320排容积CT对主动脉夹层患者手术前后肾脏血流灌注改变的初步研究  

Preliminary study of the application of 320-slice dynamic volume CT on the changes of renal blood flow before and after operation in patients with aortic dissection

作　　者：刘东婷[1] 刘家祎[1] 温兆赢[1] 李宇[1] 张楠[1] 范占明[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所医学影像科,100029

出　　处：《心肺血管病杂志》2016年第12期967-973,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81401375)

摘　　要：目的:分析主动脉夹层(AD)患者外科及介入手术前后肾脏CT灌注的改变特点,探讨其应用可行性及临床诊断价值。方法:对31例AD的患者手术前后均行双肾血流灌注检查,同时行胸腹主动脉CTA检查,测量双肾血流量参数值血流量(BF)、血容量(BV)和清除率(Clearance),根据肾动脉受累情况,分为真腔组、假腔组、骑跨组。比较各组AD患者行手术前后各灌注参数值的差异,并观察主动脉夹层各种解剖形态学指标。结果:显示Stanford B型夹层29例,Stanford A型夹层2例。肾动脉开口于真腔、假腔和骑跨组BF值的差异有统计学意义(P<0.05),假腔组BF值最低;真腔和骑跨组的差异无统计学意义(P>0.05)。术后真腔和骑跨组的BV差异有统计学意义(P<0.05),骑跨组BV值较低;余各组对比无统计学意义(P>0.05)。手术前后真腔组术后BV和Clearance减低(P<0.05),BF差异无统计学意义(P>0.05);假腔组BV减低(P<0.05),BF和Clearance差异无统计学意义(P>0.05);骑跨组手术前后各灌注参数无统计学意义(P>0.05)。结论:320排CT灌注成像可用于评价整个肾脏血流动力学特征,外科及介入手术对AD患者肾血流灌注均有影响。灌注成像有助于术前判断肾功能状态,术后及时发现肾脏缺血状况,积极治疗,防止肾衰竭的发生。Objective： To investigate the changes of renal CT perfusion in aortic dissection（ AD） patients before and after operation,and to explore the feasibility and clinical diagnostic value of CT renal perfusion. Methods： All 31 AD patients underwent renal blood perfusion imaging and thoracic and abdominal CTA before and after operation at the same time. The renal perfusion blood flow（ BF）,blood volume（ BV） and clearance of bilateral renal were measured and analyzed. Patients were divided into three groups according to the renal artery involvement,true lumen group,false lumen group and overriding group. Comparison the difference of perfusion parameter values before and after operation,and various CT imaging signs of aortic dissection patients were observed. Results： There are 29 Stanford B and 2 Stanford A AD patients. The BF values among the true lumen、false lumen and overrinding groups were different significantly（ P〈0. 05）. The BF value of the false lumen group was the lowest. The true lumen and overrinding groups showed no statistical significance for BF value（ P〉0. 05）. The BV of true lumen and overrinding group has statistically difference（ P〈0. 05）after operation,the overrinding group was the lowest,other groups had no significant difference（ P〉0. 05）.The value of BV and clearance decreased after operation significantly（ P〈0. 05）,BF had no significant difference（ P〉0. 05）; The BV of false lumen group decreased（ P〈0. 05）,BF and clearance had no significant difference（ P〉0. 05）. The perfusion parameters of overrinding group had no significant difference（ P〉0. 05）before and after operation. Conclusion： Perfusion imaging using 320-slice dynamic volume CT can be used to evaluate hemodynamic features of the whole kidney. Both of surgical and interventional operation can affect the renal perfusion of AD patients. CT renal perfusion imaging is helpful to evaluate renal functional status preoperation,and reveal the situation of renal ischemia post

关 键 词：CT灌注 肾动脉 主动脉夹层 动态容积CT 

分 类 号：R54[医药卫生—心血管疾病]