Zhu Liangsong, Wu Guangyu, Wang Jianfeng, Huang Jiwei, Kong Wen, Chen Yonghui, Xue Wei, Huang Yiran, Zhang Jin
Department of Urology Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China.
Medicine (Baltimore). 2016 Oct;95(42):e5025. doi: 10.1097/MD.0000000000005025.
To investigate the feasibility of the noncontrast-enhanced magnetic resonance angiography (NCE-MRA) to evaluate renal arteries before partial nephrectomy (PN).Retrospective analyzed 479 patients who underwent renal surgery between January 2013 and December 2015 with NCE-MRA or computed tomographic angiography (CTA) renal artery image reconstruction preoperative in our department. The renal artery reconstruction score (RARS) was based on the level of artery visualization in a 4-class criterion, and the R.E.N.A.L nephrometry score (R.E.N.A.L), arterial based complexity (ABC) were also analyzed.Of the 479 patients, the overall-lever RARS was 3.62, and the average in 2 groups was no significant difference (NCE-MRA vs CTA, P = 0.072). The performance of NCE-MRA in PN group was similar with CTA. Further comparison demonstrated that the efficiency of NCE-MRA in moderate- or low-degree tumor according to the R.E.N.A.L and ABC complexity less than 3S was equal to CTA. However, high degree (P < 0.001), 3S (P = 0.027), or 3H (P < 0.001) would affect the imaging of renal artery. Intragroup analysis showed that tumor complexity such as max tumor size (r = -o.351, P < 0.001), R.E.N.A.L (r = -0.439, P < 0.001), and ABC (r = -0.619, P < 0.001) were closely correlated with the NCE-MRA performance. The images of 2 sides of the kidney were compared in single person as well, which was meaningful for NCE-MRA patients only (NCE-MRA, P < 0.001; CTA, P = 0.182).The renal artery reconstruction performed by NCE-MRA is feasible and has a similar achievement in the PN potential recipients, with a lower side effect, and meets the requirements for making surgical decision. It has a broad application prospect in clinical practice; however, it still needs to further improve the ability in more complex tumors.
探讨非增强磁共振血管造影(NCE-MRA)在部分肾切除术(PN)前评估肾动脉的可行性。回顾性分析2013年1月至2015年12月间在我科接受肾脏手术且术前行NCE-MRA或计算机断层血管造影(CTA)肾动脉图像重建的479例患者。肾动脉重建评分(RARS)基于4级标准中的动脉可视化水平,同时分析R.E.N.A.L肾计量评分(R.E.N.A.L)、基于动脉的复杂性(ABC)。479例患者中,总体RARS为3.62,两组平均值无显著差异(NCE-MRA与CTA,P = 0.072)。NCE-MRA在PN组的表现与CTA相似。进一步比较表明,根据R.E.N.A.L和ABC复杂性小于3S的中度或低度肿瘤,NCE-MRA的效率与CTA相当。然而,高度(P < 0.001)、3S(P = 0.027)或3H(P < 0.001)会影响肾动脉成像。组内分析显示,肿瘤复杂性如最大肿瘤大小(r = -0.351,P < 0.001)、R.E.N.A.L(r = -0.439,P < 0.001)和ABC(r = -0.619,P < 0.001)与NCE-MRA表现密切相关。还对单人双侧肾脏图像进行了比较,这仅对NCE-MRA患者有意义(NCE-MRA,P < 0.001;CTA,P = 0.182)。NCE-MRA进行的肾动脉重建是可行的,在PN潜在受者中取得了相似的成果,副作用较小,满足手术决策要求。在临床实践中具有广阔的应用前景;然而,在更复杂肿瘤中的能力仍需进一步提高。