16层螺旋CT血管造影及三维重建技术在活体供肾动脉解剖学评估中的应用

Application of SCTA of 16 slices in diagnosing and evaluating renal artery anatomy of living kidney donors in renal transplantation

目的探讨16层螺旋CT血管造影在活体供肾动脉解剖学评估中的应用价值。方法36名亲属活体供肾者在肾切取前进行肾动脉16层螺旋CT血管造影及血管三维成像,血管三维成像方法包括容积再现技术(VR)、最大密度投影(MIP)、表面遮盖成像(SSD)、血管内镜技术(CTVE)、多平面重建(MPR)及曲面重建(CPR)。结果横断面CT及MPR显示所有供者的双肾大小、形态及位置均正常,肾实质密度正常,呈均匀强化。VR、MIP、CPR显示双肾动脉粗细、形态均正常;29例双肾均为单一肾动脉,2例双肾有2支肾动脉,2例左肾为2支肾动脉,3例右肾为2支肾动脉,上述结果均在术中得到证实。11例VR及MIP同时较好地显示双侧肾小盏、肾盂及输尿管上段。SSD均能很好显示肾动脉主干的起源、大小、形态及与周围的解剖关系。CTVE能较好显示腹主动脉、双肾动脉开口及肾动脉血管内腔。结论16层螺旋CT血管造影可作为活体肾移植术前了解供肾血管及形态的有效方法。

Objective To discuss the applied value of SCTA of 16 slices in evaluating renal artery anatomy of living kidney donors of renal transplantation before operation. Methods Thirty-six cases of renal artery of living relative kidney donors were examined by SCTA of 16 slices before opera- tion. VR, MIP, SSD, CTVE, MPR and CPR of renal artery were used as three-dimensional models. Results The size, shape and position of both kidneys were normal on 21）CT and MPR in 36 cases, with normal density and homogeneous enhancement of renal parenchyma. The size and shape of both renal arteries were normal on VR, MIP and CPR in 36 cases, with one renal artery of both kidneys in 29 cases, two renal arteries of both kidneys in 2 cases, two renal arteries of left kidney in 2 cases, two renal arteries of right kidney in 3 cases. All of renal arteries were proved by operation. The renal calices, renal pelvis of both kidneys and upper ureter could be displayed well by VR and MIP in 11 cases. SSD could display clearly the origin, size, shape and adjacent anatomy relationship of main renal artery. CTVE could display clearly the abdominal aorta and orifice, lumen of both renal arteries. Conclusion SCTA of 16 Slices was an effective method in diagnosing and evaluating the supply blood vessels and shape of kidney of living kidney donors of renal transplantation before operation.