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目的评估高分辨率MRCP(HR-MRCP)和高分辨率T_2WI(HR-T_2WI)显示经颈内静脉置入长期透析导管(CDC)的尖端位置和相关并发症的能力。方法 41例怀疑CDC功能不良和相关性并发症的终末期肾病(ESRD)患者接受了HR-MRCP和HR-T_2WI扫描。在扫描之前,每位ESRD患者的CDC管腔内注入5 ml生理盐水。扫描完成后由两名副主任医师对CDC的尖端位置和相关性并发症进行评估。所有患者在MRI检查后1~2 d内行胸部X线检查。对于HR-MRI诊断为CDC相关性并发症的患者,CDC在3~10 d内拔出。结果 38例成功执行了HR-MRI扫描,其中的13名ESRD患者CDC的HR-MRI结果正常,HR-T_2WI表现为“双眼征”和HR-MRCP为“双轨征”。25名患者CDC的HR-MRI结果为异常,包括纤维蛋白鞘22例、附壁血栓6例、静脉血栓3例及血凝块4例。对于纤维蛋白鞘(22例),HR-T_2WI表现为“薄环征”(小于3 mm)——环绕CDC周围薄层高信号;对于附壁血栓(6例),HR-T_2WI表现为片状高信号且基底于静脉壁;对于静脉血栓(3例),HR-T_2WI表现为“厚环征”(大于5 mm)且占满整个血管管腔;对于血凝块(4例),当CDC一侧管腔内出现血凝块时,HR-T_2WI表现为“单眼征”及HR-MRCP为“单轨征”(2例),当CDC双侧管腔内出现血凝块时,HR-T_2WI的“眼征”和HR-MRCP的“轨道征”均缺失(2例)。对于MRI诊断为CDC异常的ESRD患者,拔除CDC后发现纤维蛋白鞘12例、静脉血栓4例和血凝块4例。对于显示导管尖端的位置,HR-MRCP和胸片之间无显著性差异(P=0.132)。结论 HRMRCP联合HR-T_2WI能准确显示CDC尖端的位置及其相关并发症,是一种很有前景的无创检查方法 ,有助于ESRD患者的治疗方案调整。
Objectives To evaluate the ability of high-resolution MRCP (HR-MRCP) and high-resolution T_2WI (HR-T_2WI) to demonstrate the location of the tip and related complications of long-term dialysis catheters (CDC) implanted through the internal jugular vein. Methods 41 patients with end-stage renal disease (ESRD) suspected of having CDC dysfunction and related complications underwent HR-MRCP and HR-T 2 WI scans. Prior to scanning, 5 ml of saline was injected into the CDC of each ESRD patient. After the scan, two associate chief physicians evaluated the CDC’s tip location and related complications. All patients underwent chest X-ray examination within 1 ~ 2 days after MRI examination. For patients diagnosed with CDC-related complications by HR-MRI, CDC is removed within 3 to 10 days. Results The successful HR-MRI scan was performed in 38 cases. The HRC-MRI results of CDC in 13 ESRD patients were normal, HR-T_2WI was “double eye sign” and HR-MRCP was “double sign”. Twenty-five patients had abnormal HR-MRI findings on CDC, including 22 cases of fibrin sheath, 6 cases of mural thrombus, 3 cases of venous thrombus and 4 cases of clot. For fibrin sheath (22 cases), HR-T_2WI showed “thin ring sign” (less than 3 mm) - surrounds the thin layer around CDC high signal; for mural thrombus (6 cases), HR-T_2WI showed Flaky high signal and the basal vein wall; for venous thrombosis (3 cases), HR-T_2WI showed “thick ring sign” (greater than 5 mm) and fill the entire vascular lumen; for the blood clots (4 cases ). When blood clots appeared in the lumen of the CDC, HR-T 2WI presented as “monocular sign” and HR-MRCP as “monorale” (2 cases). When CDC bilateral lumen appeared Blood clots, HR-T_2WI “eye sign ” and HR-MRCP “orbit sign ” were missing (2 cases). For patients with ESRD whose CDC abnormalities were diagnosed by MRI, 12 cases of fibrin sheath, 4 cases of venous thrombus and 4 cases of clot were found after CDC removal. There was no significant difference between HR-MRCP and chest radiographs for the location of the catheter tip (P = 0.132). Conclusion HRMRCP combined with HR-T 2 WI can accurately show the location of CDC and its related complications. It is a promising noninvasive detection method that is helpful for the treatment of ESRD patients.