磁共振泌尿造影在肾移植病人术后监测的应用

Evaluation of clinical application of MR urography in monitoring of complication of transplanted kidney

目的 :评价磁共振泌尿造影 (MRU)对监测肾移植并发症的临床应用价值。方法 :采用快速自旋回波 (FSE)重T2 加权序列对 15例患者移植肾进行冠状位扫描 ,将图像按最大强度投影 (MIP)法重建出MRU图像。经手术病理证实为尿路便阻者 2例 ,尿漏 2例 ,吻合口动脉瘤 1例。经临床及化验室检查证实为排异反应 4例 ,环孢素A毒性反应 2例。移植肾正常 4例。结果 :各例的MRU均清晰显示移植肾在盆腔内的位置及形态 ,对梗阻的尿路、肾盂积水及尿路梗阻部位显示良好 ,解剖结构清晰 ,结合MR与其它影像资料 ,可对梗阻作出定性诊断 ,对肾周积液存在的位置及积液量显示清楚。结论 :MRU是无创伤的检查方法 ,可判断移植肾的大小、肾周积液是否存在及移植肾集合系统是否扩张 ,对尿路梗阻定位、定性准确 ,是一种新的安全的术后并发症影像监测手段 。

Objective:To evaluate the clinical application of MR urography(MRU)in monitoring of postoperative complications of transpanted kidney.Methods:15 patients were examined with fast spin echo heavily T 2 weighted sequence,acquired in coronal plane.The images of raw data were projected into a composite image of MRU using a maximum intensity projection(MIP)algorithm.5 patients were verified by operation and pathology,including ureteral obstruction (n=2),urinary fistula(n=2) and vascular anstomosis aneurysm(n=1).6 patients were verified by clinical and laboratory examnation,including renal rejection(n=4),ciclosporin A toxic reaction(n=2),and normal transplanted kidney(n=4).Results:MRU provided high resolution images of location and form of renal transplant .In all patients with urinary tract obstruction,the locations of urinary tract stenosis and the causes of hydronephrosis were distinctly shown.Postoperative fluid collections arround the graft can also be detected clearly by MRU.Conclusion:MRU is a noninvasive technique with excellent accuracy in the diagnosis of urinary tract obstruction,fluid collections and size of renal transplant.MRU is a safe imaging technique for monitoring complication of transplanted kidney.It is suitable for renal transplantation in cases suspicious of complication in the urinary system.