中国实用儿科杂志

中国实用儿科杂志

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多层螺旋CT血管造影在小儿肾血管性高血压诊断中的应用

孙书珍1，汪翼1，王锡明2，韩波1，李倩1   

  1. 1.山东大学山东省立医院儿科,山东济南 250021；2. 山东省医学影像学研究所, 山东济南 250021
  • 收稿日期:2005-11-21 修回日期:2006-02-20 出版日期:2006-06-06 发布日期:2006-06-06

The application of multispiral CT angiography to the diagnosis of renovascular hypertension in children.

Sun Shuzhen* ，Wang Yi，Wang Ximing,et al.   

  1. *Department of Pediatrics,Shandong Provincial Hospital,Shandong University，Jinan 250021，China
  • Received:2005-11-21 Revised:2006-02-20 Online:2006-06-06 Published:2006-06-06

摘要： 目的探讨多层螺旋CT血管造影(MSCTA)在儿童肾血管性高血压诊断中的临床价值。 方法山东大学山东省立医院儿科2002年以来,经MSCTA肾动脉成像确诊为血管性高血压的患儿8例，8例行彩色多普勒超声肾血流检查，6例行X线血管造影(XRA)检查，将MSCTA检查结果与彩色多普勒超声肾血流和XRA检查结果进行比较。MSCTA扫描参数取准直075mm,螺距1,管电压为90~120kV,管电流为120~150mA。扫描结束后对每一病例均行曲面重建(CPR)、多平面重建(MPR)、容积再现(VR)和最大强度投影(MIP)重建。 结果8例中MSCTA显示10条肾动脉狭窄，左侧6条，右侧4条，其中2例为两侧肾动脉狭窄;8条为起始段狭窄，2条为肾动脉中段狭窄;狭窄长度02~10cm，Ⅰ级狭窄1条，Ⅱ级狭窄6条，Ⅲ级狭窄3条。MSCTA尚可见6例肾缩小，平均长径为71cm，低于健肾15cm以上;1例伴有腹主动脉壁增厚，管腔狭窄，直径约10cm;6例行腹主动脉或选择性肾动脉造影者与MSCTA显示肾动脉狭窄部位和程度完全一致。8例行彩色多普勒超声检查者，亦可见6例肾缩小，但仅5例显示肾动脉狭窄，左侧2条，右侧3条。 结论MSCTA能准确地显示肾动脉狭窄的程度和部位，清晰地显示肾动脉壁及其腔内的情况，作为无创、简便、安全、价廉的检查方法，在一定程度上可替代有创伤性的选择性肾动脉造影。

关键词: 肾血管性高血压, 多层螺旋CT, 血管造影, 儿童

Abstract: AbstractObjectiveTo discuss the clinical application of multispiral CT angiography (MSCTA) to the diagnosis of renovascular hypertension in children. MethodsSince 2002,8 cases of diagnosed renovascular hypertension underwent MSCTA.8 cases received colourcoded Doppler ultrasonography(DUS) and 6 cases received Xray angiography (XRA).The results were compared.The scanning paremeters were as follows:collimation 075 mm,pitch 1,tube voltage 90~120kV and tube current 120~150mAs.After scanning,multiplanar reconstruction(MPR)(coronal,sagittal,oblique),maximum intensity projection(MIP) and volume rendering(VR) were reconstructed. ResultsWe visualized 10 renal arterial stenosis ( left 6 and right 4,including 2 bilateral stenosis) in 8 cases by MSCTA.Among these renal arteries 8 had lesions in the origins and 2 in the middle.The length of stenosis was 02~10cm and the Grade 1 stenosis was one renal artery,Grade 2 six renal arteries,and grade 3 three renal arteries.MSCTA showed 6 kidneys dwindled with average length 71cm,which was 15cm less than normal kidneys.One case was accompanied by wallthickening and cavitary stenosis of abdominal aorta.The locations and extent of stenosis in 6 cases by XRA and by MSCTA were identical.We found renal arterial stenosis only in 5 of 8 cases and 6 dwindled kidneys by DUS. ConclusionMSCTA can not only reveal the extent and locations of renal arterial stenosis,but also show the walls and lumens of the renal arteries.As a noninvasive and valuable examination,MSCTA can replace invasive selected renal arteriography to some extent.

Key words: Children , Multispiral CT, Angiography