Comparison of clinical value of dynamic contrast-enhanced MRI and SPECT renal dynamic imaging of GFR measurement in the evaluation of renal function in renal transplantation

Objective:To compare the clinical value of dynamic contrast-enhanced MRI(DCE-MRI)and single-photon emission computed tomography(SPECT)renal dynamic imaging in the measurement of glomerular filtration rate(GFR)in the evaluation of renal function in renal transplantation.Methods:A total of 70 recipients who underwent renal transplantation in Baogang Hospital of Inner Mongolia from April of 2015 to April of 2018 were selected as research objects.GFR was measured in renal transplant recipients by use of DCE-MRI and SPECT(GFR-MRI and GFR-SPECT respectively),and was compared with creatinine clearance rate(Ccr).The safety of contrast media was evaluated in DCE-MRI detection.Results:The bias of GFR-MRI against Ccr value was higher than that of GFR-SPECT against Ccr value,with 30%and 50%accuracy of GFR-MRI higher than that of GFR-SPECT,and the difference was statistically significant(p<.05).Pearson correlation analysis showed that GFR-MRI and GFR-SPECT values were positively correlated to Ccr(p<.05),and the correlation coefficient of GFR-MRI and Ccr was higher than that of GFR-SPECT and Ccr,with the difference statistically significant(p<.05).By Bland-Altman analysis,95%confidence interval of GFR-SPECT was 95.49 ml/(min·1.73 m^(2)),and 95%confidence interval of GFR-MRI was 62.35 ml/(min·1.73m^(2)),which was much narrower.Only 2 cases of patients developed mild rash among 70 cases of patients,and recovered spontaneously without any treatment.Conclusions:Compared with SPECT,the bias of GFR measured by DCE-MRI against Ccr is much greater.However,DCE-MRI has a higher accuracy,correlation and consistency in comparison with Ccr,and it has a narrower confidence interval.DCE-MRI can more accurately evaluate renal function in renal transplantation by measuring GFR,and it has a high safety.

Single-lung transplantation for pulmonary alveolar microlithiasis: A case report

BACKGROUND Pulmonary alveolar microlithiasis(PAM)is a rare idiopathic lung disease characterized by the accumulation of innumerable microliths.Currently,effective therapeutics for PAM are not available,and the only treatment for end-stage lung disease is lung transplantation(LuTx).Further,there are few reports that focus on LuTx for the treatment of PAM,and the follow-up reports of postoperative imaging are even rarer.CASE SUMMARY A 52-year-old man presented to Shanghai Pulmonary Hospital in 2017 after experiencing shortness of breath and exacerbation.The patient was diagnosed with PAM and referred for single-LuTx(SLuTx)on March 14,2018.Preoperative imaging results from a chest X-ray demonstrated bilateral,diffuse,symmetrical,sandstorm-like radiopaque micronodules,and pneumothorax and a computed tomography scan revealed minute,calcified military nodules in both lungs.We performed a left SLuTx,and intraoperative pathology was consistent with PAM.One week after surgery,a chest X-ray revealed slight exudation of the left lung,and one month later,the left transplanted lung exhibited good dilation,mild pulmonary perfusion injury with local infection,and left pleural effusion.Fiberoptic bronchoscopy revealed left hyperplastic granulation at the left bronchial anastomosis.Multiple sputum cultures suggested the presence of Klebsiella pneumoniae and Acinetobacter baumannii.The last follow-up was conducted in April 2019;the patient recovered well.CONCLUSION This case presents the imaging findings of a patient with PAM before and after LuTx and confirms the effectiveness of LuTx for the treatment of this disease.

Multislice spiral CT angiography in evaluation of liver transplantation candidates

BACKGROUND: Orthotopic liver transplantation has be- come the treatment of choice for patients with end-stage liver disease. This study was designed to study whether multislice spiral CT angiography (MSCTA) could be used for preoperative evaluation for orthotopic liver transplanta- tion candidates. METHODS: Eighty consecutive potential candidates for liver transplantation were evaluated with dual-phase three-di- mensional CT angiography (3DCTA). The arterial-phase was used to create vascular maps of the celiac axis (inclu- ding the origin of the hepatic common artery, left gastric artery and splenic artery) and origin of the superior mesen- teric artery. The portal venous-phase was used to analyze portal vein thrombosis and collateral vascularization of the portal vein. Statistical analyses were made using the chi- square test for differences between hepatic arterial anatomy of 80 patients and Michel's anatomy of 200 patients. Appearance of MSCTA and operative results of 16 patients were analyzed. RESULTS; Sixty-two patients (77.5%) showed conven- tional and 18 (22.5%) nonconventional hepatic arterial anatomy. A significant difference was found between the two groups in anatomy of the hepatic artery (P <0.05). Celiac axis stenosis was observed in 6 patients, SA aneu- rysm in 2, small-caliber hepatic arterial vessels in 2, and portal vein thrombosis in 15. Vascular structures of 16 ope- rative patients were well defined. CONCLUSION: As a noninvasive examination, MSCTA can provide a comprehensive preoperative vascular evalua- tion for liver transplantation candidates.

Comparative study of helical CT with contrast-enhanced ultrasound of renal carcinoma

Objective: To investigate the efficiency of helical CT comparing with contrast-enhanced ultrasound, and to im- prove the diagnosis efficiency of renal cell carcinoma (RCC). Methods: Thirty RCCs confirmed pathologically were studied retrospectively. The un-enhanced CT scan and the triphasic enhanced helical CT scan were performed in all cases, the gray-scale US and angiosonography with SonoVue were performed in all cases meantime. Results: 22 cases (73.3%) were diagnosed correctly by helical CT alone before operation. 7 cases (23.3%) were suspected as RCC with helical CT. One case (3.3%) was misdiagnosed with helical CT. 25 cases (83.3%) were diagnosed correctly with contrast-enhanced ultrasound alone pre-operation. One case (3.3%) was suspected as RCC with angiosonography. Four cases (13.3%) were misdiagnosed with angiosonography alone. 29 cases (96.7%) were diagnosed correctly by helical CT combining with angiosonography before operation, one case (3.3%) was diagnosed as renal mass with both helical CT and angiosonography. Conclusion: Contrast-enhanced ultrasound is sensitive in detecting blood flow, it can detect the enhancement of the tumor which cannot be detected by helical CT. CT and angiosonography have strong complement each other in the diagnosis of RCC.

Primary Malignant Renal Tumors in Infancy and Childhood: CT Appearances

Objective： To investigate the imaging manifestation of primary malignant renal tumor with CT. Methods： Forty-three cases of surgically and pathologically confirmed primary malignant renal tumor were retrospectively reviewed. Un-contrast and contrast CT was performed in all 43 patients in which 15 patients received MRI examination. Results： The residual normal renal tissue of 29 cases out of 34 cases of Wilms＇ tumor was enhanced and manifested ＂crescent sign＂ or ＂ring sign＂. Four cases of malignant rabdoid tumor （RTK） manifested as large mass with notable necrosis and subcapsular fluid collection; Two cases of clear cell sarcoma （CCS） showed metastases to the skull which could indicate the diagnosis; Renal cell carcinoma （RCC） （n=3） showed calcification in 1 case. Conclusion： CT can precisely delineate the location, size, extent of involvement, imaging characteristics and metastases of renal tumor, which can provide information necessary to the clinical staging, therapy planning and prognosis of the tumors.

Imaging-based diagnosis of acute renal allograft rejection

Kidney transplantation is the best available treatment for patients with end stage renal disease. Despite the introduction of effective immunosuppressant drugs, episodes of acute allograft rejection still endanger graft survival. Since efficient treatment of acute rejection is available, rapid diagnosis of this reversible graft injury is essential. For diagnosis of rejection, invasive core needle biopsy of the graft is the "gold-standard". However, biopsy carries the risk of significant graft injury and is not immediately feasible in patients taking anticoagulants. Therefore, a non-invasive tool assessing the whole organ for specific and fast detection of acute allograft rejection is desirable. We herein review current imaging-based state of the art approaches for non-invasive diagnostics of acute renal transplant rejection. We especially focus on new positron emission tomography-based as well as targeted ultrasoundbased methods.

Correlation of the CT values of abdominal aorta,renal artery and renal cortex with its thickness on 64-MDCT contrast enhanced imagesCorrelation of the CT values of abdominal aorta,renal artery and renal cortex with its thickness on 64-MDCT contrast enhance

Objective:To investigate the correlation of abdominal aorta CT value,renal artery CT value and renal cortex thickness with renal cortex CT value on contrast enhanced 64-slice CT images.Methods:96patients(50 men and 46women;16~74years)with normal kidney function,which was confirmed by kidney function test were enrolled in this study,including bilateral kidneys of 92cases and unilateral kidney of 4cases(total of 188kidneys;92left,96right).After intravenous(IV)injection of contrast agent the kidneys of the selected patients were scanned by MDCT.The scans were performed in arterial,venous and 3min delayed phases.All statistical analyses were performed by using IBM SPSS 20.0.Graphs were generated using Graph Pad Prism 5software.Quantitative data were presented as mean±standard deviation,while qualitative data were presented as frequency(%).P<0.05was considered to be statistically significant.Results:The mean renal cortex thickness was(5.19±0.81)mm in all kidneys.In the arterial phase,a statistically significant positive correlation between renal cortex CT values and abdominal aortic CT values was showed(r=0.584;P<0.001).A statistically significant positive correlation between renal cortex CT values and renal cortex thickness was demonstrated(r=0.533,P<0.0001).Likewise,there was a positive correlation between renal cortex CT value and renal artery CT values(r=0.43,P<0.001).Conclusion:It is a promising approach to assess the individual kidney function by measuring abdominal aorta CT value,renal artery CT value,renal cortex CT value and renal cortex thickness using contrast MDCT.

16层螺旋CT三维重建对活体供肾的评估价值

目的探讨16层螺旋CT三维重建在活体供肾血管解剖、肾功能评估中的应用价值。方法使用飞利浦Brilliance 16层螺旋CT扫描机对37例活体供肾者术前行螺旋CT扫描,采用容积再现技术(VR)、最大密度投影(MIP)、多平面重建(MPR)、曲面重建(CPR)重建方法进行肾血管及肾实质的三维重建技术,使用层块体积测量方法测量肾脏体积并与肾小球滤过率(GFR)进行比较,测量肾动脉直径并与GFR进行比较。结果螺旋CT三维重建血管造影显示肾脏血管的准确性为89.2%,在各种三维重建方法中,VR在显示肾脏血管全貌、不同角度观察血管方面比较清晰,MPR显示肾脏实质较好。MIP结合轴位图像在判断血管分支,确定血管数量和显示血管有无异常方面比较准确,肾脏体积与GFR呈正相关,肾动脉直径与GFR无明显相关性。结论螺旋CT三维重建技术在显示血管、肾实质及肾脏功能的评估中有明显作用。

多层螺旋CT对活体肾移植供体术前综合评价的初步研究

目的评价MSCT在活体肾供体术前综合评价中的价值。方法11例供体术前进行了MSCT三期增强扫描,均进行VR及MIP重组,观察肾实质、肾动脉、肾静脉以及集尿系统,并与9例手术结果进行对照分析。结果MSCTA显示23支肾动脉,包括左肾副动脉1例;23支肾静脉,包括1例左双肾静脉;23支肾盂输尿管,包括1例右侧双肾盂双输尿管。此外,还检出副肝静脉2例,脾动脉瘤1例。2例放弃手术,1例因肾血管原因,1例为乙肝病毒携带者;9例手术结果与MSCT所见完全吻合,准确率为100%。结论MSCT作为术前活体肾供体的一站式检查技术,有重要的临床应用价值。

64层CTVR技术在活体肾移植供体血管评价中的应用

目的探讨MSCT血管造影容积再现(VR)技术在活体肾供体术前综合评价中的应用价值。资料与方法对55例供体术前的肾脏血管结构的MSCTVR表现进行分析。结果19例可见25支副肾动脉、2例可见肾动脉过早分支、2例可见单侧双肾静脉、1例可见肠系膜上动脉压迫肾静脉。合乎临床要求的供肾46例。结论MSCTVR可较好地显示供体术前的肾脏血管结构。

64层CT三维血管成像对活体供肾移植术前的评价

目的:利用64层螺旋CT三维血管成像对活体(亲属)供肾肾移植术前进行血管情况评价,明确CTA技术在肾移植中的临床应用价值。方法:收集拟行活体肾移植术供肾者44例,行64层螺旋CT三维血管成像,了解肾脏血管起始,数目,分枝走行,有无狭窄及病变,分析其对手术的指导作用。结果:64层螺旋CT三维血管成像的影像立体感强,很好的反映了肾和肾血管的解剖结构以及肾血管的走行、变异情况。结论:64层螺旋CT三维血管成像技术是活体肾移植供肾术前检查的可靠方法,对术前取肾手术方案的制定具有指导作用。

MSCT在活体肾移植供体术前评估中的价值

目的:评价MSCT在活体肾移植供体术前评估中的价值。方法:采用MSCT对58例活体肾移植供体行平扫、肾动脉期、肾静脉期及排泄期扫描,原始图像传入AW4.2工作站,运用VR、MIP、MPR、CPR等多种后处理技术综合分析评估肾动脉、肾静脉、肾实质及集合系统,并与30例手术结果相对照。结果:所有供体均能清晰显示肾动、静脉主干及分支,副肾动脉,肾动脉过早分支,肾动静脉变异,集尿系统情况,并与手术结果相符合。结论:MSCT能清晰显示供肾的血管结构、肾实质及输尿管情况,能够作为肾移植供体术前检查最重要的影像学方法。

双低能谱CT对活体供肾动脉的术前评估

目的探讨采用宝石能谱CT低剂量对比剂、低管电压技术肾动脉成像在肾移植供体术前评估中的应用价值。资料与方法对50例活体供肾者于肾移植术前行螺旋CT肾动脉成像,将其随机分为双低组和对照组,每组25例。双低组管电压100 k V,对比剂使用威视派克(270 mg/ml);对照组管电压120 k V,对比剂使用碘普罗胺(370 mg/ml)。两组图像的重建均为40%ASi R,其他扫描参数不变。比较两组图像质量评分、肾动脉CT值、对比噪声比(CNR)、噪声、辐射剂量以及对比剂用量。结果 2名医师对两组肾动脉图像质量评分的一致性较高(Kappa=0.82)。两组的肾动脉CT值、图像质量整体评分及细节评分比较,差异无统计学意义(t=1.05、0.07、1.62,P>0.05);两组CNR、噪声及辐射剂量比较,差异有统计学意义(t=2.92、-6.95、-2.21,P<0.05);双低组的对比剂用量较对照组降低了27%。结论低浓度对比剂(270 mg/ml)联合低管电压(100 k V)及迭代重建算法在肾动脉CTA中可获得满意的图像,可作为活体肾移植供体术前检查的常规方法。

64层螺旋CT肾血管成像在肾移植活体供肾中的临床应用

目的探讨64层螺旋CT肾血管成像(CTRA)对肾移植活体供肾的临床应用价值。方法对30例活体供肾者的64层螺旋CT肾血管成像资料进行回顾性分析,并与肾移植取肾手术及DSA相对照。结果30例CTRA均清晰显示肾动脉1～4级分支,副肾动脉者13例,发生率43%,肾门前动脉分支者6例,发生率20%,肾静脉多支者3例,发生率10%,多重肾动脉并多发狭窄1例,CTRA对肾血管评估结果与取肾术中所见及DSA结果一致,敏感性及准确性为100%。结论64层螺旋CT肾血管成像是肾移植术前评价活体供肾血管的无创、安全、经济、有效的检查方法。

肾移植术后肺部感染的病原学及CT表现研究

目的探讨肾移植术后肺部感染的病原学及CT表现关系。方法回顾性分析126例肾移植术后肺部感染的病原学和CT资料,探讨不同病原菌感染的肺部CT特征。结果126例肾移植术后肺部感染细菌78例,巨细胞病毒21例,结核9例,霉菌和真菌10例,双重或混合感染25例,不明病原体8例。金黄色葡萄球菌,CMV,结核茵,霉菌感染患者CT特异性表现明显,对诊断感染有意义,其余病原体感染特异性较差,且多以混合感染形式存在,CT鉴别更加困难。结论肾移植术后肺部感染病因多种多样,且CT表现复杂,鉴别相对困难,CT应用价值更多的在于确定患者感染的严重程度及患者肺功能情况,涉及到具体的病原体感染,需与临床及实验室检查相结合,综合分析才能确诊。

64层CT肾血管成像在肾移植供体评价中的临床应用价值

目的:评价64层螺旋CT肾血管成像技术在肾移植供体评价中的临床应用价值。方法:对40例亲属供肾者行64层螺旋CT肾血管成像,应用容积再现(VR)、最大密度投影(MIP)、多平面重组(MPR)等技术进行肾血管重建,评价供肾血管情况,将影像学表现与术中所见进行对照。结果:40例供肾者1次屏气完成扫描,均获得满意的轴面图像,应用VR、MIP、MPR等后处理技术重建肾血管,可清晰显示肾动脉主干及其2～4级分支。9例单侧肾由副肾动脉供血,其中8例单侧肾见单支副肾动脉,1例双侧肾各见1支副肾动脉;9例存在肾动脉分支过早,其中1例双肾动脉均为肾动脉分支过早,共10支血管距离肾动脉开口在1.5cm以内;2例显示肾静脉解剖变异。CT血管成像对供肾动静脉主干、副肾动脉、肾动脉分支过早、肾静脉主干变异的显示与术中所见一致。结论:64层螺旋CT肾血管成像是肾移植术前评价活体供肾血管的一种无创、安全、经济、有效的检查方法。

多层螺旋CT对肾移植前肾脏活体供体的评价

活体肾移植在目前肾移植的领域中占有重要位置,并且发展迅速,但是对手术的要求较高。因而,利用多层螺旋CT对肾脏活体供体进行术前评价,包括对供肾的形态、功能及血管分布的描述对手术的顺利进行有着重要的指导作用。

多层螺旋CT扫描在移植肾动脉狭窄中的应用

目的探讨CT血管造影(MSCTA)在移植肾动脉狭窄(TRAS)中的监测评价作用。方法 15例TRAS实施了MSCTA,后处理方法为MPR、CPR、VR、MPVR、MIP及VP。对所有后处理方法进行分析,观察移植肾动脉的情况,比较各自优缺点。结果 TRAS的CT征象表现为狭窄局部血管明显变细,肾实质强化减低。CT后处理方法:①MPR仅有1例可以将移植肾的肾动脉显示于同一层面中;②CPR的13例可在冠、矢状面上显示移植肾动脉全程情况;③VR的15例均可通过旋转体位清晰观察迂曲的移植肾动脉走行状态和血管狭窄外观;④MPVR的15例可同时显示出移植肾动脉及TRAS情况;⑤MIP中9例可以同一平面上显示TRAS的部位;⑥VP的15例可以较好地显示移植肾动脉管腔内部情况,狭窄程度显示清晰。15例TRAS中吻合口狭窄者8例,吻合口远处狭窄者4例,吻合口和远处均有狭窄者2例,全程狭窄者1例。结论 MSCTA作为术后监测TRAS的影像学检查技术,能够直接清晰的显示移植肾动脉狭窄部位、形态,而且可以指导PTA及观测血管内支架植入疗效,将在临床上发挥越来越重要的应用价值。

动态增强MRI与SPECT肾动态显像测定GFR评估肾移植术肾功能的临床价值比较

目的比较动态增强MRI(DCE-MRI)与单光子发射计算机断层成像术(SPECT)肾动态显像测定肾小球滤过率(GFR)评估肾移植术肾功能的临床价值。方法选取2015年4月～2018年4月于内蒙古包钢医院接受肾移植术的患者70例为研究对象,分别采用DCE-MRI及S;PECT测定其移植肾GFR(分别为GFR-MRI、GFRSPECT),并与内生肌酐清除率(Ccr)进行比较分析。评估DCE-MRI检测中造影剂的安全性。结果检查测得患者GFR-MRI与Ccr值的偏倚高于GFR-SPECT,30%及50%精确度高于GFR-SPECT,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,GFR-MRI、GFR-SPECT值均与Ccr呈正相关(P<0.05),GFR-MRI与Ccr相关系数高于GFR-SPECT与Ccr相关系数,差异有统计学意义(P<0.05)。通过Bland-Altman分析,GFR-SPECT的95%可信区间为95.49 mL/(min·1.73m2),GFR-MRI的95%可信区间为62.35 mL/(min·1.73m^2),GFR-MRI的可信区间更窄。70例患者中仅2例出现轻微皮疹,且在未经任何治疗的情况下自行好转。结论与SPECT比较,DCE-MRI测得的GFR与Ccr偏倚较大,但与Ccr比较具有更高的精确度、相关性及一致性,可信区间更窄,DCE-MRI能更准确通过测定GFR评估肾移植术肾功能,且具有较高的安全性。

多层螺旋CT重建技术对亲属活体肾移植供肾的综合评价

目的探讨多层螺旋CT（MSCT）重建技术在亲体肾移植供肾评价中的应用价值。方法2006年1月-2009年1月在北京协和医院行亲体肾移植的供肾者6名,其中男3名,女3名,平均年龄50.1岁（37-53岁）;均在术前使用64排螺旋CT机进行动态扫描,用最大密度投影、曲面重建、容积再现等技术对肾血管及集合系统进行多种方法重建。对6名供者的手术资料进行随访追踪,术中结果作为对照。结果术前MSCT检查能清晰显示6名供者的腹主动脉、双侧肾动脉、肾静脉和集合系统大小、形态、走行以及与周围结构的关系。其中5名双肾均为单支动脉供血,1名右肾见1支副肾动脉。6名供者均成功切取左肾并移植给受者。术前对供体肾MSCT检查结果与手术所见一致。结论MSCT重建技术可对亲属活体肾移植术前供体肾脏进行综合评价,该技术具有方便、快捷及无创的优点,值得进一步推广。