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肾动脉狭窄是肾性高血压的重要病因之一,最常见的原因是动脉粥样硬化和大动脉炎,狭窄段多位于近肾门的2 cm以内,而远端或者分支狭窄相对少见[1-3]。肾动脉的走行扭曲可导致血流动力学的改变,血管的重塑又能刺激斑块的形成。与以往的有创测量方式肾动脉造影术相比,多层螺旋CT血管造影(CT angiography, CTA)结合其强大的后处理功能,能够无创地显示肾动脉走行、曲度和斑块的形成[3-4]。本研究旨在基于肾动脉64层螺旋CTA,通过容积再现和曲面重建技术,比较肾动脉主干形态学、强化的CT值,以及肾动脉主干的变异曲度与肾动脉狭窄的临床相关性。
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62例患者双侧均为单支肾动脉发育,未见副肾动脉,肾动脉狭窄62支,对侧肾动脉正常62支。狭窄侧和非狭窄侧肾动脉主干长度差异无统计学意义(t=0.303,P=0.924);平均管腔直径差异亦无统计学意义(t=1.158,P=0.287);狭窄侧管腔横截面积略大于非狭窄侧,但差异无统计学意义(t=1.385,P=0.184)(表1)。
组别 肾动脉主干长度(mm) 管腔横截面积(mm2) 平均管腔直径(mm) 肾动脉主干平均CT值(HU) RA/AA
(%)肾皮质的平均强化CT值(HU) 狭窄侧(n=62) 34.51±13.12 20.52±7.22 5.39±0.53 349.54±51.23 94.25±3.46 278.41±35.47 非狭窄侧(n=62) 35.27±14.74 18.97±5.05 5.27±.062 353.31±54.37 93.46±3.62 284.21±37.92 t值 0.303 1.385 1.158 0.397 1.242 0.879 P值 0.924 0.184 0.287 0.884 0.251 0.402 注:表中,CTA:CT血管造影;CT:计算机体层摄影术;RA/AA:肾动脉主干强化 CT 值与腹主动脉强化 CT 值的比值。 表 1 62例肾动脉狭窄患者狭窄侧和非狭窄侧CTA结果的比较(
)$\scriptstyle\bar x \pm s$ Table 1. The comparison of CTA data in plaque stenosis and non-stenosis renal artery for 62 patients (
)$\scriptstyle\bar x \pm s$ 由表1可见,狭窄侧和非狭窄侧的肾动脉主干平均CT值、RA/AA、肾皮质的平均强化CT值差异均无统计学意义(t=0.397、1.242、0.879,P=0.884、0.251、0.402)。
狭窄侧和非狭窄侧肾动脉最大曲度分别为(0.15±0.02)和(0.08±0.02),差异有统计学意义(t=19.487,P<0.05),典型病例的CTA容积再现曲度测量图见图2;肾动脉主干起点至最大曲度顶点的距离分别是(9.62±1.34) cm和(9.79±1.47) cm,差异无统计学意义(t=0.673,P>0.05);狭窄侧肾动脉主干起点至狭窄近端的距离为(9.42±1.61) cm,与肾动脉主干起点至最大曲度顶点的距离[(9.62±1.34) cm]比较,差异无统计学意义(t=0.752,P>0.05),典型病例的CTA曲面重建肾动脉主干面积测量图和肾动脉主干走行曲度图分别见图3和图4。
图 2 肾动脉狭窄患者(女性,62岁)左肾动脉CTA容积再现曲度测量图
Figure 2. Curvature measurement of left renal artery stenosis patients(female, 62 years old) in CT angiography volume rendering
基于CTA对肾动脉狭窄与肾动脉主干形态学特征的相关性分析
Correlation analysis between renal artery stenosis and renal artery trunk morphological features based on CT angiography
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摘要:
目的 研究肾动脉狭窄与肾动脉主干的形态学特征,特别是与肾动脉变异曲度的相关性。 方法 收集62例肾动脉狭窄的患者[男性37例、女性25例,年龄36~78(52.64±16.32)岁]进行肾动脉CT血管造影(CTA),分别测量狭窄侧与非狭窄侧的肾动脉主干的平均管腔直径、管腔横截面积、长度、主干CT值、肾动脉主干强化CT值与腹主动脉强化CT值的比值(RA/AA)、肾皮质的平均强化CT值、最大曲度、肾动脉主干起点至最大曲度顶点的距离以及狭窄侧肾动脉主干起点至狭窄近端的距离。组间比较采用配对样本t检验。 结果 肾动脉狭窄62支,对侧肾动脉正常62支,伴有斑块形成的肾动脉狭窄侧,其肾动脉走行的最大曲度(0.15±0.02)明显大于非狭窄侧(0.08±0.02),差异有统计学意义(t=19.487,P<0.05),而狭窄侧与非狭窄侧的肾动脉主干的平均管腔直径、管腔横截面积、长度、肾动脉主干CT值、RA/AA、肾皮质的平均强化CT值分别为(5.39±0.53) mm、(20.52±7.22) mm2、(34.51±13.12) mm、 (349.54±51.23) HU、(94.25±3.46)%、(278.41±35.47) HU和(5.27±.062) mm、(18.97±5.05) mm2、 (35.27±14.74) mm、(353.31±54.37) HU、(93.46±3.62)%、(284.21±37.92) HU,二者比较差异均无统计学意义(t=1.158、1.385、0.303、0.397、1.242、0.879,均P>0.05)。狭窄侧与非狭窄侧肾动脉主干起点至最大曲度顶点的距离分别为(9.62±1.34) cm和(9.79±1.47) cm,差异无统计学意义(t=0.673,P>0.05)。狭窄侧肾动脉主干起点至狭窄近端的距离为(9.42±1.61) cm,与肾动脉起点至最大曲度顶点的距离[(9.62±1.34) cm]比较,差异无统计学意义(t=0.752,P>0.05)。 结论 CTA能够直接显示肾动脉水平的形态,其变异曲度与肾动脉狭窄有一定的相关性。 -
关键词:
- 肾动脉梗阻 /
- 形态学 /
- 血管造影术 /
- 体层摄影术,X线计算机
Abstract:Objective To determine the correlation between renal artery stenosis and renal artery trunk morphological features, especially the renal artery variation of curvature. Methods A total of 62 patients[37 men and 25 women, aged 36−78(52.64±16.32) years] with diagnosed unilateral renal artery stenosis were subjected to CT angiography. The data between stenotic renal arteries and nonstenotic renal arteries were measured. These data included the inner diameter of the renal artery trunk, cross-sectional area, length, main CT value, the ratio of CT value of renal artery to abdominal aorta(RA/AA), average enhanced CT value of the renal cortex, maximum curvature, distance from the starting point to the maximum curvature vertex of the renal artery trunk, and the distance from the starting point to the narrow proximal side of the renal artery stenosis. Contrast analysis of the correlation was also performed. T test was used for all comparisons between groups in statistics. Results All data were divided into two groups(62 cases of stenotic renal arteries and 62 cases of nonstenotic renal arteries). The renal maximum curvature of the plaque side(0.15±0.02) was significantly greater than those in the normal side(0.08±0.02), and the differences were significant(t=19.487, P<0.05). The other parameters including the inner diameter of the renal artery trunk, cross-sectional area, length, renal artery CT value, RA/AA, and average enhanced CT value of the renal cortex were(5.39±0.53) mm, (20.52±7.22) mm2, (34.51±13.12) mm, (349.54±51.23) HU, (94.25±3.46)%, (278.41±35.47) HU and(5.27±0.62) mm, (18.97±5.05) mm2, (35.27±14.74) mm,(353.31±54.37) HU, (93.46±3.62)%, (284.21±37.92) HU, respectively. All differences had no statistical significance(t=1.158, 1.385, 0.303, 0.397, 1.242, and 0.879, respectively; all P>0.05). The distance from the starting point to the maximum curvature vertex of the renal artery trunk in the narrow and normal sides were(9.62±1.34) cm and(9.79±1.47) cm, respectively, and the difference was not statistically significant(t=0.673, P>0.05). The distance from the starting point to the narrow proximal side of the renal artery stenosis was(9.42±1.61) cm, and no significant difference(t=0.752, P>0.05) was observed between the distance[(19.62±1.34) cm] from the starting point to the maximum curvature vertex and to the narrow proximal side. Conclusion CT angiography can directly show the shape of renal artery trunk, which variation curvature has a certain correlation with the renal artery stenosis. -
Key words:
- Renal artery obstruction /
- Morphology /
- Angiography /
- Tomography, X-ray computed
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表 1 62例肾动脉狭窄患者狭窄侧和非狭窄侧CTA结果的比较(
)$\scriptstyle\bar x \pm s$ Table 1. The comparison of CTA data in plaque stenosis and non-stenosis renal artery for 62 patients (
)$\scriptstyle\bar x \pm s$ 组别 肾动脉主干长度(mm) 管腔横截面积(mm2) 平均管腔直径(mm) 肾动脉主干平均CT值(HU) RA/AA
(%)肾皮质的平均强化CT值(HU) 狭窄侧(n=62) 34.51±13.12 20.52±7.22 5.39±0.53 349.54±51.23 94.25±3.46 278.41±35.47 非狭窄侧(n=62) 35.27±14.74 18.97±5.05 5.27±.062 353.31±54.37 93.46±3.62 284.21±37.92 t值 0.303 1.385 1.158 0.397 1.242 0.879 P值 0.924 0.184 0.287 0.884 0.251 0.402 注:表中,CTA:CT血管造影;CT:计算机体层摄影术;RA/AA:肾动脉主干强化 CT 值与腹主动脉强化 CT 值的比值。 -
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