Use of Spiral Computed Tomography for Pre-operative Evaluation of Living Donors of Renal Transplantation

以四相電腦斷層攝影做爲腎臟活體移植捐贈者之評估

王家槐(Jia-Hwia Wang) ； 沈書慧(Shu-Huei Shen) ； 龍藉泉(Che-Chuan Loong) ； 張延驊(Yen-Hwa Chang) ； 張政彥(Cheng-Yen Chang)

《中華放射線醫學雜誌》 33卷2期 (2008/06) Pp. 65-71

摘要

近三十年來隨著移植技術之成熟，腎臟移植的數量大幅成長，活體腎臟捐贈的需求也隨之上升。對捐贈者術前評估主要是針對血管構造，導引手術之方向，減少手術併發症，並排除預備捐贈之腎臟潛在之病變（例如結石與腫瘤）。傳統上術前評估皆採用血管攝影檢查為主要檢查工具。近年來電腦斷層技術快速成長，不但掃描速度增加，解析度也大為提高，已成為評估腎臟正常解剖構造與病理的有力工具。本研究前瞻性的以電腦斷層攝影評估活體腎臟捐贈者，希望評估以電腦斷層攝影取代過去較具侵入性的血管攝影檢查，成為活體腎臟移植捐贈者術前評估工具的可能性，並設計出最佳標準化之檢查方式。
於2005年1月至12月期間，共有22人次經臨床醫師轉介接受檢查，做為活體腎臟捐贈之術前評估。電腦斷層攝影的流程包括phase Ⅰ不施打對比劑(precontrast)，phase Ⅱ腎動脈相(arterial phase)，phase Ⅲ腎實質相(nephrographic phase)與phase IV 分泌相(excretory phase)。所得之原始軸狀影像相容之3D工作站，重組冠狀切面(MPR)。所得結果並與手術發現作對照。
22位病患開刀之結果發現術前評估所提供之資訊，包括腎動脈、靜脈之數目與變異，以及集尿系統之型態，皆與手術結果符合。此外，電腦斷層攝影並偵測其餘的病變包括腎結石(5/22，22.7%)，腎囊腫(renal cyst)，腎上腺之嗜鉻細胞瘤(pheochromocytoma)，以及骨盆腔的畸胎瘤。電腦斷層血管攝影不僅提供關於腎實質、集尿系統與其他腹腔疾病之資訊，在血管的評估準確率亦相當高。

並列摘要

As the technique of organ transplantation progressed in recent thirty years, renal transplantation grew magnificantly, and the needing of living donors progressed, too. In the past, angiography was used for the pre-operative imaging evaluation. Because of the fast progress of computed tomography, not only shortened the scan time but resolution improved a lot, it has become the most powerful tool for evaluating the normal anatomy and pathological condition of kidneys. In this study, we use spiral computed tomography for pre-operative evaluation of renal living donors, expecting it can replace angiography, which is more invasive, and establishes a better protocol in the evaluation of living donors in renal transplantation.
From January, 2005 to December, 2005, we had 22 people referred from clinical doctors for pre-operative evaluation of living donors of renal transplantation. The protocol of computed tomography (CT) was as followings: phase Ⅰ, precontrast; phase Ⅱ, arterial phase focusing on renal arteries; phase Ⅲ, nephrographic phase; phase Ⅳ excretory phase. The raw axial helical images were reconstructed at 3D workstation for coronal multiplanar reconstruction (MPR). The operative findings were correlated with the findings of the preoperative CT images.
CT angiography is highly accurate in renal vascular evaluation. Renal artery is most clearly seen in phase Ⅱ and renal vein in phase Ⅲ. By four phases protocol, the information of morphology of renal vessels and collecting system were completely compatible with operative findings. Other pathology including renal stone (5/22, 22.7%), renal cyst, pheochromocytoma of adrenal gland and pelvic teratoma were also detected.
CT angiography may replace the more invasive traditional angiography to become the first line pre-operative imaging modality in living donors of renal transplantation.