目的 明确64层螺旋CT灌注参数 值与灌注图变化在肾积水患者肾功能评价 中的应用价值及对临床治疗的指导意义。 方法 将我院2013年6月-2015年12月收治 65例肾积水患者纳入观察组，由同期进行 健康体检者中随机抽取65例作为对照组。 患者均应用64层螺旋CT扫描仪检查，先行 常规CT平扫，采取多层连续动态电影扫描 模式对所选层面进行灌注扫描，之后行CT 增强扫描。分析肾积水患者CT影像表现、 灌注图，对比肾积水患者与正常体检者肾 皮质及肾髓质BF、PS、BV、PBV等 CT灌注 参数。结果 肾积水患者CT影像主要表现 为患侧后腹膜纤维化致患侧输尿管狭窄、 肾盂输尿管扩张及肾功能减退。肾积水患 者的肾皮质BF、PS、BV、PBV等参数值分 别为(208.4±28.6)ml·100ml-1·min-1、 (30.7±6.6)ml·100ml - 1·min - 1、 (27.5±4.3)ml·100ml-1、(46.6±5.0) ml·100ml-1，肾髓质BF、PS、BV、PBV等 参数值分别为(102.7±18.2)ml·100ml1 ·min - 1、(51.7±7.2)ml·100ml - 1 ·min-1、(18.5±4.0)ml·100ml-1、 (21.2±1.6)ml·100ml-1，均低于正常体 检者，差异有统计学意义(P﹤0.05)。结论 64层螺旋CT灌注成像技术具有较高空间与 时间分辨率，可获得良好解剖图像与清晰 三维图像，利用灌注图及灌注参数对患肾 功能进行精确定量评价，进而为临床治疗 提供指导。

Objective To explore the application value of 64 slice spiral CT perfusion parameters and changes perfusion images in the evaluation of renal function in patients with hydronephrosis and its guiding significance in clinical treatment. Methods 65 cases of patients with hydronephrosis who were admitted in our hospital between June 2013 and December 2015 were included in the observation group. 65 cases of healthy people who underwent physical examination during the same period were randomly selected and included in the control group. All patients were examined with 64 slice spiral CT scanner. Firstly, conventional CT plain scan was performed. Multi-slice continuous dynamic cine scanning mode was adopted to scan the selected layer. Then, CT enhanced scan was performed. The CT imaging findings and perfusion images of patients with hydronephrosis were analyzed. BF, PS, BV, PBV and other CT perfusion parameters of renal cortex and medulla were compared between patients with hydronephrosis and normal healthy people. Results The CT images of patients with hydronephrosis mainly manifested as the posterior peritoneal fibrosis induced ureteral stenosis, pyeloureterectasis and renal hypofunction. Renal cortex parameters such as BF, PS, BV and PBV [(208.4±28.6) ml·100ml1 ·min-1, (30.7±6.6) ml·100ml-1·min-1, (27.5±4.3) ml·100ml-1·min-1, (46.6±5.0) ml·100ml-1] and renal medullary parameters such as BF, PS, BV and PBV [(102.7±18.2) ml·100ml-1·min-1, (51.7±7.2) ml·100ml-1·min-1, (18.5±4.0) ml·100ml-1, (21.2±1.6) ml·100ml-1] in patients with hydronephrosis were lower than those in normal controls (P<0.05). Conclusions 64 slice spiral CT perfusion imaging is with high spatial and temporal resolution which can obtain good anatomic images and clear three-dimensional images. Perfusion images and perfusion parameters can be used for precise and quantitative evaluation of renal function in patients. Its can evaluate the degree of renal function damage, so as to provide guidance for clinical treatment.