双能量CT灌注成像对体外冲击波治疗肾结石前后肾功能变化的评估

Evaluation of kidney function before and after extracorporeal shock wave therapy using CT perfusion imaging

目的研究肾结石患者经不同能量的冲击波碎石治疗后，患者。肾血流的近期变化，并探讨体外冲击波碎石治疗最优能量。方法29例肾结石患者，分为两组，分别用9～10kV（19例）、10～11kV（10例）进行体外冲击波治疗，并在治疗前即时、后24～72h行双能量多层螺旋CT灌注扫描，监测患者肾脏各项灌注参数，并同时监测治疗前后血肌酐、尿素氮等参数变化。结果肾结石患者碎石前、后肾脏结石周围区域（能量冲击中心区域）各项灌注参数MIP、血流量（BF）、血容量（BV）、对比剂达峰时间（TTP）、毛细血管表面通透性（Ps）及平均通过时间（MTT）均存在统计学差异，P〈0．05；远结石区域治疗前、后各项灌注参数无统计学差异，P〉0．05。治疗前、后血肌酐、尿素氮无统计学差异，P〉0．05。结论本研究表明CT灌注成像各项血流动力学参数变化可用于评估体外冲击波碎石治疗前、后肾功能的变化，且血流灌注参数变化早于血肌酐、尿素氮等变化。此外，本研究证实9～10kV、10～11kV为肾结石体外冲击波治疗的安全能量。

Objective By use of dual energy CT perfusion imaging, to study the renal blood flow changes in the kidney stone patients who were subjected to different energy levels of extracorporeal shock wave therapy, and to find the best therapy energy, which could be used in clinic. Methods Twenty-nine renal stone patients were recruited into our study, they were divided into two groups, 9-10 kV therapy energy （19 cases）, 10-11 kV therapy energy （10 cases）. All the patients were accepted dual energy CT perfusion before and after （24-72 hours） extracorporeal shock wave therapy. And we monitored the perfusion parameters changes such as maximum intensity projection （MIP）, blood flow （BF）, blood vol- ume （BV）, time to peak （TTP）, permeability surface （PS）, mean transit time （MTT） changes, and also monitored the serum creatinine, blood urea nitrogen, and other parameters before and after treatment. Results The perfusion parame- ters such as MIP, BF, BV, TTP, PS and MTT in stone surrounding area （energy impact center area） were significant differences before and after therapy, P 〈0.05, far stone area, they showed no significant differences before and after treatment, P〈0.05. The serum creatinine, blood urea nitrogen level showed no significant differences before and after therapy, P 〈0.05. Conclusion CT perfusion imaging can be used to evaluate renal function changes in the patients before and after with extracorporeal shock wave lithotripsy. And the the hemodynamic changes are earlier than the serum creati- nine, blood urea nitrogen changes. And we also get the conclusion that 9-10 kV and 10-11 kV are the safety energy of the extracorporeal shock wave therapy.