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目的探讨多层螺旋CT血管造影(MSCTA)在儿童肾血管性高血压诊断中的临床价值。方法山东大学山东省立医院儿科2002年以来,经MSCTA肾动脉成像确诊为血管性高血压的患儿8例,8例行彩色多普勒超声肾血流检查,6例行X线血管造影(XRA)检查,将MSCTA检查结果与彩色多普勒超声肾血流和XRA检查结果进行比较。MSCTA扫描参数取准直0·75mm,螺距1,管电压为90~120kV,管电流为120~150mA。扫描结束后对每一病例均行曲面重建(CPR)、多平面重建(MPR)、容积再现(VR)和最大强度投影(MIP)重建。结果8例中MSCTA显示10条肾动脉狭窄,左侧6条,右侧4条,其中2例为两侧肾动脉狭窄;8条为起始段狭窄,2条为肾动脉中段狭窄;狭窄长度0·2~1·0cm,Ⅰ级狭窄1条,Ⅱ级狭窄6条,Ⅲ级狭窄3条。MSCTA尚可见6例肾缩小,平均长径为7·1cm,低于健肾1·5cm以上;1例伴有腹主动脉壁增厚,管腔狭窄,直径约1·0cm;6例行腹主动脉或选择性肾动脉造影者与MSCTA显示肾动脉狭窄部位和程度完全一致。8例行彩色多普勒超声检查者,亦可见6例肾缩小,但仅5例显示肾动脉狭窄,左侧2条,右侧3条。结论MSCTA能准确地显示肾动脉狭窄的程度和部位,清晰地显示肾动脉壁及其腔内的情况,作为无创、简便、安全、价廉的检查方法,在一定程度上可替代有创伤性的选择性肾动脉造影。

The application of multispiral CT angiography to the diagnosis of renovascular hypertension in children

Objective To discuss the clinical application of multispiral CT angiography (MSCTA) to the diagnosis of renovascular hypertension in children.Methods Since 2002,8 cases of diagnosed renovascular hypertension underwent MSCTA.8 cases received colour-coded Doppler ultrasonography(DUS) and 6 cases received X-ray angiography (XRA).The results were compared.The scanning paremeters were as follows:collimation 0.75 mm,pitch 1,tube voltage 90~120kV and tube current 120~150mAs.After scanning,multiplanar reconstruction(MPR)(coronal,sagittal,oblique),maximum intensity projection(MIP) and volume rendering(VR) were reconstructed.Results We visualized 10 renal arterial stenosis ( left 6 and right 4,including 2 bilateral stenosis) in 8 cases by MSCTA.Among these renal arteries 8 had lesions in the origins and 2 in the middle.The length of stenosis was 0.2~1.0cm and the Grade 1 stenosis was one renal artery,Grade 2 six renal arteries,and grade 3 three renal arteries.MSCTA showed 6 kidneys dwindled with average length 7.1cm,which was 1.5cm less than normal kidneys.One case was accompanied by wall-thickening and cavitary stenosis of abdominal aorta.The locations and extent of stenosis in 6 cases by XRA and by MSCTA were identical.We found renal arterial stenosis only in 5 of 8 cases and 6 dwindled kidneys by DUS.Conclusion MSCTA can not only reveal the extent and locations of renal arterial stenosis,but also show the walls and lumens of the renal arteries.As a noninvasive and valuable examination,MSCTA can replace invasive selected renal arteriography to some extent.