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目的探讨多层螺旋CT血管造影(MSCTA)在儿童肾血管性高血压诊断中的临床价值。方法山东大学山东省立医院儿科2002年以来,经MSCTA肾动脉成像确诊为血管性高血压的患儿8例,8例行彩色多普勒超声肾血流检查,6例行X线血管造影(XRA)检查,将MSCTA检查结果与彩色多普勒超声肾血流和XRA检查结果进行比较。MSCTA扫描参数取准直0·75mm,螺距1,管电压为90~120kV,管电流为120~150mA。扫描结束后对每一病例均行曲面重建(CPR)、多平面重建(MPR)、容积再现(VR)和最大强度投影(MIP)重建。结果8例中MSCTA显示10条肾动脉狭窄,左侧6条,右侧4条,其中2例为两侧肾动脉狭窄;8条为起始段狭窄,2条为肾动脉中段狭窄;狭窄长度0·2~1·0cm,Ⅰ级狭窄1条,Ⅱ级狭窄6条,Ⅲ级狭窄3条。MSCTA尚可见6例肾缩小,平均长径为7·1cm,低于健肾1·5cm以上;1例伴有腹主动脉壁增厚,管腔狭窄,直径约1·0cm;6例行腹主动脉或选择性肾动脉造影者与MSCTA显示肾动脉狭窄部位和程度完全一致。8例行彩色多普勒超声检查者,亦可见6例肾缩小,但仅5例显示肾动脉狭窄,左侧2条,右侧3条。结论MSCTA能准确地显示肾动脉狭窄的程度和部位,清晰地显示肾动脉壁及其腔内的情况,作为无创、简便、安全、价廉的检查方法,在一定程度上可替代有创伤性的选择性肾动脉造影。
Objective To investigate the clinical value of multislice spiral CT angiography (MSCTA) in the diagnosis of renovascular hypertension in children. Methods Pediatric Department of Shandong Provincial Hospital, Shandong University Since 2002, 8 children diagnosed as having vascular hypertension by MSCTA renal artery imaging, 8 underwent color Doppler ultrasound renal blood flow examination and 6 underwent X-ray angiography XRA), comparing MSCTA findings with color Doppler ultrasound renal blood flow and XRA findings. MSCTA scan parameters taken straight 0 · 75mm, pitch 1, the tube voltage is 90 ~ 120kV, the tube current is 120 ~ 150mA. Surface reconstruction (CPR), multiplanar reconstruction (MPR), volume rendering (VR), and maximum intensity projection (MIP) reconstruction were performed for each case after the end of the scan. Results MSCTA showed 10 renal artery stenosis in 8 cases, 6 left and 4 right sides, of which 2 were bilateral renal artery stenosis, 8 were stenosis at the beginning, 2 were stenosis at the middle of the renal artery, and stenosis length 0 · 2 ~ 1 · 0cm, Ⅰ grade Ⅰ stenosis, Ⅱ grade stenosis 6, Ⅲ stenosis 3. MSCTA still visible 6 cases of renal shrinkage, the average long diameter was 7.1cm, lower than the kidney more than 1.5cm; 1 case of abdominal aortic wall thickening, stenosis, diameter of about 1.0cm; 6 cases of abdomen Aorta or selective renal artery angiography and MSCTA showed exactly the site and extent of renal artery stenosis. 8 cases of color Doppler ultrasound examination, also showed 6 cases of renal shrinkage, but only 5 cases showed renal artery stenosis, left 2, right 3. Conclusion MSCTA can accurately show the extent and location of renal artery stenosis, clearly shows the renal artery wall and its cavity, as a non-invasive, simple, safe and inexpensive method of examination, to some extent, alternative traumatic Selective renal artery angiography.