螺旋CT血管造影及血管仿真内镜技术对肾动脉狭窄的诊断与评价

Application of SCTA and CTVE in diagnosising of renal artery stenosis

目的：探讨螺旋ＣＴ血管造影（ＳＣＴＡ）及血管仿真内镜技术（ＣＴＶＥ）在肾动脉狭窄（ＲＡＳ）诊断中临床应用价值。方法：７例ＲＡＳ及１例ＲＡＳ肾切除术后患者行肾动脉ＳＣＴＡ及三维重建，三维重建方法包括：表面遮盖成像（ＳＳＤ）和最大密度投影（ＭＩＰ）。３例同时行肾动脉血管ＣＴＶＥ成像。结果：ＳＣＴＡ ２ＤＣＴ图像显示７例ＲＡＳ患侧肾体积明显缩小，肾皮质明显变薄，无或部分强化。７例ＲＡＳ ＳＳＤ和ＭＩＰ均可清晰显示肾动脉主干狭窄的部位、狭窄程度与范围，但不能显示肾段较小肾动脉的狭窄情况。１例ＲＡＳ肾切除术后ＭＩＰ和ＳＳＤ未见肾动脉及其分支显示。３例肾血管ＣＴＶＥ能显示狭窄的肾动脉开口及管腔明显变窄。结论：ＳＣＴＡ及ＣＴＶＥ是诊断肾动脉主干狭窄的有效方法，基本上可代替动脉血管造影。

Objective:To evaluate SCTA,CTVE for diagnosis of renal artery stenosis.Methods:8 cases of renal artery stenosis (RAS) were examined by SCTA,which was reconstructed by SSD and MIP techniques.Additional CT virtual endoscopy (CTVE) of renal arteries were performed in 3 cases .Results:The size of kidney with RAS (n=7) was very small with thin cortex of kidney and no or slight enhancement on 2D CT.The location,degree and extent of stenosis of the main renal arteries(n=7) were clearly demonstrated by SSD and MinIP.However,the stenosis of renal segmental artery and its branches were unable to be demonstrated.Left renal artery and its branches due to resection of left kidney with RAS(n=1) were not shown by SSD and MIP.CTVE displayed clearly the stenosis of the orifice and the small lumen of RAS (n=3).Conclusion:SCTA and CTVE are effective methods in detecting stenoses of the main renal arteries,and can partially replace conventional angiography.