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Background and Purpose: kidney transplant ESRD most effective treatment. Traditional cadaveric donor kidney can not meet the clinical needs of the growing living donor kidney transplants rapid development in the field of kidney transplantation, occupy an increasingly important position. With the development of living donor kidney transplants, the increasing demands of the surgery, living donor kidney preoperative assessment becomes particularly important. Digital subtraction angiography (digital subtraction angiography and DSA) and intravenous pyelogram (intravenous pyelography, IVP) combination has been considered the gold standard for preoperative evaluation of living donor kidney. With the continuous development of imaging technology, multi-slice spiral CT is widely used because of its high temporal resolution, high spatial resolution, high density resolution, more and more attention in the field of living donor kidney transplants. The complementarity of the original image and the post-processing of multi-slice spiral CT image demonstrated for renal vessels, in real terms, and the collection system to a more comprehensive understanding of the donor kidney. At present, the domestic fewer reported in the literature in this regard. The purpose of this study is to explore the 64-slice spiral CT in living donor kidney transplants for kidney preoperative assessment of the value, suitable for clinical choice for kidney develop reasonable for nephrectomy surgery program to provide a more simple and practical examination means. MATERIALS AND METHODS: our hospital from May 2008 to February 2009 pre-line for kidney removal surgery and GE 64-slice spiral CT enhanced inspection kidney transplant living donor 48 cases, including 31 males and 17 females, aged 22-67 years old, with an average age of 44.83 years old. The group 1 cases are unrelated donor kidney transplants, the remaining 47 cases the donor and the recipient. Examples preoperative donor except CT examination, underwent Radionuclide renal dynamic imaging, kidneys, color Doppler and other auxiliary examination to exclude surgical contraindications. 48 cases for those who, in addition to one cases of renal vessels do not meet the transplant conditions and to give up the donor kidney, the remaining examples are line open for kidney cut to take surgery, cut to take the left kidney 22 Li, the right kidney 25 Li (including one case is self-body kidney transplant). Scan American GE Lightspeed 64-row VCT. Scan range: Vascular period, since thoracic 11 vertebrae on the edge to the level of the iliac crest; the excretory phase from the adrenal gland to the pubic symphysis levels. Scanning parameters: 120KV tube voltage; automatic mA tube current pitch 0.984:1, the tube speed 0.35s / R; the collimator thickness 64 × 0.625mm. Scanning methods: first level sweep, after the use of high-pressure syringe through the cubital vein injection of non-ionic contrast agent (concentration of 350 mgI / ml) 100ml enhanced scan line. This group for those points I, II, III three groups, the respective numbers of 21,15,12, excretory phase scan were in each group the vascular, each using a scanning method 300 ~ 600s after the injection of contrast medium. Scanning method used by the three groups of subjects are as follows: group I adopt artificial trigger scanning (GE Smart Prep software system); the Ⅱ group with fixed phase scan; Ⅲ group using the Shuangliu rate a scan. Scanning the raw data obtained standard reconstruction, reconstruction thickness 0.625mm reconstruction interval 0.625mm, and then rebuild the data transmitted to the ADW 4.3 workstation, using volume rendering (volume rendering VR), maximum intensity projection (maximum intensity projection, MIP) curved planar reformation (curved planer reformation, CPR), multi-planar reconstruction (multiplanar reformation, MPR), a variety of post-processing method for image reconstruction show renal vascular substantial and collection system. By three experienced diagnostician evaluation of image quality, VR, MIP, CPR, MPR and shaft bit like renal vascular observed (1) the number, length, location, course and adjacent relationship, whether the vessel wall plaque calcification lumen stenosis or dilated, whether there emboli. (2) the degree of renal parenchyma, with or without delayed enhancement, a preliminary assessment of the functional state of the kidneys, kidney size, shape, understanding the spatial relationship of the kidney and surrounding tissue, especially the ribs, cover of kidney; (3) pelvis ureter with or without the innate variation, hydrocephalus, stenosis. Renal vein like the image quality is divided into 1, 2, 3, three, statistics at all levels of the number of cases of different scanning methods group. Accuracy of MSCT examination results in the preoperative and postoperative records, renal ultrasonography and radionuclide dynamic imaging results were compared preoperative evaluation MSCT assessment for renal vascular, renal parenchyma, renal function, and collection systems. SPSS13.0 software package univariate analysis of variance of the measurement data, hierarchical data nonparametric rank sum test, a = 0.05 level of inspection. Results: Image quality evaluation: (1) the CT values ??of the renal artery and renal vein between the three groups, respectively, for the mean one-way ANOVA analysis, F values ??were $ 392.1 (P <0.05), 12.139 (P <0.05) , the CT values ??of the renal artery and renal vein between the groups were statistically different; renal artery CT values ??mean compare> Ⅱ group I> Ⅲ group; renal vein CT values ??were compared in group Ⅰ> Ⅲ II group; respectively for two or two among the three groups of renal artery and renal vein CT values ??were compared, Comparison of CT values ??of renal artery: Ⅰ, Ⅲ group difference was statistically significant (P <0.05), Ⅰ, Ⅱ group, Ⅱ, Ⅲ group, the difference was not statistically significant; Comparison of CT values ??of the renal vein: Ⅰ, group Ⅱ, Ⅱ, Ⅲ group difference was statistically significant (P <0.05), Ⅰ, Ⅲ group difference was not statistically significant. (2) the renal vein image quality grading Statistics: three groups of renal vein image quality according to the aforementioned criteria divided into Level 1, 2 and 3, the the 1,2 level image can meet the diagnostic requirements, three images can not meet the diagnostic requirements. Ⅰ, Ⅱ group, the proportion of the group III renal vein image number of cases accounted for the group to meet the diagnostic requirements were 90.5% (19/21), 53.3% (8/15), 91.6% (11/12). The number of cases among the three groups of different levels of image quality nonparametric rank sum test, x to 2 = 9.540, P = 0.008 <0.05, groups between the different levels of the number of cases the difference was statistically significant, the image quality difference; three then pairwise comparisons between groups Ⅰ, Ⅱ group and II group III difference was statistically significant (P <0.05), Ⅰ, Ⅲ group difference was not statistically significant. (3) double-rate scanning method renal artery and vein CT difference statistics: according to the level of the renal artery and vein difference, the image quality of the group III renal vein was classified as good the (CT difference 80HU), General (CT difference between between 40HU and 80HU) and poor (CT difference <40HU) three levels, all levels, the number of cases of this group were six cases, four cases, two cases. 2. Renal vascular evaluate: (1) renal artery: 48 cases of donor renal arteries are single branch by 28 patients (28/48), 20 cases; presence of multivessel renal artery (two or more than two) (20/48); the early branch by the presence of 19 cases (19/48), bilateral exist in 3 patients (3/48), the unilateral exist in 16 cases (16/48), 10 cases left, right side 6 cases. 22 patients with the Vice renal artery (ARA) (22/48), including 6 cases of bilateral exist ARA (6/48), 16 patients with unilateral exist ARA (16/48), left nine cases, seven cases right ; 22 cases ARA total of 32, eight of which originated in the abdominal aorta (abdominalaorta 29) (8/32), 24 originated in the trunk of the renal artery (RA) (24/32), into the upper pole 3 into the lower pole of kidney. Visible originated in the renal artery adrenal artery (5/48) are located on the right side visible renal artery origin the diaphragmatic artery (11/48); 11 cases, including nine cases of unilateral beings, the left one cases, the right side in eight cases, five cases of renal artery disease; 48 cases of donor cases of anterior branch of the right renal artery hard plaque formation, two cases of left renal artery at the beginning of punctate calcification, were kidneys artery stenosis at the beginning, the other was a small aneurysm of the right renal artery proximal segment formation. (2) renal vein: 35 cases for bilateral renal vein are single branch (35/48), 13 cases of donor unilateral presence of multivessel (2 to 3) renal vein (13/48), in which the left two cases, the right side in 11 cases. This group of 18 cases of donor renal vein variation in abnormal tributaries, and are located on the left side. Tributaries or traffic branch ring aortic left renal vein variation in 1 case, three cases of left renal vein confluence late 15 cases the donor renal vein abnormalities, including gonadal vein, lumbar veins, half azygos vein and adrenal vein. The two cases for the left renal vein comply with nutcracker syndrome, but no clinical symptoms. (3) the display capabilities of different post-processing techniques Vice renal artery and renal vein differ MIP images show the number of blood vessels VR like little more than axial position as the most accurate, the most basic judgment basis. In addition, in the display of the renal artery branches, MIP image are obviously superior to VR like. 3. The renal parenchyma assessment: The group of 48 patients with donor, 3 cases of renal cyst, one case at the beginning because of the right renal artery stenosis lead to the right renal insufficiency, renal parenchyma delay, and thus indirectly to determine the perfusion reduced function is impaired. The 4 cases donor match congenital lobulated kidney variation. VR like clearly shows that in 96 of the 48 cases of donor kidneys, ribs covered for kidney upper 11, middle 47, the lower 38. Collection system assessment: three cases in this group collection system abnormality, 1 case of left renal duplication deformity; 1 cases the right kidney with mild hydronephrosis, with mild dilatation of the ureter in the previous paragraph; 1 cases unenhanced image of the right kidney small stones. Operative control: Four patients seen for CT diagnostic results do not match the number of renal vascular surgery cases were seen in the right renal artery double, a vice renal artery, but preoperative CT diagnosis Deputy renal artery omissions; another 3 cases seen in the right renal vein are dual-branched, preoperative CT examinations are diagnosed with a single branch. The remaining cases were seen in line with preoperative CT findings. Conclusion: 1 through a multi-slice spiral CT examination to achieve the effect of DSA, ultrasound, IVP, a number of checks to living donor kidney comprehensive assessment of the full range of preoperative clinical provides a more convenient, effective screening method has good practical value and application prospects. 2.64 row spiral CT is a more efficient and accurate inspection techniques in kidney transplant living donor preoperative evaluation of applications, it will fast volume scanning with powerful image processing functions combined, can be fully and clearly show for renal blood vessels, the essence of the collection system and surrounding tissue, and thus suitable for clinical selection kidney as well as provide an important reference for the development of reasonable and feasible surgical options. 3 the Shuangliu rate scanning method can achieve a scan complete renal artery and vein check, shorten the inspection time, a reduced radiation dose, and to get a better artery and vein fused image, worthy of promotion and application.
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