螺旋CT重建技术对肾解剖和肾肿块的手术前评估

PRESURGICAL EVALUATION OF RENAL ANTOMY AND RENAL MASS WITH THE RECONSTRUCTION TECHNOLOGY OF HELICAL CT

目的 在外科手术前，用多层螺旋CT横断面图重建的3D—CT和3D—CTA，对肾脏肿块进行评估，对肾的解剖进行演示。方法 经过身体检查和超声检查以后，对20例怀疑肾肿快的患者再做多层螺旋CT检查。先扫描横断面图像，然后用横断面图像去重建3D-CT和3D—CTA图像，记录下肾肿块的数目、位置、大小以及周围结构等。由2位专家完成CT结果的评估。结果 20例患者中13例经病理组织学证实为肾细胞癌，其他为肉芽肿肾盂肾炎、肾脓肿、单纯肾囊肿、感染性肾囊肿、血管平滑肌脂肪瘤、大嗜酸粒细胞瘤以及动静脉瘘各1例。在肾细胞癌患者中，工期3例，Ⅱ期7例，Ⅲ期3例。肾细胞癌肿块的大小23～60mm，平均（36．41±8．23）mm。2例肾细胞癌患者显示血管受侵袭，11例患者集合系统受侵袭。结论 3D-CT和3D—CTA是非损伤性的、有效的成像技术，可有效地在手术前对肾肿块加以评估。

Objective To determine the efficacy of three-dimensional computed tomography （3D-CT） and three-dimensional computed tomographic angiography （3D-CTA） that were reconstructed by using the axial images of the multiphasic helical CT in the preoperative evaluation of renal masses and demonstration of renal anatomy. Methods Twenty patients that were suspected of having renal masses upon initial physical examination and ultrasonographic evaluation were examined through multiphasic helical CT.Two experts executed CT evaluations. Axial images were first examined and then used to reconstruct 3D-CT and 3D- CTA images. Number, location, size of the renal masses and other findings were noted. Renal vascularization and relationships of the renal masses with the neighboring renal structures were further investigated with 3D-CT and 3D-CTA images. Results Out of 20 patients, 13 were histopathologically confirmed renal cell carcinoma.The diagnoses of the remaining seven patients were granulomatous pyelonephritis, abscess, simple cyst, infected cyst, angiomyolipoma, oncocytoma and arteriovenous fistula. In the renal cell carcinoma group, 3 patients were in stage Ⅰ, 7 patients in stage Ⅱ, and 3 patients in stage Ⅲ disease. Sizes of renal cell carcinoma masses were between 23 mm to 60 mm （36.41 ± 8.23mm）. Vascular invasion was shown in 2 renal cell carcinoma patients. Collecting system invasion was identified in 11 of 13 renal cell patients. These radiologic findings were confirmed with surgical specimens. Conclusion 3D-CT and 3D-CTA are non-invasive, effective imaging techniques for the preoperative evaluation of renal masses.