多层螺旋CT灌注成像对肾积水肾功能可复性的预测价值

Predictability of multi-slice CT perfusion in the restorability of renal function of hydronephrotic kidneys

目的探讨多层螺旋 CT(MSCT)灌注成像在肾积水肾功能可复性预测中的价值。方法建立大白兔单侧输尿管部分梗阻肾积水模型。分为对照组,梗阻2、4及8周组,后3组在解除梗阻后再饲养4周,各组在梗阻解除前、后均行 MSCT 灌注扫描,测量右肾皮、髓质的血流量(BF)、血容量(BV)值并进行比较。然后处死实验动物制成普通病理切片,观察各组病理改变。结果 (1)MSCT 检查显示梗阻2周组在梗阻解除后,其右肾皮质的 BF、BV 分别为(864±32)ml·100 g^(-1)·min^(-1)、(19.5±0.9)ml/100 g,较梗阻解除前[分别为(630±37)ml·100 g^(-1)·min^(-1)、(14.0±1.2)ml/100 g)]上升,差异有统计学意义(t 值分别为-19.37、-12.11,P 值均<0.01);右肾髓质的 BF、BV 分别为(182.1±7.5)ml·100 g^(-1)·min^(-1)、(8.37±0.51)ml/100 g,比梗阻解除前[分别为(132.6±3.9)ml·100 g^(-1)·min^(-1)、(5.13±0.35)ml/100 g)]也明显上升,差异有统计学意义(t 值分别为-23.52、-11.51,P 值均<0.01)。(2)梗阻4周、8周组在梗阻解除后,其右肾皮质BF[分别为(525±15)、(512±10)ml·100 g^(-1)·min^(-1)]、BV[分别为(12.8±0.6)、(9.4±1.0)ml/100 g]与梗阻解除前[分别为(515±23)、(505±16)ml·100 g^(-1)·min^(-1),(12.2±0.8)、(10.3±0.5)ml/100 g]相比,差异无统计学意义(P 值均>0.05)。(3)组织学上,梗阻时间短,解除梗阻后的病理变化较轻,梗阻时间长,解除梗阻后的病理变化重。结论 MSCT 灌注成像不仅能够提供肾积水形态学的信息,又能提供血流灌注的信息,在肾积水肾功能可复性预测中有一定价值。

Objective To evaluate the predictability of MSCT perfusion in the restorability of renal function of hydronephrotic kidneys with unilateral partial ureteric obstructed rabbit model as to explore a method to predict the restorability of renal function of hydronephrotic kidneys and to investigate the changes of MSCT perfusion parameters during the course of the restore of renal function. Methods Establish a unilateral partial ureteric obstructed rabbits hydronephrotic model. Hydronephrotic rabbits were grouped as control, 2, 4 and 8 week （G2w, G4w and G8w） after obstruction and the later 3 groups of rabbits were reared for further 4 weeks after the obstruction was released. MSCT perfusion scanning was performed and the specimen was made into histological slices with HE staining Results BF and BV value of renal cortex and medulla of G2w after obstruction [ （ 864 ±32 ） ml · 100 g^-1 · min ^-1, （ 19. 5 ± 0. 9 ） ml/100 g （ cortex ） ; （182. 1 ±7.5） ml · 100 g^-1 ·min^-1, （8.37 ± 0.51） ml/100 g （medulla）] was released restored in substance and approached that of control [ （899 ±63） ml· 100 g^-1· min^-1, （21.6 ± 1.4）ml/100 g （cortex） ;（193.5 ± 16. 5）ml ·100 g^-1· min^-1 ,（8.50 ±0. 54） ml/100 g （medulla） ]while there was no significant restore in that of G4w and Gsw after obstruction[ （525 ± 15） ml ·100 g^-1· min^-1, （ 12. 8 ± 0. 6）ml/100 g（G4w） ;（512± 10）ml· 100 g^-1·min^-1 （9.4 ± 1.0） ml/100 g（G8w）] was released. Histologically, there was a positive correlation between the duration of obstruction and the seriousness of pathologic changes. Conclusion MSCT perfusion can provide information not only morphologically but also about renal perfusion of hydronephrotic kidneys.