移植肾磁共振成像特征的探讨

Research into MRI Features of the Transplanted kidney

目的:探讨移植肾的MRI表现、材料与方法:对35例移植肾进行MRI检查,根据临床症状及生化资料将其分成三组,即非排斥组22例;排斥组(急性、慢性)5例;少尿、无尿组8例。MRI观察项目:(1)移植肾大小,(2)移植肾皮髓质分辨率(四级),(3)移植肾血管能见度(四度)。结果:非排斥组,肾脏外形无增大,皮髓质分辨率Ⅱ级以上达95％,血管能见度Ⅱ度以上达95％,排斥组,急性:肾脏外形均增大,皮髓质分辩模糊均在Ⅱ级以下,血管能见度在1～0度范围;慢性:肾脏稍偏小,皮髓质分辨率及血管能见度均在Ⅱ～Ⅰ级(度)范围。少尿、无尿组,早期肾脏无增大,皮髓质分辨清楚,Ⅱ级达75％,而血管能见度差,Ⅰ度达75％。本文重点讨论少尿、无尿组的病因,MRI特征及血管能见度改变的临床意义。结论:MRI能较好地显示移植肾的变化,并对其CMD和PVV级别进行判断。

Purpose: To investigate MRI features of transplanted kidney. Materials and Methods; Thirty - five patientswith transplanted kidney underwent the examination of MR imaging, based on clinical symptoms and biochemical informations in all patients, and them were divided into the following four groups: 1) non -rejected kidney (n = 22), 2) acute rejected kidney (n =3), 3) chronic rejected kidney(n: 2), and 4) oliguria or anuria group (n=8). The items of observation on MRI included the size, cortico-medullary differentiation(CMD) and parenchymal vessel visibility(PVV) of transplanted kidney. Results: in 1st group, the size of all transplanted kidney were normal but CMD and PVV in 21 Patients (95% )reached to grade Ⅱ; in 2nd group, the transplanted kidney more or less enlarged, CMD were less than grade Ⅱ and PVV ranged between grade 1 - 0; in 3rd group, the transplanted kidney more or less diminished, PVV and CMD ranged between grade Ⅱ- Ⅰ; and in 4th group, the size of the transplanted kidney non -changed obviously at early term but CMD and .PVV in 6 patients (75% ) reached to gradeⅡ and Ⅰ, respectively. The paper discussed emphatically the cause led up to oliguria or anuria, MRI features, and the clinic importance of PVV change from tronsplanted kidney. Conclusion:MRI can not only better display the size changing of transplanted kidney but also can mere accurately identify the grade of its CMD and PVV, and therefore it is useful for evaluating the state of transplanted kidney.