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目的:应用多层螺旋CT血管成象(multislicespiralcomputedtomographicangiography,MSCTA)三维重建技术检查维持性血液透析(MHD)患者血管通路狭窄情况,为手术修复和经皮经腔血管成形术(PTA)提供指导。方法:采用TOSHIBA16层螺旋CT,对19例临床拟为血管通路功能不良的MHD患者进行检查,采用对侧肢体外周静脉注射非离子型碘造影剂,注射速度3ml/s,造影剂总量50～100ml。注射后延时25～30s行多层螺旋CT扫描检查、采象,应用最大密度投影、容积成象和曲面重建技术对图象数据进行处理和三维重建。结果:MSCTA配合三维重建技术可获得空间分辨率很高的透析血管通路全景图,包括动脉流入道、吻合口和静脉流出道,血管走行情况和狭窄部位均获得清晰显示。检查发现内瘘吻合口狭窄4例;静脉流出道狭窄10例16个部位,其中4例形成明显静脉侧支循环;前臂内瘘局部扩张6例;锁骨下静脉狭窄3例;头静脉汇入锁骨下静脉处狭窄1例;上腔静脉狭窄1例。根据MSCTA的结果,对8例患者进行了动静脉内瘘手术修复,4例进行了数字减影血管造影(DSA)介导PTA,手术直视和DSA证实了MSCTA诊断的准确性,手术和PTA干预的短期效果令人满意。结论:MSCTA是一项评估透析血管通路的先进手段,具有无创伤、成象迅速、高清晰度等优点,能全面、准确地评估MHD患者内瘘情况,并为进一步治疗提供指导。
OBJECTIVE: To investigate the vascular access stenosis in patients with maintenance hemodialysis (MHD) by multi-slice spiral CT angiography (MSCTA) three-dimensional reconstruction and provide guidance for surgical repair and percutaneous transluminal angioplasty (PTA). Methods: TOSHIBA 16-slice spiral CT was used to examine 19 cases of MHD patients who were considered as vascular access dysfunction. The non-ionic iodine contrast medium was injected into the contralateral limb through intravenous injection. The injection speed was 3 ml / s, 100ml. Post-injection delay of 25 ~ 30s multi-slice spiral CT scan imaging, mining, application of the maximum density projection, volume imaging and surface reconstruction technology for image data processing and three-dimensional reconstruction. Results: MSCTA combined with 3D reconstruction technique resulted in a panoramic view of dialysis vascular access with high spatial resolution, including arterial inflow, anastomosis, and venous outflow, with clear vascular access and stenosis. 4 cases of venous outflow tract stenosis were found in 10 cases, of which 4 cases formed obvious venous collateral circulation; 6 cases of local dilatation of internal fistula; 6 cases of subclavian vein stenosis; 3 cases of subclavian vein stenosis; 1 case of inferior vena cava stenosis; 1 case of superior vena cava stenosis. According to the results of MSCTA, eight patients underwent surgical repair of arteriovenous fistula, four underwent digital subtraction angiography (DSA) -mediated PTA, direct surgical observation and DSA confirmed the accuracy of MSCTA diagnosis, surgery and PTA The short-term effect of the intervention is satisfactory. Conclusion: MSCTA is an advanced method to evaluate dialysis vascular access. It has the advantages of non-invasiveness, rapid imaging and high definition. It can evaluate the fistula of MHD patients comprehensively and accurately and provide guidance for further treatment.