Smith Daniel, Chudgar Avni, Daly Barry, Cooper Matthew
Arch Surg. 2012 Dec;147(12):1114-22. doi: 10.1001/archsurg.2012.1466.
To determine the safety, clinical yield, and cost of computed tomography angiography (CTA) use in the workup of potential renal transplant recipients.
Single-site, retrospective review of medical, surgical, and radiologic records.
Large university tertiary care center.
Potential recipients of transplants from living donors.
Computed tomography with and without 100 mL of iodixanol intravenous contrast enhancement as part of the preoperative workup.
Mean pre- and post-CTA estimated glomerular filtration rate and number of patients requiring emergent dialysis after CTA, number of patients who had their treatment changed by CTA findings, patient predictors of significant CTAs, and cost per significant CTA.
From July 20, 2006, through December 10, 2010, a total of 179 transplant candidates underwent CTA. Forty-two patients were predialysis at the time of CTA. Mean (SD) serum creatinine levels in this group were unchanged after CTA (5.06 [2.13] mg/dL vs 5.00 [2.28] mg/dL [to convert to micromoles per liter, multiply by 88.4], P = .49), and no patients required subsequent emergent dialysis. Forty-one patients (22.9%) had their treatment changed by CTA findings. Multivariate logistic regression analysis revealed 3 patient history and physical criteria that predicted significant CTA findings: chronic infection (odds ratio, 10.91; 95% CI, 2.72-43.69; P < .001), patient weight less than 69 kg (3.11; 1.49-6.51; P < .001), and ventral torso surgical scarring (4.13; 1.57-10.84; P < .001). Diagnostic cost per significant CTA study was $2660, with an estimated reduced cost of $1480 per significant study with screening using 1 of the 3 predictors.
Diagnostic CTA is a safe and cost-effective procedure for both operative planning and screening for potentially prohibitive abdominal disease.
确定计算机断层扫描血管造影（CTA）在潜在肾移植受者检查中的安全性、临床收益及成本。
对医疗、外科及放射学记录进行单中心回顾性研究。
大型大学三级医疗中心。
活体供体肾移植的潜在受者。
术前检查中进行CT平扫及静脉注射100 mL碘克沙醇增强扫描。
CTA检查前后估算的肾小球滤过率均值、CTA检查后需要紧急透析的患者数量、因CTA检查结果而改变治疗方案的患者数量、CTA检查有重要发现的患者预测因素以及每项重要CTA检查的成本。
2006年7月20日至2010年12月10日，共有179例移植候选者接受了CTA检查。42例患者在CTA检查时处于透析前状态。该组患者CTA检查前后的血清肌酐水平均值（标准差）无变化（5.06 [2.13] mg/dL对5.00 [2.28] mg/dL [换算为微摩尔每升时，乘以88.4]，P = 0.49），且无患者需要随后紧急透析。41例患者（22.9%）因CTA检查结果而改变治疗方案。多因素逻辑回归分析显示，有3项患者病史及体格检查标准可预测CTA检查有重要发现：慢性感染（比值比，10.91；95%可信区间，2.72 - 43.69；P < 0.001）、患者体重小于69 kg（3.11；1.49 - 6.51；P < 0.001）以及腹部手术瘢痕（4.13；1.57 - 10.84；P < 0.001）。每项重要CTA检查的诊断成本为2660美元，使用3项预测因素之一进行筛查后，每项重要检查的估计成本降低1480美元。
诊断性CTA对于手术规划及筛查潜在的腹部疾病是一种安全且具有成本效益的检查方法。
