摘要目的评价磁共振成像(MRI)和三维(3D)增强磁共振血管成像(MRA)对胰肾联合移植并发症的诊断价值,并与穿刺活检和DSA进行对比.方法 5位患者于术后28天至2年进行5次MR检查(采用GE 1.5T MR机型),成像技术包括轴位和矢状位脂肪抑制SE序列T1WI及FSE序列T2WI,3D增强MRA扫描后行轴位或矢状位脂肪抑制T1WI扫描,计算胰肾移植物的实质增强平均百分率(MPPE).3D增强MRA采用"Smartprep"技术,其资料均采用最大信号强度投影(MIP)及多平面重建(MPR)进行处理.结果在5例移植胰腺中,MRI示2例正常,1例急性排斥反应,1例慢性排斥反应伴70%纤维化和1例迟发性胰腺炎.在5例移植肾中,MRI示4例正常,1例急性排斥反应伴肾梗死.MPPE能鉴别梗死和其他并发症.3D增强MRA能显示血管并发症,如移植血管狭窄、闭塞、动脉瘤形成或血管连接处狭窄等,其结果与DSA相当.结论 MRI和3D增强MRA的联合应用便于胰肾联合移植并发症的诊断.

abstractsObjective To evaluate the value of magnetic resonance imaging (MRI) and three dimensional (3D) contrast magnetic resonance angiography (MRA) in the diagnosis of complications of simultaneous pancreas-kidney transplantation (SPKT), as confirmed by biopsy and digital subtraction angiography (DSA).Methods Five MR examinations of five patients were performed within 28 days to 2 years after surgery on GE 1.5T MR system. Imaging techniques included axial and sagittal chemical fat-suppressed T1-weighted image (T1WI) and T2-weighted image (T2WI), additional contrast axial or saggital chemical fat-suppressed T1WI were obtained after 3D contrast MRA for calculating the mean percentage of the parenchymal enhancement (MPPE) of the pancreas and kidney. 3D contrast MRA was performed with Smartprep technique. MRA data were analyzed with maximum intensity projection (MIP) and multi-planner reformat (MPR).Results In five cases of transplant pancreases, MRI found two normal pancreas grafts, one case of acute rejection, one case of chronic rejection with 70% fibrosis and one case of late pancreatitis. In five transplant kidneys, MRI detected four normal kidney grafts and one case of acute rejection with infarction. MPPE could distinguish infarction from other complications. 3D contrast MRA could display vascular complications of SPKT, such as stenosis or occlusion, aneurysm formation of transplanted vessels and narrowing at the site of anastomosis, as confirmed by DSA.Conclusion With combined application of MRI and 3D contrast MRA, complications of SPKT can be clearly identified.