先天性肾异位和融合畸形的多层螺旋CT血管成像分析

Analysis of multi-slice spiral CT angiography manifestations in congenital ectopic kidney and renal fusion malformation

目的:分析先天性肾异位和融合畸形在多层螺旋CT血管造影(MSCTA)中的表现。方法:搜集4例盆腔异位肾、4例交叉异位肾、8例马蹄肾的MSCTA资料,采用容积再现(VR)血管生长技术(AV)进行肾脏及血管重建,分析其影像学表现。结果:4例盆腔异位肾中,2例肾动脉起自腹主动脉下段、1例起自左侧髂总动脉经肾门进入肾脏,1例3支副肾动脉分别起自左侧髂总动脉,于侧后方和背侧进入肾脏,4例肾静脉发自肾门,汇入下腔静脉下段。4例交叉异位肾中,3例双肾下极、1例内侧缘融合,双侧肾动脉分别起自腹主动脉下段或同侧髂总动脉,3例双肾静脉分别汇入下腔静脉下段,1例双肾静脉汇合成1支主干后再汇入下腔静脉。8例马蹄肾中,6例双侧肾动脉开口位置低于正常,3例双肾副肾动脉、1例左肾2支副肾动脉(发生率50%),1例左肾2支副肾静脉、2例左肾静脉肾门外汇合变异(发生率37.5%)。结论:MSCTA能清楚显示先天性肾脏融合和异位的肾脏位置、形态及血管异常。

Objective：To analyze the multi-slice spiral CT angiography （MSCTA） manifestations of congenital ectopic kidney and renal fusion malformation. Methods： The MSCTA materials of pelvic ectopic kidney （4 cases）, crossed ectopic kidney （4 cases） and horseshoe kidney （8 cases） were recruited. Volume rendering （VR）, add vessel （AV） were used for kidney and blood vessel reconstruction, the imaging manifestations were analyzed. Results：Of the 4 cases with pelvic ectopic kidney, there were renal artery deriving from the lower abdominal aorta （2 cases）, from left arteria iliaca communis （1 case） then entering kidney via renal hilum. The other one case showed 3 accessory renal arteries derived from left arteria iliaea eommunis,then converging via posterior and dorsal side and entered the kidney. In all of the four cases,renal veins origina- ted from renal hilum and converged into the lower segment of inferior vena cava. Of the 4 cases with crossed eetopic kidney, 3 eases had the confluence at the lower pole of bilateral kidney,and one case had fusion of medial edge. Bilateral renal artery of these four cases derived from the lower segment of aorta abdominalis,or the ipsilateral arteria iliaca communis. Three ca- ses had bilateral renal veins entering into the lower segment of inferior vena cava separately,and one case had bilateral renal veins converging into one main trunk then entering inferior vena cava. Of the 8 cases with horseshoe kidney,6 cases had the opening of bilateral renal artery lower than that of normal position, 3 cases with accessory renal arteries in bilateral kidneys and one case with two accessory renal arteries in the left kidney with the incidence rate as 50 %. One case had two accessory renal veins in the left kidney, two cases had left renal vein anomaly showing renal veins converging outside renal hilum, with the incidence rate as 37.5 %. Conclusion： MSCTA can clearly show the position, morphology and vascular anomalies of con- genital renal fusion and ectopic kidney.