Kawamoto Satomi, Montgomery Robert A, Lawler Leo P, Horton Karen M, Fishman Elliot K
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 N Caroline St, Room 3254, Baltimore, MD 21287-0801, USA.
Radiographics. 2004 Mar-Apr;24(2):453-66. doi: 10.1148/rg.242035104.
Since its introduction in 1995, laparoscopic nephrectomy has become the preferred technique at many medical centers for the harvesting of kidneys from living donors for transplantation. Because the field of view at laparoscopic surgery is limited, preoperative radiologic evaluation of the donor's anatomy---the renal veins and arteries, collecting system, and parenchyma--is critical. Spiral computed tomographic (CT) angiography is a fast, safe, minimally invasive, and generally accepted method for preoperative evaluation of the renal vessels. Multi-detector row CT scanners offer shorter image acquisition time, narrower collimation, better spatial resolution, and less tube heating than do single-detector row CT scanners. Multi-row scanners also provide more complete anatomic coverage, increased contrast enhancement of the arteries, and greater longitudinal spatial resolution--all of which are important both for accurate imaging of the renal vasculature and for three-dimensional postprocessing of image data. Dual-phase multi-detector row CT angiography combined with three-dimensional postprocessing enables minimally invasive and highly accurate depiction of the preoperative donor anatomy. To make the most effective use of this method, radiologists must be familiar with its technical aspects, advantages, and potential pitfalls. They also must be able to identify variations in vasculature and in renal and extrarenal anatomy that are important for laparoscopic donor nephrectomy.
自1995年引入以来，腹腔镜肾切除术已成为许多医疗中心从活体供体获取肾脏用于移植的首选技术。由于腹腔镜手术的视野有限，术前对供体解剖结构——肾静脉和动脉、集合系统及实质——进行放射学评估至关重要。螺旋计算机断层扫描（CT）血管造影是术前评估肾血管的一种快速、安全、微创且普遍接受的方法。与单排探测器CT扫描仪相比，多排探测器CT扫描仪的图像采集时间更短、准直更窄、空间分辨率更高且球管发热更少。多排扫描仪还能提供更完整的解剖覆盖、增强动脉的对比增强以及更高的纵向空间分辨率——所有这些对于准确成像肾血管系统以及对图像数据进行三维后处理都很重要。双期多排探测器CT血管造影结合三维后处理能够以微创且高度准确的方式描绘术前供体解剖结构。为了最有效地利用这种方法，放射科医生必须熟悉其技术方面、优势和潜在陷阱。他们还必须能够识别对腹腔镜供体肾切除术重要的血管系统以及肾脏和肾外解剖结构的变异。
