Raman Steven S, Pojchamarnwiputh Suwalee, Muangsomboon Kobkun, Schulam Peter G, Gritsch H Albin, Lu David S K
Department of Radiology, David Geffen School of Medicine at the University of California at Los Angeles, BL-428 CHS/Box 951721, Los Angeles, CA 90095-1721, USA.
AJR Am J Roentgenol. 2006 Jun;186(6):1630-8. doi: 10.2214/AJR.05.0983.
Our objective was to determine the efficacy of 16-MDCT angiography in preoperative evaluation of vascular anatomy of laparoscopic renal donors.
Fifty-five consecutive renal donors (25 men and 30 women) underwent 16-MDCT angiography followed by donor nephrectomy. In the arterial and nephrographic phases, images were acquired with 60% overlap and 0.6-mm reconstruction in both phases after 120 mL of iohexol was injected at 4 mL/sec. On a 3D workstation, images were evaluated retrospectively by two abdominal imagers blinded to surgical results with respect to number and branching pattern of renal arteries and major and minor renal veins. These CT angiography results were compared with surgical findings.
The surgically confirmed sensitivity of both reviewers (1 and 2) using the MDCT data for detection of renal arteries was 98.5% (65 of 66), and accuracies were 97.0% for reviewer 1 and 95.5% for reviewer 2. Sensitivity and accuracy detection of renal veins was 97% (61 of 63) and 98% (62 of 63) for reviewer 1 and reviewer 2, respectively. Sensitivity and accuracy detection of early arterial bifurcation (< 2 cm from aorta) was 100% (14 of 14), and sensitivity in detection of late venous confluence (< 1.5 cm from aorta) was 100% (8 of 8). All major renal venous variants were identified; reviewer 1 identified 78% (18 of 23) minor venous variants, and reviewer 2 identified 83% (19 of 23) minor venous variants. There were no hemorrhagic complications at surgery. Excellent agreement between reviewers (kappa = 0.92-0.97) was achieved for detection of normal and variant anatomy.
16-MDCT angiography enabled excellent preoperative detection of arterial anatomy and venous laparoscopic donor nephrectomy.
我们的目的是确定16层螺旋CT血管造影术在腹腔镜肾供体血管解剖结构术前评估中的有效性。
连续55例肾供体（25例男性和30例女性）接受16层螺旋CT血管造影术，随后进行供肾切除术。在动脉期和肾实质期，以4 mL/秒的速度注入120 mL碘海醇后，在两个阶段均以60%的重叠率和0.6毫米的重建层厚采集图像。在三维工作站上，由两名对手术结果不知情的腹部影像诊断医师对图像进行回顾性评估，评估内容包括肾动脉的数量和分支模式以及肾主静脉和副静脉。将这些CT血管造影结果与手术发现进行比较。
两位评估者（评估者1和评估者2）使用MDCT数据检测肾动脉的手术确认敏感性均为98.5%（66例中的65例），评估者1的准确率为97.0%，评估者2的准确率为95.5%。评估者1和评估者2检测肾静脉的敏感性和准确率分别为97%（63例中的61例）和98%（63例中的62例）。检测早期动脉分支（距主动脉<2厘米）的敏感性和准确率为100%（14例中的14例），检测晚期静脉汇合（距主动脉<1.5厘米）的敏感性为100%（8例中的8例）。所有主要肾静脉变异均被识别；评估者1识别出78%（23例中的18例）的副静脉变异，评估者2识别出83%（23例中的19例）的副静脉变异。手术中无出血并发症。在检测正常和变异解剖结构方面，评估者之间达成了极好的一致性（kappa = 0.92 - 0.97）。
16层螺旋CT血管造影术能够在术前出色地检测动脉解剖结构，并有助于腹腔镜供肾切除术。
