreitet, was als wesentlicher Beitrag zur Standardisierung von Clearanceergebnissen mit ^99mTc-MAG₃ anzusehen ist. Außerdem wird eine Auswahl geeigneter Algorithmen für die Verwendung verschiedener Clearancesubstanzen präsentiert.
Ergänzend erfolgt eine detaillierte Beschreibung eines ganz wesentlichen Teils der nuklearmedizinischen Nierendiagnostik: Die Berechnung der seitengetrennten, relativen Clearance nach einer Methode, die in die Software der meisten Kamerahersteller implementiert ist.

Abstract

There are several principles which can be used for clearance determination, and a number of different methods are applied under each principle, some of them dependent on the radiopharmaceutical used. A large variety of different algorithms, which were determined empirically, are available for methods employed in clinical routine. Experts seldom agree on their usefulness and accuracy, and they are employed to different extents depending on the country.
This review article presents the physiological basics of clearance determination and gives a short overview of the radiopharmaceuticals used as well as showing the theoretical background of the respective clearance determination methods. The paper focuses on the author's modification of the single-sample method, which has been known since the 1970's. The resulting new algorithms are meanwhile widely used especially in Germany, which is a considerable contribution to the standardization of clearance results using ^99mTc-MAG₃. Furthermore, a selection of suitable algorithms for the use of different clearance substances is offered.
A further, essential aspect of renal diagnostics in nuclear medicine is described in detail: The calculation of the split clearance using a method implemented in the software of most camera manufacturers.

Nierenfunktion - Clearance - GFR - ERPF - TER

Renal function - clearance - GFR - ERPF - TER

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1 Bezugsquelle von PC-Programmen zur Clearenceberechnung nach dieser Methode siehe unter „Hinweise” am Ende dieses Artikels.