双源CT上肢血管造影在透析患者血透通路评估中的应用价值  

The Application Value of Dual-Source CT Upper Limb Angiography in the Evaluation of Hemodialysis Access in Dialysis Patients

作　　者：史恒峰[1] 王祥发[1] 刘伟[1] 胡汉金[1] 朱娟[1] SHI Hengfeng;WANG Xiangfa;LIU Wei(Department of Radiology,Anqing Hospital Affiliated to Anhui Medical University,Anqing,Anhui Province 246003,P.R.China)

机构地区：[1]安徽医科大学附属安庆医院医学影像科,安庆246003

出　　处：《临床放射学杂志》2022年第4期718-723,共6页Journal of Clinical Radiology

摘　　要：目的 探讨双源CT直接法与间接法CT血管造影(CTA)在评估透析患者上肢血透通路功能不全中的临床应用价值。方法 回顾性分析本院72例慢性肾衰竭行上肢自体动静脉内瘘(AVF)后通路功能不全的透析患者,分别进行直接法(15例)和间接法(61例)上肢CTA检查,并对原始图像行容积再现(VR)、最大密度投影(MIP)、曲面重组(CPR)等三维处理,观察血透通路及并发症影像学表现。比较两种扫描方式上肢血管的图像质量、血管狭窄程度、动脉瘤、侧支血管显示,以及对比剂用量和一般资料;以DSA结果或临床资料为金标准,评估两种方法诊断血管病变的诊断准确率。结果 两组患者的年龄、性别、基础病等一般资料及内瘘血管狭窄程度、动脉瘤、侧支血管的显示等影像学表现上的差异均无统计学意义(P>0.05);直接法与间接法CTA均可清晰显示血管,两者评分差别无明显统计学意义(P>0.05),但是直接法上臂及前臂图像质量评分高于间接法,间接法中心静脉图像评分高于直接法,直接法对比剂使用量明显少于间接法;直接法与间接法均可准确评估上肢血管病变,诊断准确率差异无统计学意义(P>0.05)。结论 直接法和间接法CTA均可准确地评估上肢血管病变,对怀疑中心静脉病变推荐使用间接法CTA,对于残存肾功能患者,推荐使用直接法CTA。Objective To explore the clinical application value of dual-source CT direct and indirect angiography(CTA) in evaluating the dysfunction of upper extremity hemodialysis access in dialysis patients.Methods A retrospective analysis of 72 patients with chronic renal failure who underwent upper extremity arteriovenous fistula(AVF) and access insufficiency were performed in our hospital.Direct method(15 cases) and indirect method(61 cases) of upper extremity CTA were performed respectively,and the original Image volume rendering(VRT),maximum intensity projection(MIP),curved surface reconstruction(CPR) and other three-dimensional processing to observe the imaging manifestations of hemodialysis pathways and complications.Compared the image quality,the degree of vascular stenosis,the display of aneurysms,collateral vessels,the amount of contrast medium and general data of the two scanning methods of upper extremity blood vessels;used DSA results or clinical data as the gold standard to evaluate the accuracy of the diagnosis of vascular disease by the two methods rates.Results There was no statistically significant difference in the two groups of patients in general in-formation such as age,gender,underlying diseases,and the degree of stenosis of internal fistula vessels,the display of aneu-rysms,and collateral vessels(P> 0.05).The indirect method CTA could clearly show blood vessels,and the difference be-tween the two scores was not statistically significant(P> 0.05),but the image quality score of the upper arm and forearm ofthe direct method was higher than that of the indirect method,and the central vein image score of the indirect method washigher than that of the direct method.The amount of contrast agent used in the method was significantly less than that of thedirect method;both the direct method and the indirect method could accurately assess upper extremity vascular disease,andthe difference in diagnostic accuracy was not statistically significant(P> 0.05).Conclusion Both direct and indirectCTA can accurately ass

关 键 词：双源CT 动静脉内瘘 CTA 血透通路 

分 类 号：R692.5[医药卫生—泌尿科学] R816.7[医药卫生—外科学]