超选择栓塞治疗急性肾出血及CT血管成像在显示责任血管中的作用

Super-selective embolization for acute renal hemorrhage and the role of CTA in displaying offending arteries

目的研究超选择肾动脉栓塞(renal artery embolization,RAE)治疗急性肾出血的成功率,以及栓塞前CT血管成像(computed tomography an giography,CTA)在显示责任血管中的作用。方法选择2016年1月至2021年12月苏州大学附属第一医院介入科和苏州市相城人民医院介入科完成的RAE病例。以发现并栓塞责任血管、出血停止、血压恢复为技术成功,以康复出院为临床成功,以RAE前后肌酐、尿素氮、肾小球滤过率的变化,以及栓塞相关并发症评价安全性。进一步筛选,病因为创伤或医源性损、有确切出血征象、有术前增强CT的病例。将增强CT数据回传工作站,行最大密度投影(maximal intensity projection,MIP)、曲面重建(curved planar reformation,CPR)、容积再现(volume rendering,VR)重建。以RAE术中造影为金标准,研究CTA的灵敏度和特异度。结果共纳入52例,首次技术成功率90.4%,补救技术成功率96.2%,临床成功率92.3%。临床成功的48例患者中,RAE前后血清肌酐、尿素氮、肾小球滤过率差异无统计学意义,均在正常值范围内。随访期间无RAE相关并发症。共16例完成CTA重建。MIP、VR、CPR的灵敏度分别为68.8%、62.5%、68.8%。综合3种重建方法,CTA总的灵敏度为75.0%,特异度均为100%。结论我中心超选择RAE治疗急性肾出血的技术成功率为96.2%。对于创伤或医源性损伤所致的急性肾出血,栓塞前CTA可显示出血责任血管,联合多种重建方法效果更好。

Objective To investigate the success rate of super selective renal artery embolization(RAE)in the treatment of acute renal hemorrhage in our center and the role of computed tomography angiography(CTA)in the identification of offending arteries.Methods Patients with acute renal hemorrhage treated by RAE in our center in recent 6 years were included.Technical success was defined as to find and embolize the offending arteries,stop bleeding and restore blood pressure.Clinical success was determined by rehabilitation and discharge.The safety was evaluated by the changes of creatinine,urea nitrogen and estimated glomerular filtration rate before and after RAE,and the complications related to embolism.Further screening the cases caused by trauma or iatrogenic damage,with definite bleeding signs,and with pre-RAE enhanced CT.The enhanced CT data was returned to the workstation,and the maximal intensity projection(MIP),curved planar reformation(CPR),and volume rendering(VR)reconstruction were performed in the arterial phase.The sensitivity and specificity of CTA were studied compared with intra-RAE angiography as the gold standard.Results A total of 52 cases were included,including 29 cases caused by iatrogenic damage,9 cases caused by trauma and 14 cases caused by other reasons.The first technical success rate was 90.4%,the remedial technical success rate was 96.2%,and the clinical success rate was 92.3%.In 48 patients with clinical success,the changes of creatinine,urea nitrogen and glomerular filtration rate before and after RAE were not statistically significant,and all were within the normal range.There were no RAE-related complications during follow-up.CTA reconstruction was completed in 16 patients.The sensitivity of MIP,VR and CPR were 68.8%,62.5%and 68.8%,respectively.The overall sensitivity of the three reconstruction methods was 75.0%.The specificity was 100%.Conclusion The technical success rate of RAE in the treatment of acute renal hemorrhage is 96.2%in our center.For acute renal hemorrhage caused by trauma or iatrogenic injury,pre-RAE CTA can display the offending arteries,and it can obtain a better effect to combine multiple reconstruction methods.