64排螺旋CT三维重建在肾脏移植中的价值

背景：目前应用相对无创的多排螺旋CT来替代有创的数字减影血管造影进行评价肾脏移植手术中肾脏解剖及功能情况，主要集中在16排螺旋CT及以下机型，鲜有关于64排螺旋CT应用在肾脏移植中的报道。 目的：探讨64排螺旋CT三维重建技术在肾脏移植手术中供者肾脏及受者肾脏的检查价值。 方法：对7例拟自愿捐献一侧肾脏给其亲属进行活体肾脏移植的供者肾脏及6例接受了肾脏移植的受者肾脏进行了CT平扫、动脉期、静脉期及延迟期增强扫描，并对增强扫描各期进行多平面重建、容积再现技术、最大密度投影及曲面重建等三维后处理。 结果与结论：7例供者CT血管造影显示左右肾均为1条肾动脉者4例；左肾2条肾动脉，右肾1条肾动脉者1例；左肾3条肾动脉，右肾两条肾动脉者2例；所有供者左右肾均见1条肾静脉及1套肾盂输尿管。MPR重建显示左肾囊肿1例，CT尿路造影显示双肾功能均未见异常，与手术对照，符合率100%。6例受者中CT血管造影显示6例移植肾动脉、静脉及输尿管吻合口均未见狭窄及内瘘，其中4例移植肾大小形态及密度正常，增强扫描动脉期皮质髓质分界清晰，皮质CT值均在150 HU以上，静脉期肾脏实质强化均匀，CT尿路造影显示肾脏泌尿功能正常；2例移植肾增强扫描动脉期皮质髓质分界不清，皮质CT值均小于100 HU，静脉期肾脏实质强化较弱，延迟10 min扫描仅见少量对比剂排泄，经过肾脏穿刺确诊为排斥反应。结果表明，64排螺旋CT三维重建技术能完成对肾实质、肾血管以及泌尿系统的综合评价，可作为肾脏移植前后评价肾脏解剖及功能的较好方法。 关键词：体层摄影术，X射线计算机；后处理；肾移植；三维重建；排斥

Value of 64-slice spiral computerized tomography for three-dimensional reconstruction in renal transplantation

BACKGROUND: In recent years, some researchers began to apply a relatively non-invasive multi-slice spiral computerized tomography (CT) to replace digital subtraction angiography (DSA) to evaluate renal anatomy and function of kidney transplantation, but the relevant reports mainly focused on that in the 16-slice (or below) spiral CT, few on the 64-slice spiral CT. OBJECTIVE: To evaluate the value of 64-slice spiral CT three-dimensional reconstruction in donor and recipient kidney for renal transplantation. METHODS: Seven patients who were voluntary to donate their one kidney to their relatives and 6 patients who were about to receive kidney from others were done plain CT scan, arterial phase, venous phase and delayed phase enhanced scanning, and enhanced scanning periods were processed with three-dimensional reconstruction techniques including multiplanar reconstruction, volume rendering technique, maximumintensity projection and curved projection reconstruction. RESULTS AND CONCLUSION: In 7 donors, according to CT angiography, one renal artery in each side of the kidneys was presented in 4 cases, two renal arteries in the left kidney and one in the right in 1 case, three renal arteries in the left kidney and two renal arteries in the right in 2 cases; one renal vein and one set of renal pelvis and ureter were presented in both left and right kidney in all cases. MPR reconstruction showed left renal cyst in 1 case, kidney functions were normal in all cases according to CT urography. The above mentioned results shown by 64-slice spiral CT three-dimensional reconstruction were all proven by surgery. In recipients, according to CT angiography, renal artery, vein and ureter were no stricture and fistula in all 6 cases. CT scanning of 4 cases of the transplanted kidneys showed normal size, normal shape and density. Arterial phase enhanced scanning showed clear boundaries in renal cortex and renal medulla, and CT values were greater than 150 HU. Venous phase enhanced scanning showed the renal parenchyma uniform, CT urography showed urinary function normal. Artery enhanced scanning of 2 cases of the transplanted kidney showed unclear boundaries in renal cortex and renal medulla, CT values less than 100 HU. Venous phase enhanced scanning showed the kidney parenchyma were weak, delayed 10-minute scanning showed only a small amount of contrast medium excretion, which confirmed rejection by renal biopsy. 64 slice spiral CT three dimensional reconstruction can basically replace other imaging examinations before and after renal transplantation, and can be the best option for renal transplantation.