多层螺旋CT灌注评价单侧输尿管梗阻解除后肾功能早期恢复的初步应用

Application of Multi-Slice CT Perfusion Scan in the Evaluation of Early Recovery of Renal Function After Releasing of Unilateral Ureteral Obstruction

目的:研究单侧输尿管梗阻解除后肾功能早期恢复的规律,分析多层螺旋CT(MSCT)灌注参数在肾积水肾功能可复性评估中的临床应用价值。方法:建立大白兔右侧输尿管部分梗阻肾积水模型。分对照组、梗阻2周组、梗阻4周组及梗阻8周组,后3组在解除梗阻后饲养4周,各组在梗阻解除前、后均行MSCT灌注扫描、彩色多普勒超声显像(CDFI)及单光子正电子发射计算机体层成像(SPECT)测定,后处死试验动物制成普通病理切片。结果:①各梗阻组的总肾小球滤过率(GFR)均明显低于正常对照组,解除梗阻后,各组总GFR与解除梗阻前无显著性差异;②梗阻2周、4周组及8周组右肾GFR均显著低于正常对照组,梗阻解除后,2周组的右肾GFR有所恢复;③梗阻4周组和8周组在梗阻解除后,其肾动脉的舒张末速度(EDV)显著低于正常对照组,梗阻2周组在梗阻解除后,肾动脉EDV与正常对照组无显著性差异;④梗阻2周组在梗阻解除后,其右肾皮质、髓质的血流量(BF)、血容量(BV)值较梗阻解除前明显上升,接近正常对照组水平,而梗阻4周组、8周组在梗阻解除4周后,其右肾BF、BV则未见明显恢复,明显低于正常对照组;⑤随着梗阻时间的延长,患肾病理学改变愈明显。结论:MSCT灌注成像能够提高积水肾脏形态学和血流灌注的信息,其与CDFI相结合有望成为预测肾功能可复性的金标准。

Objective：To evaluate the predictability of multi-slice CT （MSCT） perfusion scan in the restorability of renal function in rabbit model with partial unilateral （right） ureteric obstruction and to investigate the changes of MSCT perfusion parameters during the recovery course of renal function. Methods： Hydronephrotic rabbits were randomly assigned into control, 2-, 4-, and 8-week obstruction groups. BUN and Cr levels of all the obstruction groups before obstruction and 4 weeks after the obstruction were measured and compared with that of the control respectively. MSCT perfusion scan, color Doppler flow imaging, and SPECT examinations were performed and renal specimens were observed with HE staining. Results： Glomerular filtration rates （GFR） in the three obstruction groups were lower than that in control group, and no significant change was found among the obstruction groups in total GFR after the obstruction was released. There was a slight recovery in right renal GFR only in 2-week obstruction group after obstruction was released. The end diastolic velocity （EDV） of intrarenal arteries in 4- and 8-week obstruction groups, instead of 2-week obstruction group, after reperfusion was significantly lower than that in control group. Blood flow （BF） and blood volume （BV） values of renal cortex and medulla in 2-week group restored significantly even to the level of control group after reperfusion, but changed little in 4- and 8-week groups. There was a positive correlation between duration of obstruction and degree of pathologic changes. Conclusion： MSCT perfusion scan is a useful method to evaluating the recovery of renal function of obstructive hydronephrosis, especially combined with color Doppler flow imaging.