本文選題：移植腎 + 血管解剖��； 參考：《華中科技大學(xué)》2014年博士論文

【摘要】：第一部分：基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)在評(píng)估移植腎血管解剖方面的研究 目的：評(píng)估基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)在顯示移植腎血管解剖方面的價(jià)值,并和彩色多普勒超聲(CDUS)及術(shù)中記錄結(jié)果進(jìn)行對(duì)照。 材料和方法：應(yīng)用GE公司1.5T HD MR掃描儀對(duì)75名行腎移植手術(shù)后臨床需要排除血管并發(fā)癥的患者進(jìn)行彩色多普勒超聲掃描及非對(duì)比劑增強(qiáng)磁共振血管成像掃描,所有患者檢查前均簽署知情同意書(shū)。由兩名放射科專(zhuān)家對(duì)SLEEK顯示移植腎血管解剖結(jié)構(gòu)進(jìn)行評(píng)估,并將SLEEK結(jié)果與彩色多普勒超聲及術(shù)中記錄結(jié)果進(jìn)行對(duì)照。 結(jié)果：總共75名腎移植患者,所有患者均成功進(jìn)行了SLEEK掃描及彩色多普勒超聲掃描。有三名患者移植了兩個(gè)腎臟,總共有78例移植腎進(jìn)行了圖像評(píng)估,所有患者的圖像質(zhì)量都是可以接受的。圖像質(zhì)量評(píng)分為優(yōu)秀的占85%(66/78),良好的占10%(8/78),一般的占5%(4/78)。在檢查移植腎血管吻合方式方面,SLEEK檢查結(jié)果與術(shù)中記錄完全吻合,發(fā)現(xiàn)72個(gè)腎臟被移植在右側(cè)髂窩,6個(gè)腎臟被移植在左側(cè)髂窩。移植腎動(dòng)脈與髂外動(dòng)脈端側(cè)吻合的有43例,移植腎動(dòng)脈與髂內(nèi)動(dòng)脈端端吻合的有35例,所有78例移植腎靜脈均與髂外靜脈端側(cè)吻合。這一結(jié)果與彩色多普勒超聲對(duì)比沒(méi)有明顯統(tǒng)計(jì)學(xué)意義(P0.05)。SLEEK在檢出副腎動(dòng)脈方面明顯優(yōu)于彩色多普勒超聲(P0.05),根據(jù)手術(shù)記錄75名患者的78個(gè)移植腎中有9個(gè)移植腎有副腎動(dòng)脈,SLEEK發(fā)現(xiàn)了其中的8例,超聲只發(fā)現(xiàn)了2例。 結(jié)論：基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)無(wú)創(chuàng)、無(wú)輻射在顯示移植腎血管解剖方面顯示出了很好的應(yīng)用價(jià)值,在顯示移植腎的位置和血管吻合方法方面與彩色多普勒超聲沒(méi)有顯著統(tǒng)計(jì)學(xué)差異,在顯示副腎動(dòng)脈方面優(yōu)于彩色多普勒超聲。對(duì)臨床醫(yī)生評(píng)估移植腎的術(shù)后狀態(tài)提供了新的客觀依據(jù)。 第二部分：基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)在評(píng)估移植腎血管并發(fā)癥方面的研究 目的：評(píng)估基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)在顯示移植腎血管并發(fā)癥方面的價(jià)值,并和彩色多普勒超聲(CDUS)、 DSA及手術(shù)結(jié)果進(jìn)行對(duì)照。 材料和方法：應(yīng)用GE公司1.5T HD MR掃描儀對(duì)23名行腎移植手術(shù)后經(jīng)超聲檢查后臨床高度懷疑血管并發(fā)癥的患者行非對(duì)比劑增強(qiáng)磁共振血管成像掃描掃描,所有患者檢查前均簽署知情同意書(shū)。隨后其中有15名患者行DSA檢查(6人行球囊擴(kuò)張及支架植入術(shù),7人行球囊擴(kuò)張術(shù),2人僅行血管造影),8名患者進(jìn)行了手術(shù)。由兩名放射科專(zhuān)家對(duì)SLEEK顯示移植腎血管并發(fā)癥進(jìn)行評(píng)估,并將SLEEK結(jié)果與彩色多普勒超聲、DSA及手術(shù)結(jié)果進(jìn)行對(duì)照。 結(jié)果：23名行腎移植手術(shù)后經(jīng)超聲檢查后臨床高度懷疑血管并發(fā)癥的患者,所有患者均成功進(jìn)行了SLEEK掃描。經(jīng)DSA及手術(shù)確定的23名并發(fā)癥患者中移植腎動(dòng)脈狹窄有11例,移植腎動(dòng)脈閉塞有3例,移植腎動(dòng)脈扭曲有3例,移植腎靜脈狹窄有2例,動(dòng)靜脈瘺有2例,假性動(dòng)脈瘤有1例,肌纖維發(fā)育不良有1例。SLEEK檢查出了其中所有的23例并發(fā)癥,彩色多普勒超聲檢查出了其中19例,兩者沒(méi)有明顯的統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論：基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)無(wú)創(chuàng)、無(wú)輻射在顯示移植腎血管并發(fā)癥方面顯示出了很好的應(yīng)用價(jià)值,其結(jié)果與彩色多普勒超聲并無(wú)明顯統(tǒng)計(jì)學(xué)差異。 第三部分：基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)對(duì)移植腎動(dòng)脈狹窄的評(píng)估：與DSA相對(duì)照 目的：以數(shù)字減影血管造影(DSA)為金標(biāo)準(zhǔn),評(píng)估基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)在顯示移植腎狹窄方面的價(jià)值。 材料和方法：本研究收集行SLEEK掃描并行DSA進(jìn)一步確診的腎移植患者11例,所有患者檢查前均簽署知情同意書(shū)。應(yīng)用GE公司1.5T HD MR掃描儀對(duì)11名腎移植患者行非對(duì)比劑增強(qiáng)磁共振血管成像掃描掃描,隨后11名患者行DSA檢查。由兩名放射科醫(yī)生對(duì)SLEEK顯示移植腎動(dòng)脈狹窄程度進(jìn)行評(píng)估,并將SLEEK結(jié)果與DSA結(jié)果進(jìn)行對(duì)照。 結(jié)果：11名經(jīng)DSA驗(yàn)證的的腎移植患者均成功進(jìn)行了SLEEK掃描。經(jīng)DSA確定的1度狹窄患者有4例,2度狹窄有6例,3度狹窄有1例。除了1例輕度狹窄患者被SLEEK過(guò)高估計(jì)狹窄程度外,其余均與DSA顯示的一致,SLEEK對(duì)臨床上顯著狹窄(狹窄程度50%)的陽(yáng)性預(yù)測(cè)值為87.5%,陰性預(yù)測(cè)值為100%,靈敏度為100%,特異度為75%,準(zhǔn)確度為：90.9%。SLEEK與DSA在評(píng)估移植腎動(dòng)脈狹窄程度方面的有著很好的相關(guān)性(r=0.96；P0.05)。相對(duì)于DSA, SLEEK會(huì)稍微過(guò)高估計(jì)移植腎動(dòng)脈狹窄的程度,但是這個(gè)差異沒(méi)有顯著統(tǒng)計(jì)學(xué)意義(Wilcoxon符號(hào)秩檢驗(yàn),P=0.57)。Bland-Altman plot顯示以DSA為金標(biāo)準(zhǔn)SLEEK產(chǎn)生的誤差很低(平均誤差,3.2%±7.3%)。 結(jié)論：基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)無(wú)創(chuàng)、無(wú)輻射,在評(píng)估移植腎動(dòng)脈狹窄方面與DSA有著很好的一致性。SLEEK可以成為一種臨床上評(píng)估移植腎動(dòng)脈狹窄的方法。 第四部分：腎移植患者腎動(dòng)脈SLEEK掃描中BSP TI的參數(shù)優(yōu)化 目的：評(píng)估基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列(SLEEK)應(yīng)用在移植腎動(dòng)脈方面時(shí)BSP TI的參數(shù)優(yōu)化。 材料和方法：對(duì)20名行腎移植的健康志愿者,應(yīng)用GE公司1.5T HD MR掃描儀分別進(jìn)行血液抑制反轉(zhuǎn)時(shí)間(BSP TI)為500、800、1100、1400ms掃描,比較不同BSPTI下移植腎動(dòng)脈主干、分支與腎實(shí)質(zhì)的相對(duì)信號(hào)強(qiáng)度。 結(jié)果：20名志愿者均成功實(shí)現(xiàn)了非對(duì)比劑移植腎動(dòng)脈血管成像。BSP TI由500～1400ms,移植腎動(dòng)脈遠(yuǎn)端分支的信號(hào)強(qiáng)度逐漸增強(qiáng)。在BSP TI=800ms或1100ms時(shí),移植腎動(dòng)脈與移植腎實(shí)質(zhì)之間的相對(duì)信號(hào)強(qiáng)度最高。 結(jié)論：在血流正常情況下BSP TI為800ms或1100ms時(shí)成像效果較好。
[Abstract]:Part one: a study of the vascular anatomy of renal allograft based on the noncontrast enhanced magnetic resonance angiography sequence (SLEEK) based on the multi flipping pulse space labeling technique
Objective: To evaluate the value of non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on multi reversal pulse space labeling technique in displaying the vascular anatomy of the transplanted kidney, and to compare with the results of color Doppler ultrasound (CDUS) and intraoperative records.
Materials and methods: color Doppler ultrasound scan and non contrast enhanced MRI scan were performed on 75 patients who were required to exclude vascular complications after renal transplantation by GE's 1.5T HD MR scanner. All patients signed informed consent before the examination. Two radiologists showed the transplant kidney to SLEEK. The vascular anatomy was assessed, and the results of SLEEK were compared with the results of color Doppler ultrasound and intraoperative recording.
Results: a total of 75 renal transplantation patients, all patients were successfully scanned with SLEEK and color Doppler ultrasound. Three patients had two kidneys. A total of 78 transplanted kidneys were evaluated. All the patients were acceptable. The image quality score was 85% (66/78), and the good accounted for 10%. 8/78) generally accounted for 5% (4/78). The results of SLEEK examination were fully anastomosed with the intraoperative records in examining the anastomosis of renal allograft. 72 kidneys were transplanted in the right iliac fossa and 6 kidneys were transplanted in the left iliac fossa. 43 cases were anastomosed to the end to side of the external iliac artery and 35 cases of the transplanted renal artery and the end-end of the internal iliac artery were anastomosed. All 78 cases of renal vein graft were anastomosed to the end to side of the external iliac vein. The results were not statistically significant compared with color Doppler ultrasound (P0.05).SLEEK was obviously superior to color Doppler ultrasound (P0.05) in the detection of the accessory renal artery, and 9 of the 78 transplanted kidneys had the pararenal artery in the 78 transplant kidneys. SLEEK 8 of them were present, and only 2 cases were found by ultrasound.
Conclusion: the non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on the multi reversal pulse space labeling technique is noninvasive. No radiation is of great value in displaying the vascular anatomy of the transplanted kidney. There is no significant difference between the color Doppler ultrasound and the location of the transplanted kidney and the method of vascular anastomosis. It shows that the accessory renal artery is superior to color Doppler ultrasound. It provides a new objective basis for clinicians to evaluate the postoperative state of transplanted kidney.
The second part: a study of non contrast enhanced magnetic resonance angiography (SLEEK) based on multi reversal pulse space labeling technique in assessing the complications of renal allograft
Objective: To evaluate the value of non contrast enhanced magnetic resonance angiography (SLEEK) based on multi reversal pulse space labeling technique in displaying renal vascular complications and to compare with color Doppler ultrasound (CDUS), DSA and surgical results.
Materials and methods: non contrast enhanced MRI scans were performed in 23 patients with highly suspected vascular complications after ultrasound examination with GE's 1.5T HD MR scanner. All patients signed informed consent before examination. 15 of them were followed by DSA examination (6 patients were treated with balloon dilatation. And stent implantation, 7 patients underwent balloon dilatation, 2 patients underwent only angiography, and 8 patients underwent surgery. Two radiologist experts evaluated the renal vascular complications of SLEEK, and compared the results of SLEEK with color Doppler ultrasound, DSA and surgical results.
Results: 23 patients with highly suspected vascular complications after renal transplantation were successfully scanned by SLEEK. There were 11 cases of renal graft stenosis in 23 patients with DSA and surgery, 3 cases of transplant renal artery occlusion, 3 transplanted renal artery distortion and 2 renal vein graft stenosis. There were 2 cases of arteriovenous fistula, 1 cases of pseudoaneurysm, 1 cases of myfibrous dysplasia with.SLEEK, all of which were detected in 23 of them, and 19 of them were detected by color Doppler ultrasound. There was no significant difference between the two cases (P0.05).
Conclusion: non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on multi reversal pulse space labeling technique is noninvasive, and no radiation has a good application value in showing the complications of renal transplantation, and there is no significant difference between the results and color Doppler ultrasound.
Third part: evaluation of renal allograft stenosis by non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on multi flip pulse space labeling technique: relative to DSA
Objective: To evaluate the value of non contrast enhanced magnetic resonance angiography (SLEEK) based on multi reversal pulse space labeling (DSA) as the gold standard in the display of renal graft stenosis.
Materials and methods: This study collected 11 patients with SLEEK scan and DSA further confirmed renal transplantation. All patients signed informed consent before examination. The GE company 1.5T HD MR scanner was used to scan 11 renal transplant patients with non contrast enhanced MRI scan, and 11 patients were followed by DSA examination. Two patients were radiating by DSA. They evaluated the degree of renal artery stenosis by SLEEK and compared the results of SLEEK with that of DSA.
Results: 11 DSA confirmed renal transplant patients successfully performed SLEEK scan. There were 4 cases of 1 degree stenosis confirmed by DSA, 6 cases with 2 degree stenosis and 1 cases with 3 degree stenosis. Except for 1 cases of mild stenosis, the degree of stenosis was higher than that of DSA, and SLEEK was a positive clinical stenosis (50% in the degree of stenosis). The predictive value was 87.5%, the negative predictive value was 100%, the sensitivity was 100%, the specificity was 75%, and the accuracy was: 90.9%.SLEEK and DSA had a good correlation (r=0.96; P0.05) in assessing the degree of renal artery stenosis (r=0.96; P0.05). Relative to DSA, the degree of renal artery stenosis was too high to be estimated, but there was no significant difference in this difference. The significance of the study (Wilcoxon signed rank test, P=0.57).Bland-Altman plot shows that the error produced by DSA is the gold standard, and the error produced by SLEEK is very low (the average error is 3.2% + 7.3%).
Conclusion: the non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on the multi reversal pulse space labeling technique is noninvasive, without radiation, and has a good consistency with DSA in assessing the renal artery stenosis..SLEEK can be a clinical evaluation of renal allograft stenosis.
The fourth part: parameter optimization of BSP TI in renal artery SLEEK scanning of renal transplant patients.
Objective: To evaluate the parameters optimization of BSP TI using non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on multi reversal pulse space labeling technique in the application of renal allograft artery.
Materials and methods: in 20 healthy volunteers who underwent renal transplantation, the GE 1.5T HD MR scanner was used to perform a 50080011001400ms scan (BSP TI), respectively, to compare the relative signal intensity of the renal artery and the renal parenchyma under the different BSPTI.
Results: all the 20 volunteers successfully realized the.BSP TI from 500 to 1400ms, and the signal intensity of the distal branch of the transplanted renal artery was gradually enhanced. The relative signal intensity between the transplanted renal artery and the renal parenchyma was the highest at BSP TI=800ms or 1100ms.
Conclusion: when the blood flow is normal, the imaging effect of BSP TI is 800ms or 1100ms.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R445.2;R699.2

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4 劉芳;趙俊功;李力;朱悅琦;喬瑞華;韓峻峰;包玉倩;賈偉平;項(xiàng)坤三;;3T磁共振血管成像對(duì)糖尿病下肢血管病變的診斷價(jià)值[A];2008內(nèi)分泌代謝性疾病系列研討會(huì)暨中青年英文論壇論文匯編[C];2008年

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6 張玉忠;張雪林;昌仁民;;磁共振血管成像在腦動(dòng)靜脈畸形診斷中的作用[A];2003年全國(guó)醫(yī)學(xué)影像技術(shù)學(xué)術(shù)會(huì)議論文匯編[C];2003年

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2 湯浩;基于多翻轉(zhuǎn)脈沖空間標(biāo)記技術(shù)的非對(duì)比劑增強(qiáng)磁共振血管成像序列在評(píng)估移植腎血管解剖和并發(fā)癥方面的研究[D];華中科技大學(xué);2014年

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2 程凱亮;三維增強(qiáng)磁共振血管成像對(duì)周?chē)鷦?dòng)脈狹窄性疾病的臨床和實(shí)驗(yàn)研究[D];吉林大學(xué);2006年

3 闞興亮;增強(qiáng)掃描磁共振血管成像及在周?chē)苄约膊≈械呐R床應(yīng)用[D];延邊大學(xué);2007年

4 齊石;增強(qiáng)磁共振血管成像在評(píng)估盆和下肢動(dòng)脈狹窄性疾病遠(yuǎn)端血管中的應(yīng)用[D];吉林大學(xué);2005年

5 徐亮;三維對(duì)比增強(qiáng)磁共振血管成像對(duì)頸部動(dòng)脈病變的診斷價(jià)值[D];山東大學(xué);2006年

6 Jagadeeswar Reddy.L;無(wú)對(duì)比劑的二維時(shí)間飛躍法磁共振血管成像與多排CT血管成像在診斷下肢動(dòng)脈疾病的對(duì)比研究[D];大連醫(yī)科大學(xué);2011年

7 孫勤學(xué);增強(qiáng)磁共振血管成像（CE-MRA）診斷胡桃?jiàn)A綜合癥的價(jià)值探討[D];浙江大學(xué);2007年

8 鄔晴媛;3.0T時(shí)間分辨磁共振血管成像在下肢周?chē)鷦?dòng)脈閉塞性疾病的應(yīng)用研究[D];復(fù)旦大學(xué);2010年

9 林銳;零點(diǎn)充填技術(shù)抑制小血管節(jié)段性狹窄偽影的模型研究[D];汕頭大學(xué);2005年

10 郭建鋒;呼吸導(dǎo)航冠狀動(dòng)脈磁共振血管成像評(píng)價(jià)冠狀動(dòng)脈狹窄的初步研究[D];蘇州大學(xué);2007年

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