多层螺旋CT血管成像在肾静脉血栓诊断和治疗中的应用

目的探讨多层螺旋CT血管成像（multi-slice spiral CT angiography，MSCTA）在肾静脉血栓（renal vein thrombosis，RVT）诊断和治疗中的临床应用价值。方法收集首诊RVT患者8例，慢性期RVT并左肾静脉重度狭窄或闭塞患者5例，均行CT平扫、动脉期及静脉期增强扫描，采用容积再现（volume rendering，VR）血管生长技术（addvessel，AV）进行血管重建，分析RVT、肾静脉侧支循环表现。结果13例RVT患者中，首诊8例（双侧3例，左侧5例），CT平扫呈均匀稍高密度影，增强扫描示肾静脉主干及分支内见充盈缺损影，4例血栓延伸至下腔静脉内，1例合并左腰静脉干、左睾丸静脉内血栓，1例左睾丸静脉侧支循环形成。慢性期5例，CT平扫左。肾静脉结构显示不清，左肾静脉主干4例不显影，1例细如线样，均显示左卵巢静脉曲张，右卵巢静脉、双侧髂内静脉侧支循环形成。结论MSCTA能准确诊断RVT及肾静脉侧支循环，指导临床制定治疗方案。

Application of multi-slice spiral CT angiography in diagnosing and treatment of renal vein thromboembolism

Objective To discuss the applied value of MSCTA in diagnosing and treatment of renal vein thromboembolism （RVT）. Methods Eight patients with acute RVT patients, and 5 chronic RVT patients with severe stenosis or occlusion of the left renal vein were subjected to MSCTA scan- ning including unenhanced scanning and contrast-enhanced scans （including late artery phase and ve- nous phase）. Volume rendering （VR） and add vessel （AV） were used to reconstruct the vessel, and RVT and the collateral pathways were analyzed. Results Among these 13 cases, 8 were initially diag- nosed （3 bilateral cases and 5 left-side cases）, showing slightly homogeneous high density in unen- hanced scanning, and filling defect in enhanced scanning of the trunk and branch of the renal veins, with 4 cases of thrombosis extending into inferior vena cava, 1 case of thrombosis converging left lum- bar vein and left testicular vein, and 1 case of left testicular vein collateral circulation. Among 5 cases of chronic left RVT, all the cases showed unclear left renal vein structure in CT unenhanced scanning （4 cases without developing and 1 case with fine line for the left renal vein）. The varicose of left ovari- an veins, and the collateral branches of right ovarian vein and bilateral internal iliac veins were found in all the 5 cases. Conclusions MSCTA can accurately diagnose the circulation of collateral branches of renal vein and RVT, and give guidance for clinical treatment.