活体供肾术前评估中16层螺旋CT的价值

目的：评价16层螺旋CT三维重建在活体供肾血管、肾实质、泌尿系统评估中的实际应用价值.方法：回顾2004年以来41例活体肾移植供体临床资料,术前均行16层螺旋CT扫描,采集肾动脉期、静脉期以及排泄期的影像数据,采用MIP、VR、MPR和CRP等三维图像后处理技术,评估供体肾动脉、肾静脉、泌尿集合系统和肾实质情况,与术中所见相对照.结果：41例供肾动脉显示,34例双肾单支动脉供血,其中2例左肾动脉、3例右肾动脉分支较早;4例右肾见一支副肾动脉,3例左肾见一支副肾动脉;术中证实有1例右副肾动脉,1例左肾动脉早期分支未能在影像中显示清楚,准确率95.1%.41例供肾静脉显示,37例双肾静脉为单支,4例右侧双支肾静脉;术中证实5例右侧双支肾静脉未能在影像中显示,准确率87.8%;泌尿集合系统显影满意,1例左侧双肾盂双输尿管畸形.结论：16层螺旋CT三维重建能准确显示供体肾脏血管、泌尿集合系统、肾实质解剖及可能的病理情况,给临床肾移植术前评估提供有价值的帮助,可作为供体术前检查的首选方法.

Preoperative Evaluation of the Living Donors with 16 Detector-slice Spiral CT with 3-dimensional Reconstruction

Objective：To evaluate the accuracy of 16 detector-slice spiral CT with 3 dimensional reconstruction for renal parenchyma,vessels anatomy and urinary tract in living renal donors. Methods： We performed 41 Living renal transplantation from 2004 to 2010. All the renal donors were examined with 16 detector slice spiral CT be fore operation. The data of the images from artery-period, vein-period and excrete-period were reconstructed by MIP, VR, MPR and CRP postprocessing technique. The anatomical locations of renal parenchyma, vessels and u rinary tract were assessed. The results were compared with those in surgery. Results：In 41 cases, CT angiography （CTA） demonstrated that 34 cases had one renal artery in each side of kidneys （2 left renal arteries and 3 right renal arteries had early branches, respectively）, 4 had one right accessory artery and 3 had one left accessory artery. In the operation, it was proved that 1 case with one right accessory artery and 1 case with one left early branch were missed on CTA. The accuracy of CTA was 95.1%. 37 cases had one renal vein in both kidneys and 4 had two right renal veins were displayed on CTA. However, 5 cases with two right renal veins, which were not disclosed before, were found in the operation. The accuracy of CTA was 87.8%o. The urinary tracts were displayed accurately and found that 1 case had the deformity of left double renal pelvis and ureter. Conclusions： 16 detectorslice spiral CT with 3 dimensional reconstruction can display renal parenchyma,vessels anatomy, urinary tract and abnormalities of living renal donors accurately. This technique is reliable for evaluation of renal vessels and can be the first choice in routine preoperative examination for living renal donors.