256层iCT在上肢动静脉瘘CTA检查的临床应用

目的探讨256层iCT对尿毒症血液透析患者行上肢动静脉瘘CT血管造影术（CTA）检查的临床应用价值。方法收集尿毒症血液透析上肢动静脉造瘘患者30例，采用飞利浦256层iCT行上肢动静脉瘘CTA检查，选择临床提示造瘘时间0-3年内，血液透析流速〈200ml／min患者。从非患侧手背注射对比剂350安射力60-80m1．监测气管分又处下方1cm处的降主动脉，阈值150HU，达到阈值后再延迟15s从头侧开始扫描。后处理使用飞利浦星云5．0工作站，使用最大密度投影（MIP），多平面重建（MPR），曲面重建（CPR）等多种重建方法。对造瘘血管狭窄段进行多种方法分析处理。结果30例患者中引流动脉异常1例（0．33％），造瘘血管异常9例（30％），回流静脉异常20例（66．7％）。结论上肢动静脉瘘CTA检查可以准确显示造瘘血管情况异常程度，血管异常与造瘘时间与穿刺次数有关，上肢动静脉瘘CTA对临床造瘘血管狭窄诊断提供帮助。

Objective To evaluate the clinical value of CT angiography （ CTA ） with 256-slice CT scanner for autogenous arteriovenous fistula dysfunction in hemodialysis patients. Methods 30 hemodialysis patients with autogenous arteriovenous fistula dysfunction of the affected upper limbs underwent CTA the fistula was used within 0-3years, flow rate was lower than 200ml/min. A total of 60-80ml of contrast agent was injected into the antecubital vein of contralateral limb, the bifurcation of the trachea at lcm below the descending aorta was monitored, threshold was 150HU, when reaching the threshold, delay 15s before starting scanning from the head side. Using different postprocessing techniques such as maximum intensity projection （ MIP ） , multiple planar reconstruction （ MPR ） , surface reconstruction （ CPR ） and other reconstruction methods at the Philips cloud 5 work station. The stenosis of fistula were analyzed with several ways. Results The fistula could be clearly displayed on CTA.In 30 hemodialysis patients, including draining artery variation 1 （ 0,33% ） , vascular fistula variation 9 （ 30% ） , regurgitant vein variation 20 （ 66.7% ） . Conclusion CTA examination of the upper extremity arteriovenous fistula can accurately show the abnormal fistula, and the abnormal blood vessel related to the time of the puncture and the number of puncture. It is an important tool to diagnose the stenosis of the fistula.