多层螺旋CT图像后处理诊断移植肾动脉狭窄

背景:对肾移植后并发移植肾动脉狭窄患者的诊断及随访是否可采用一种无创伤、特异性高、安全的检查方法。目的:评估多层螺旋CT图像后处理技术对移植肾动脉狭窄的诊断价值。方法:对11例临床怀疑为移植肾动脉狭窄的患者进行移植肾动脉期的增强扫描,扫描后所得到的数据经容积重建、最大密度投影、曲面重建、多平面重建处理成像。结果与结论:11例患者均诊断为移植肾动脉狭窄,10例多层螺旋CT图像后处理技术显示移植肾动脉狭窄程度54%～75%,1例移植肾动脉狭窄程度<50%。吻合口狭窄10例,其中合并移植肾动脉主干狭窄2例;移植肾动脉分支狭窄1例。经数字减影血管造影检查9例,狭窄程度75%～95%,8例置入支架,1例球囊扩张;1例给予药物治疗随访,于2年后出现肾功能进一步恶化及难治性高血压,置入支架。1例无临床症状,经多层螺旋CT移植肾动脉狭窄程度<50%,随访4年肾功能、血压正常。支架置入治疗的患者中1例行球囊扩张者2年后彩色多普勒提示移植肾吻合口狭窄,行多层螺旋CT检查移植肾动脉狭窄程度<50%,随访4年3个月,肾功能、血压正常。提示多层螺旋CT后成像技术可作为移植肾动脉狭窄的诊断依据,对区分临床疑似病例,制定支架置入治疗方案,以及术后随访观察有一定的临床参考价值。

Transplant renal artery stenosis examined by multi-slice spiral CT angiography

BACKGROUND:Whether a high specificity,no wound and safety examination method can be used in the diagnosis of transplant renal artery stenosis after kidney transplantation.OBJECTIVE:To evaluate the diagnostic value of multi-slice spiral CT angiography in the diagnosis of transplant renal artery stenosis.METHODS:Eleven patients who were doubtful with transplant renal artery stenosis received the transplant renal artery phase enhanced multi-slice spiral CT scanning before operation.The data obtained after scanning was used to process the image after volume rendering,maximum intensity projection,surface reconstruction and multi-planar reconstruction imaging.RESULTS AND CONCLUSION:All the 11 patients were diagnosed with transplant renal artery stenosis.Multi-slice spiral CT angiography showed that the stenosis degree of 10 patients was 54%-75%,one patients had the stenosis degree that less than 50%.Ten patients had anastomotic stenosis,two patients had truncal stenosis of the renal artery and one patient had transplant renal artery branch stenosis.Multi-slice spiral CT angiography of nine patients showed that the stenosis degree was 75%-95%,and eight patients received stent implantation,one patient had balloon dilatation.One patient was treated with drug therapy and follow-up for 2 years,and 2 years later,the patient suffered renal function further deterioration and refractory hypertension and received stent implantation.One patient was normal in clinical symptoms,and the stenosis degree was less than 50%,and 4-year follow-up results indicated the normal blood pressure and renal function.Among the patients received stent implantation,one patient received balloon dilatation,and the color Doppler flow after 2 years showed the transplant renal artery stenosis,and the multi-slice spiral CT angiography showed the stenosis degree was less than 50%.After followed-up for 51 months,the renal function and the blood pressure were returned to normal level.Multi-slice spiral CT angiography can be used as the basis for the diagnosis of transplant renal artery stenosis,and has some clinical reference value for distinguish the clinically suspected cases,design the treatment options for stent implantation and postoperative follow-up observation.