多层螺旋CT后处理图像和肾动态显像在亲属活体供肾术前的综合评价

Preoperative Comprehensive Evaluation of Family Living Donor Kidneys with MDCT Postprocessing Imaging and Renal Dynamic Imaging

【目的】评价多层螺旋CT(MDCT)后处理图像和肾动态显像对于亲属活体供肾摘取手术前评估供肾状态的价值。【方法】施行开放供肾摘取手术20例,术前全部供者使用MDCT后处理图像显示供肾血管、上尿路、肾实质及供肾与周围脏器的共建关系,将术中所见和术后摘取的供肾与术前的CT后处理图像进行对照。使用99mTc-DTPA肾动态显像评价肾脏功能。【结果】30例准备行供肾摘取手术的供者中共有20例供者施行了手术,20例供肾者CT后处理后均获得了满意的CT血管成像(CTA)、CT尿路成像(CTU)、多平面重建(MPR)以及容积再现(VR)图像,清晰地显示了肾血管的分支、树木、长短、粗细、上尿路的形态、肾实质情况、肾脏与毗邻周围器官的空间立体关系。其余10例未行手术的原因是肾动态显像示供者肾功能不良而不适合供肾。【结论】联合多层螺旋CT后处理图像和肾动态显像可以对亲属活体供肾移植前的结构和功能进行很好的评价。

[Objective]To evaluate the value of multi-detector spiral CT （MDCT） postprocessing imaging and renal dynamic imaging in the assessment of preoperative living donor kidneys. [Methods]Twenty kidneys were donated for transplantation using an open extraperitoneal nephrectomy, and 20 cases were performed with MDCT postprocessing imaging before operation for assessing the condition of the renal arteries and veins, the upper urinary tract, renal parenchyma and spatial interrelationships of the kidneys and adjacent organ. The MDCT postprocessing imaging was compared with intraoperative surgical findings and the harvested kidney to evaluate the sensitivity and accuracy of MDCT postprocessing imaging. [Results] The MDCT raw data of 20 cases were reconstructed with CT postprocess- ing technique. The CT postprocessing imaging accurately showed renal vascular anatomy, the upper urinary tract, renal parenchyma and spatial interrelationships of the kidneys and adjacent organ. The findings of preoperative CT post-processing imaging of renal donors were well agreed with surgical findings. [Conclusion]MDCT postprocessing imaging can replace DSA, IVP to accurately assess living donor renal vasculature, the upper urinary tract, renal parenchyma and spatial interrelationships of the kidneys and adjacent organ.