多层CT血管成像在老年肾动脉狭窄相关疾病中的应用价值

Multidetector CT Angiography in the Diagnosis of Geriatric Renal Artery Stenosis Disease

目的：以数字减影血管造影（DSA）为参考标准,探讨多层CT血管成像（MDCTA）在无创诊断老年肾动脉狭窄相关性疾病中的应用价值。方法：对我院2012年1月至2014年3月经DSA证实的老年肾动脉狭窄相关疾病患者48例（男性27例,女性21例,年龄65~79岁,平均年龄71±5岁）,于DSA术前行MDCTA前瞻性对照研究,观察MDCTA显示肾动脉狭窄的程度、位置、形态和数目等情况,并对不同病因所引起的肾动脉狭窄进行CT影像分析。结果：48例肾动脉狭窄相关疾病包括动脉粥样硬化性肾动脉狭窄42例、大动脉炎1例、先天性肾动脉发育不良1例、肾动脉纤维性肌性结构不良1例、肾动脉瘤1例、自发性肾动脉夹层1例和腹膜后肿瘤压迫1例。DSA证实狭窄肾动脉60支,均为主肾动脉,其中双侧26例,左侧5例,右侧3例。起始部狭窄48支,中部狭窄3支,全程狭窄9支。MDCTA显示血管狭窄65例,其敏感度为100%,特异度为87.8%,准确度为95.1%,阳性预测值为92.3%,阴性预测值为100%。狭窄程度MDCTA分级：0级36支,Ⅰ级20支,Ⅱ级29支,Ⅲ级11支,Ⅳ级5支;DSA分级：0级41支,Ⅰ级19支,Ⅱ级27支,Ⅲ级10支,Ⅳ级4支,两种检查方法评价肾动脉狭窄程度差异无统计学意义（Pearsonχ2=0.5805,P=0.965）。结论：MDCTA能清晰显示肾动脉狭窄的位置、数目和形态,并精确评价其狭窄程度和鉴别肾动脉狭窄相关性疾病的病因,可作为老年肾动脉相关性疾病无创性诊断的首选方法。

Purpose： To assess the diagnosis value of Multidetector CT Angiography （MDCTA） in aged patients with renal arterial stenosis as an noninvasive method, and to assess the CT imaging features in early diagnosis and management. Methods： This prospective study included 48 patients with renal arterial stenosis confirmed by DSA. The morphology features, location, and degree of renal vascular stenosis were analyzed on CT images. Results： Of these 48 aged patients with renal arterial stenosis, ARAS could be found in 42 cases, renal arteritis in 1 case, congenital renal arterial dysplasia in 1 case, fibromuscular dysplasia in 1 case, renal aneurysm in 1 case, spontaneous renal artery dissection in 1 case, and retroperitoneal tumor in 1 case. Sixty cases of renal arteries stenosis （all of them were main renal arteries） were confirmed by DSA, including 26 cases of bilateral main renal arteries, 5 cases of left, and 3 right; 48 cases of initiation site stenosis, 3 cases of central stenosis and 9 cases of full stenosis. Sixty-five cases of renal arteries stenosis were confirmed by MDCTA. The sensitivity of CTA was 100%, specificity was 87.8% and accuracy was 95.1%; Positive predictive value was 92.3%, negative predictive value was 100%. The stenosis grade of MDCTA were： 36 cases of 0 grade, 20 cases of grade Ⅰ, 29 cases of grade 11, 11 cases of grade UI, 5 cases of grade Ⅳ. The stenosis grade of DSA were： 41 cases of 0 grade, 19 cases of grade I, 27 cases of grade Ⅱ, 10 cases of grade m, 4 cases of grade IV. There was no significant difference in stenosis grade between MDCTA and DSA （Pearson X2=0.5805, P=0.965） .Conclusion： MDCTA can clearly visualize the morphology, location, and number of renal arterial stenosis, and can be used to evaluate the grade of stenosis. It has an important value in the differential diagnosis and clinical management in aged patients of renal arterial stenosis as a noninvasive method.