肾CTA-CTU融合成像在肾肿瘤术前评估中的价值

The Value of Renal CTA-CTU Fusion Image in Preoperative Evaluation of Renal Tumors

目的探讨CT血管造影-CT泌尿系统造影(CTA-CTU)融合成像在肾肿瘤术前评估中的临床价值。方法回顾性分析29例行腹腔镜保留肾单位手术(LNSS)肾肿瘤患者术前的CT资料及CTA-CTU融合图像,在肿瘤定位诊断的基础上,观察肾肿瘤的形态、大小,并确定其与肾动脉、肾集合系统的解剖关系,评价肾肿瘤血供及患肾血管变异情况、肾集合系统侵犯情况,并与术中所见对照,分析CTA-CTU融合成像的术前控制价值。结果29例肾肿瘤患者均获得满意的轴位原始图像,应用容积再现(VR)等后处理技术,显示肾肿瘤位置、形态、大小与术中所见一致。肾肿瘤外凸率、肾动脉记数,融合成像与术中情况均显著相关(r=0.664,P<0.001)、(r=0.632,P<0.001)。肾肿瘤与集合系统距离与术中肾集合系统处理情况构筑受试者工作特征曲线(ROC),计算曲线下面积(AUC)为0.748。结论多排螺旋CT(MDCT)融合成像可直观、准确地显示肾肿瘤位置、大小、外凸率及与肾门血管、集合系统关系、肿瘤血供及患肾血管变异情况,为临床手术方式评估提供重要参考。

Objective To investigate the preoperative values of the fusion image of CTA-CTU in renal tumor.Methods Preoperative CT images and CT fusion images in 29 patients with renal tumor who underwent laparoscopic nephron sparing surgery were reviewed retrospectively.The morphology and size of renal tumors were observed,and the anatomical relationship between tumors with renal artery and renal collecting system were determined.The blood supply of renal tumor,the variation of renal artery,and the invasion of renal collecting system were evaluated,as to analyze the preoperative control value of CTA-CTU fusion imaging compared with the intraoperative findings.Results The axial source images of 29 patients were acquired successfully.The position,shape and size of renal tumors were consistent with those observed during operation by volume rendering and other post-processing images.For the exogenous rate of renal tumor and renal artery count,fusion image was significantly correlated with the intraoperative observations(r=0.664,P<0.001),(r=0.632,P<0.001).The receiver operator characteristic(ROC)curve was yielded based on the distance between the kidney tumor and the nearest collecting system and the treatment of the intraoperative renal collecting system,and the area under the curve(AUC)was 0.748.Conclusion MDCT fusion image can show the location,size,exogenous rate of renal tumors,and is related with renal hilar vessels and collecting system,tumor feeding artery and variation of renal vessels intuitively and accurately,which was important to clinical for guiding surgical plans.