三维对比剂增强MR血管成像诊断慢性缺血性肾病的临床价值

The Clinical Significance of 3DCE-MRA in Diagnosis of Chronic Ischemic Nephropathy

目的探讨三维对比剂增强MR血管成像(3DCE-MRA)在诊断慢性缺血性肾病中的临床价值。方法选择一组疑有慢性缺血性肾病的患者,应用Siemens公司Sonata型1.5T超导型磁共振成像系统,对肾动脉进行3DCE-MRA扫描,对比剂为钆喷替酸葡甲胺(Gd-DTPA);在MRA扫描后2d内进行肾动脉彩色多普勒超声检查;对比观察肾动脉图像;同时观察血肌酐与肾动脉狭窄程度的关系。结果在18例患者中,3DCE-MRA显示6例肾动脉无异常,5例肾动脉狭窄(其中1例为双侧狭窄),7例肾动脉显著狭窄(其中1例为双侧狭窄);彩色多普勒超声7例肾动脉无异常,4例肾动脉狭窄,7例肾动脉显著狭窄(其中1例为双侧狭窄)。18例患者均有血肌酐升高,明显升高的则肾动脉显著狭窄或双侧狭窄。结论3DCE-MRA检查有无创、安全血管图像清晰准确等优点,可以做为筛选肾动脉狭窄,诊断慢性缺血性肾病的重要方法。

Objective：To explore the clinical value of three - dimensional contrast - enhanced MR angiography （3DCE - MRA） in the diagnosis of ischemic nephropathy. Methods： 18 patients suspected to have chronic ischemic nephropathy were included in the study. Siemens Sonata type 1.5T superconductive MRI scanner was used to scan renal artery and process 3DCE - MRA with Gd - DTPA as contrast medium. Within 2 days after MRA, color ultrasound doppler was employed to scan the renal artery. The images of renal artery were investigated comparatively, and the correlation between serum creatine and the renal artery stensis was analysed simutanously. Results：Of the 18 patients, 6 displayed normal renal artery, 5 displayed mild- moderate renal artery stensis （1 of whom with bilateral stensis）, 7 displayed serious renal artery stensis（ 1 of whom with bilateral stensis） in 3DCE- MRA. While in color ultrasound doppler exam, 7 were normal, 4 were mild- moderate ,and 7 were serious（ 1 of whom with bilateral stenosis）. Serum creatinine increased in all of the 18 patients. Patients with remarkablely increased serum creatinine had very serious or bilareral renal artery stenosis. Conclusion： 3DCE- MRA is non- invasive, safe and acurate, and can be used as an important method to screen renal artery stensis and diagnose ischemic nephropathy.