CT血管成像及重组技术在移植肾动脉狭窄中的应用  

The Clinical Applicationof Multi-Slice Spiral Computed Tomographical Angiography and Three-Dimensional Reconstruction Image for Evaluating Transplant Renal Artery Stenosis

作　　者：刘婷 李楠[2] LIU Ting;LI Nan(Department of Radiology,Jinshazhou Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong Province 510050,P.R.China)

机构地区：[1]广州中医药大学金沙洲医院放射科,510050 [2]中山大学附属第一医院放射介入科,广州510080

出　　处：《临床放射学杂志》2021年第8期1588-1593,共6页Journal of Clinical Radiology

摘　　要：目的探讨多层螺旋CT血管成像(MSCTA)及重组技术在移植肾动脉狭窄(TRAS)患者中的应用价值。方法搜集2015年1月至2020年6月就诊于中山大学附属第一医院的肾功能受损的移植肾患者进行多普勒超声检查,确诊22例TRAS患者,再行MSCT扫描、采集图像,应用最大密度投影(MIP)、容积再现(VR)、曲面重组(CPR)技术及三维重组对图像进行处理。将CT重组图像与数字减影血管造影(DSA)手术结果进行对照,并探讨其对TRAS的诊断及手术方式的指导价值。结果22例患者均成功行MSCTA检查并行血管重组。其中轻度狭窄1例,中度狭窄2例,重度狭窄19例。所有病变部位均经DSA证实,所得影像清晰。DSA示轻度、中度、重度狭窄分别为1例、6例和15例。CTA与DSA对病变狭窄程度判断的相关系数为0.8(P=0.000)。根据CT重组图像指导,22例患者中5例患者行球囊扩张术,17例行球囊扩张并支架置入术,术后血肌酐由术前(282.3±211.4)μmol/L降至(166.7±80.4)μmol/L(术后1个月)(P=0.016)、尿素氮由(14.6±6.6)mmol/L降至(9.2±4.1)mmol/L(术后1个月)(P=0.001)。1例伴高血压患者术后用药减少。结论MSCTA及重组技术是一种评估移植肾动脉血管状况的重要手段,能准确评估移植肾动脉解剖及狭窄状况,为后期介入手术干预提供重要的诊断及指导价值。Objective To investigate the feasibility and clinical value of multi-slice spiral computed tomography angiography(MSCTA)and three-dimensional reconstruction image for the detection of transplant renal artery stenosis(TRAS)and guiding interventional treatments.Methods We evaluated the presence of renal artery stenosis confirmed by US in 22 recipients who presented with allograft dysfunction after renal transplantation between January 2015 and June 2020.The patients were examined by MSCTA and the images were reformed as maximum intensity projection(MIP),volume rendering(VR),curved planar reformation(CPR)and three-dimensional image reconstruction technique.Subsequently,they were treated with endovascular approaches.Serum creatinine(Scr)levels and blood urea nitrogen(BUN)were evaluated before and after theprocedure.The characteristics and stenosis of these lesions with CTA and digital subtraction angiography(DSA)were also analyzed.Results MSCTA clearly demonstrated the lesions and anatomical feature,of which the lesions of mild stenosis were 1,moderate stenosis 2 and severe stenosis 19.And DSA showed 1 case of mild stenosis recipients,6 cases of moderate stenosis recipients and 15 cases of severe stenosis recipients.MSCTA provided positive coincidence with DSA,which the correlation index was 0.8 with statistical significance(P=0.000).Percutaneous transluminal angioplasty was performed in 5 patients,and stent placement was done in 17 patients.The technical success was 100%.The mean Scr level and BUN preintervention was(282.3±211.4)μmol/L and(14.6±6.6)mmol/L,and it decreased to(166.7±80.4)μmol/L and(9.2±4.1)mmol/L 1 month post-intervention,and all of them had statistical significance.Conclusion MSCTA is a reliable imaging technique for the assessment of TRAS with advantages of convenience,high definition and three-dimensional reconstruction.It can provide accurate evaluations of the conditions of occlusive lesions,which can be of great clinical significance to subsequent interventional therapies.Furthermore,inter

关 键 词：多层螺旋CT血管成像 移植肾动脉狭窄 介入治疗 

分 类 号：R699.2[医药卫生—泌尿科学]