【摘要】 【目的】评估64层螺旋CT血管成像(64-MSCTA)在显示先天性微小肾动静脉畸形(rAVM)方面的应用价值。【方法】回顾性收集分析本院2005年10月至2013年1月期间主诉无痛性肉眼血尿、CTA资料完整并确诊的先天性rAVM的患者共11例。所有患者均先后于我院行双肾64-MSCT平扫+增强扫描及数字减影血管造影(DSA)检查。容积数据采用容积再现(VR)和最大强度投影(MIP)技术重建增强扫描皮质期肾脏血管。CT图像由2名影像医师进行双盲法阅片并取得一致意见。【结果】11例rAVM病灶均由DSA证实。其中6例范围较大的rAVM病灶于CT增强扫描皮质期即可显示,采用MIP及VR技术行血管三维重建后提示病灶均由单支肾动脉供血,均未见副肾动脉供血;5例微小rAVM病灶于CT增强扫描(包括薄层扫描)未见显示,应用CTA血管三维重建后发现了肾脏微小的迂曲畸形血管团。DSA示11例rAVM部位、大小及形态均与CTA血管三维重建图像表现一致。【结论】对于不明原因的血尿患者且常规CT检查无异常发现时,建议行CTA成像以免漏诊微小rAVM。更多还原

【Abstract】 【Objective】 To evaluate the role of 64-MSCT angiography(64-MSCTA) in the detection of the small congenital renal arteriovenous malformation(rAVM). 【Methods】11 cases who were detected rAVM by 64-MSCT three phase renal enhancement scan from October 2005 to January 2013 in our hospital were collected and analyzed retrospectively. All cases were further followed by digital subtraction angiography(DSA) examination. Images were reconstructed using volume rendering(VR) and full thickness maximum intensity projection(MIP) reconstruction technique to make a renal vascular reconstruction in renal cortex enhancement phase. Two urogenital radiologists were blind to interpret and analyzed the CT images independently and finally got an consistency. 【Results】 All 11 cases being diagnosed rAVM were confirmed by DSA, among whom, 6 were detected having irregular twisted vascular lesions in renal cortex enhancement phase, and all abnormal arterioles were supplied by a single renal artery without accessory renal artery supply after MIP or VR reconstruction were made. And the remaining 5 having no abnormal findings previously were also identified having slightly tortuous abnormal arterioles lesions after the CTA reconstruction were particularly made afterward. The location, volume as well as the shape of all eleven lesions demonstrated in 3-D reconstruction of MIP or VR images manifested quite similar to those appeared in DSA examination. 【Conclusions】 For patients with hematuria without any abnormal findings through CT examination, we suggest that 64-MSCTA as a routine protocol to eliminate the possibility of small congenital rAVM lesions.更多还原