64层螺旋CT血管成像及三维重建后处理技术对活体供肾血管的评估

Evaluation of 64-slice spiral CT angiography and three-dimensional reconstruction in assessing renal vessels of living donors in renal transplantation

目的评价64层螺旋CT血管成像及三维重建后处理技术对活体供肾血管术前评估的临床价值。方法回顾性分析2011年1月至2013年3月临沂市人民医院泌尿外科61例亲属活体肾移植供者术前64层螺旋CT血管成像及三维重建影像资料,观察供肾实质、肾动脉、肾静脉和肾盂、输尿管排泄系统,并与术中所见结果进行对照分析。结果 64层螺旋CT血管成像及三维重建图像基本清晰显示所有供者的双肾解剖结构及毗邻关系情况。肾实质密度及肾动脉管径、形态均正常,其中47例双肾均为单支肾动脉,4例左肾为2支肾动脉,5例右肾为2支肾动脉,5例双肾均为2支肾动脉。53例容积再现结合最大密度投影图像对输尿管排泄系统显示较好,49例表面遮盖成像图像较好地显示了肾动脉主干的起源、管径、形态及与周围组织的解剖关系,肾动脉CT仿真内镜成像能清晰显示腹主动脉、双肾动脉开口及肾动脉管腔。61例供者均行单侧肾切除术,术前血管成像结果与术中所见基本吻合。结论 64层螺旋CT血管成像及三维重建后处理技术能真实反映肾血管的解剖及毗邻关系,在某种程度上完全可以替代数字减影血管造影,可作为术前评估活体供肾血管的有效方法。

Objective To discuss the clinical value of 64-slice spiral CT angiography （SCTA） and three-dimensional reconstruction in evaluating renal vessels of living donors in renal transplantation. Methods Sixty-one donors of hying-related renal transplantation were examined by 64-slices SCTA and three-dimensional reconstruction was used to observe the renal parenchyma, artery, vein, and collecting system before operation. The results were compared with intraoperative findings. Results The anatomy and adjacent structures of both kidneys did not have apparent abnormalities, and the density of renal parenchyma and the size and shape of both renal arteries were not abnormal in all donors on SCTA. One renal artery of both kidneys in 47 cases, two renal arteries of the left kidney in 4, two renal arteries of the right kidney in 5, two or more renal arteries of both kidneys in 5 were showed on SCTA. The renal collecting system was well displayed by volume rendering and maximum intensiey projection in 53 cases. Shaded surface display clearly displayed the origin, size, shape and adjacent anatomy relationship of main renal artery, and CT virtual endoscopy also displayed the abdominal aorta and orifice, lumen of both renal arteries in 49 cases. Conclusion SCTA of 64 slices and 3- dimensional reconstruction can actually reflect the anatomy of renal vessels and act as an effective method in evaluating the anatomy and adjacent relationship of kidney donors of living renal transplantation before operation, which may completely replace digital subtraction angiography in a certain degree.