CT静脉血管成像在尿毒症血液透析患者中心静脉狭窄闭塞中的应用价值  

The use of multi- detector computed tomography venography and three dimensional reconstruction image in evaluating the central venous occlusive disease of hemodialysis patients

作　　者：李楠[1] 陈斌[1] 林润[1] 戴海涛[1] 唐可禺 温春勇 杨建勇[1] 黄勇慧[1] Li Nan;Chen Bin;Lin Run;Dai Haitao;Tang Keyu;Wen Chunyong;Yang Jianyong;Huang Yonghui(Department of lnterventional Radiology,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院放射介入科,广州510080

出　　处：《中华肾脏病杂志》2018年第8期561-566,共6页Chinese Journal of Nephrology

摘　　要：目的探讨多层螺旋cT静脉血管成像（multi-detector computed tomography venography, MDCTV）及三维重建在尿毒症血液透析患者中心静脉狭窄闭塞性病变中的应用价值。方法采用Toshibal28层螺旋CT对60例上肢肿胀的尿毒症血液透析患者进行检查，采用对侧肢体外周静脉注射非离子型碘造影剂，注射速度4ml／s，造影剂总量80—100ml，采用智能触发技术进行扫描，设定触发扫描阈值，监测点置于上腔静脉腔内，行多层螺旋CT扫描检查、采像，应用最大密度投影、容积成像、曲面重建技术及三维重建对图像数据进行处理。结果对60例尿毒症血液透析肢体肿胀患者行MDCTV检查，共发现75处狭窄，其中头臂静脉狭窄47处，上腔静脉狭窄15处，锁骨下静脉狭窄13处；其中轻度狭窄1处，中度狭窄19处，重度狭窄24处，完全闭塞31处。所有病变部位均经数字减影血管造影（digital subtraction angiography，DSA）证实，所得影像清晰。DSA示轻度狭窄为5处，中度狭窄为14处，重度狭窄为7处，完全闭塞为49处。CT血管成像与DSA虽然在狭窄程度上存在一定差别，但其相关系数为0．401。60例患者中53例患者行球囊扩张术，40例患者行支架植入术，术后上肢或颜面部肿胀明显减轻，血管通路恢复正常，能满足正常血液透析的需要。结论MDCTV是一种评估尿毒症血液透析患者中心静脉血管状况的重要手段，具有无创性、高分辨率、三维重建等重要优点，能准确评估尿毒症血液透析患者中心静脉状况，对后期介人手术干预提供重要的临床支持。Objective To evaluate the feasibility and value of multi- detector computed tomography venography （MDCTV） and three dimensional reconstruction image in the assessment of central venous occlusive disease in hemodialysis patients, and in the value of guiding interventional treatments. Methods Sixty hemodialysis patients with swelling of upper limbs were scanned by Toshiba 128-multisliee spiral computed tomography （128- MSCT） and totally 80-100 ml non-ionic contrast media was injected into each of the patients via the peripheral veins of the contralateral limb with the rate of 4 ml/s. MSCT scanning was taken by the technique of intelligent triggering after setting scanning triggering threshold, with the monitoring point set in the development of the lumen of inferior vena cava, to detect the position and degree of vascular stenosis. The images were reformed as maximum intensity projection （MIP）, volume rendering （VR）, curved planar reformation and three- dimensional image reconstruction technique. Results MDCTV clearly demonstrated the lesion location in all cases enrolled. Seventy- five occlusive lesions were detected in the total of 60 hemodialysis patients with swelling of upper limbs by MDCTV, of which the lesions of brachiocephalic vein was 47, superior vena cava 15 and subclavian vein 13. Among the 75 stenosis lesions, the number of complete occlusive, severe, moderate and mild stenosis was 31, 24, 19 and only 1, respectively. MDCTV provided information coincident with that of digital subtraction angiography （DSA）, which the correlation index was 0.401, while DSA showed that number of complete occlusive, severe, moderate and mild stenosis was 49, 7, 14 and 5, respectively. Percutaneous translaminal angioplasty was performed in 53 patients, and stent placement was done in 40 patients. After interventional treatments, swelling of upper limbs were obviously relieved and vascular accesses got functional recovery to the extent that they could meet the requirement of hemodialysis. Conclusions MDC

关 键 词：尿毒症 肾透析 血管造影术 中心静脉狭窄闭塞性病变 介入治疗 

分 类 号：R816.2[医药卫生—放射医学] R692.5[医药卫生—临床医学]