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双源CT血管成像对肾移植术前肾活体供体的评估

时间:2017-11-07 14:00:16 来源: 代写硕士论文

                       作者:白林 蒲红 彭泽华 高燕 陶客言

【摘要】目的  探讨双源CT血管成像对肾移植术前肾活体供体评估的价值。方法  使用双源CT对32例受检者行尿路的增强动态扫描,采集肾动脉期、静脉期及排泄期的影像数据,进行MPR、MIP及VR等后处理。评估肾血管的解剖结构及变异,肾实质及上尿路的形态、功能。结果  双源CT血管成像清晰显示了肾血管、肾实质及上尿路影像。25例双肾动脉均为单支,7例发生变异(异位肾动脉1例,肾动脉多支变异伴副肾动脉1例,副肾动脉2例,副肾动脉与肾动脉早期分支并存2例),肾动脉狭窄1例;28例双肾静脉为单支,4例变异(右肾双支静脉伴左肾静脉走行异常1例,双肾副肾静脉1例,右副肾静脉2例);27例肾实质正常,左肾萎缩2例,小囊肿2例,肌脂瘤1例;30例尿路显影正常。结论  双源CT血管成像具有快速、高分辨成像的优势,超越常规多层螺旋CT(MDCT)的影像后处理功能,能为肾移植术前全面、准确地评估活体供体提供可靠的依据。
【关键词】双源CT血管成像  影像处理  肾移植术  活体供体
【Abstract】Objective  To evaluation the value of The reconstruction technique of Dual-source CT angiography (DSCTA) for preoperative evaluation of living renal donors. Methods  32 cases of renal living donors underwent enhanced scanning of the kidneys and the uninary with DSCT ,imaging data of the artery-period,veins-period,excrete-period were reconstructed by volume rendering(VR),maximum intensity projection(MIP),multiplanar reconstructon (MPR) techniques, the anatomical locations and variation of renal arteries and veins were assessed, so du the morphology and function of the kidneys and the uninary. Results  Imagings of the renal blood vessels,substance and uninary were displayed with high-resolution. 25 cases have normal renal arteries, 7 cases of renal arteries were happened variation(1 case of  arteries variation with different origin was found, 1 case of multi-vessel  variation of renal arteries with accessory arteries, 2 cases of accessory arteries were found,2 cases of accessory arteries combined with early branching of the arteries were found).Stenosis of renal arteries were found in one case. renal veins were displayed with normal in 28 cases, 4 cases were found variation (double right renal veins and variation of the course with the left renal vein was found in 1 case, left and right accessory veins were found in 1 case, right accessory veins were found in 2 cases). Renal parenchymas were displayed with  normal in 27 cases, atrophy of left kidneys were found in 2 cases, cortical cyst were found in 2 cases and angiomyolipoma was found in 1 case. Uninaries were displayed with normal in 30 cases. Conclusions  DSCT have greatly superiority in high-speed scanning with high-resolution and stronger reconstruction technique more than MDCT. It can provide reliable basis for preoperative evaluation of living renal donors fully and truly.
【Key words】Dual-source CT angiography  Image processing  Renal transplantation  Living donors  
        随着CT血管成像设备和技术的发展,双源CT以其高分辨、无创、低风险、低成本、便捷等优势,成为了解血管解剖及血管病变的主要手段。本文对32例肾移植术前双源CT血管成像活体供体评估的可靠性进行评价。
        1  资料与方法
        收集我院2007年8月到2010年5月肾移植活体供体进行双源CT血管成像检查32例,男15例,女17例,年龄28-63岁,平均年龄45岁。体检合格,无禁忌症。23例实施手术供肾(8例行腹腔镜左肾切取,12例行开放式左肾切取,3例行开放式右肾切取)。
        使用西门子双源CT机。注射使用双筒高压注射器。对比剂选用碘普罗安370mg/ml,剂量70ml, 注射流率5ml/秒,继而以同样流率注射0.9%生理盐水60ml。
        采用对比剂触发扫描技术,动脉期和静脉期包括双肾区向下延伸至髂总动脉分支;排泄期包括全尿路。
        数据后处理,将三期扫描影像数据分别应用容积重建(VR)、最大密度投影(MIP)及多平面重建(MPR)技术进行后处理。部分采用表面遮盖(SSD)和曲面重建(CPR)技术进行处理。
影像评价,由两位以上经验丰富医师和扫描技师共同在双源CT后处理工作站进行并完成。
        2  结果
        32例受检者CT数据经后处理均获得满意的CTA影像,清晰显示了肾血管的数量、分支、位置、变异,肾实质的形态、大小以及上尿路病变及变异。

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