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目的探讨多层螺旋 CT(MSCT)灌注成像在肾积水肾功能可复性预测中的价值。方法建立大白兔单侧输尿管部分梗阻肾积水模型。分为对照组,梗阻2、4及8周组,后3组在解除梗阻后再饲养4周,各组在梗阻解除前、后均行 MSCT 灌注扫描,测量右肾皮、髓质的血流量(BF)、血容量(BV)值并进行比较。然后处死实验动物制成普通病理切片,观察各组病理改变。结果 (1)MSCT 检查显示梗阻2周组在梗阻解除后,其右肾皮质的 BF、BV 分别为(864±32)ml·100 g~(-1)·min~(-1)、(19.5±0.9)ml/100 g,较梗阻解除前[分别为(630±37)ml·100 g~(-1)·min~(-1)、(14.0±1.2)ml/100 g)]上升,差异有统计学意义(t 值分别为-19.37、-12.11,P 值均<0.01);右肾髓质的 BF、BV 分别为(182.1±7.5)ml·100 g~(-1)·min~(-1)、(8.37±0.51)ml/100 g,比梗阻解除前[分别为(132.6±3.9)ml·100 g~(-1)·min~(-1)、(5.13±0.35)ml/100 g)]也明显上升,差异有统计学意义(t 值分别为-23.52、-11.51,P 值均<0.01)。(2)梗阻4周、8周组在梗阻解除后,其右肾皮质BF[分别为(525±15)、(512±10)ml·100 g~(-1)·min~(-1)]、BV[分别为(12.8±0.6)、(9.4±1.0)ml/100 g]与梗阻解除前[分别为(515±23)、(505±16)ml·100 g~(-1)·min~(-1),(12.2±0.8)、(10.3±0.5)ml/100 g]相比,差异无统计学意义(P 值均>0.05)。(3)组织学上,梗阻时间短,解除梗阻后的病理变化较轻,梗阻时间长,解除梗阻后的病理变化重。结论 MSCT 灌注成像不仅能够提供肾积水形态学的信息,又能提供血流灌注的信息,在肾积水肾功能可复性预测中有一定价值。
Objective To investigate the value of multislice spiral CT (MSCT) perfusion imaging in prediction of renal function renaturation in hydronephrosis. Methods The unilateral ureteral obstruction hydronephrosis model was established in rabbits. Divided into control group, obstructive 2,4 and 8 weeks group, the latter 3 groups were re-raised after obstruction for 4 weeks, the group before and after the obstruction was removed, MSCT perfusion scanning to measure the right kidney, medullary blood flow (BF), blood volume (BV) values and compared. Then sacrifice experimental animals made of common pathological sections, observe the pathological changes in each group. Results (1) MSCT showed that BF, BV of the right renal cortex were (864 ± 32) ml · 100 g -1 · min -1, (19.5% ± 0.9) ml / 100 g compared with the control group [(630 ± 37) ml · 100 g · -1 · min -1 and (14.0 ± 1.2) ml / 100 g, respectively) The difference was statistically significant (t = -19.37, -12.11, P <0.01 respectively); the BF and BV of the medulla of the right kidney were (182.1 ± 7.5) ml · 100 g ~ (-1) (-1) and (8.37 ± 0.51) ml / 100 g respectively, which were significantly higher than before (132.6 ± 3.9) ml · 100 g -1 · min -1 and (5.13 ± 0.35) ml / 100 g)] was also significantly increased, the difference was statistically significant (t values were -23.52, -11.51, P values were <0.01). (2) The right renal cortex BF [(525 ± 15), (512 ± 10) ml · 100 g -1 (-1) min -1, ] And BV [(12.8 ± 0.6) and (9.4 ± 1.0) ml / 100 g, respectively) and those before obstruction (515 ± 23 and 505 ± 16 and 100 g -1 min (-1), (12.2 ± 0.8), (10.3 ± 0.5) ml / 100 g]. There was no significant difference between the two groups (P> 0.05). (3) Histologically, the obstruction time is short, pathological changes after the obstruction is lightened, obstruction time is long, and pathological changes after obstruction are relieved. Conclusion MSCT perfusion imaging can not only provide morphological information of hydronephrosis, but also provide information on blood perfusion. It is of value in predicting renaturation of renal function in hydronephrosis.