64层螺旋CT血管成像及三维重建后处理技术对活体供肾血管的评估

目的 评价64层螺旋CT血管成像及三维重建后处理技术对活体供肾血管术前评估的临床价值.方法 回顾性分析2011年1月至2013年3月临沂市人民医院泌尿外科61例亲属活体肾移植供者术前64层螺旋CT血管成像及三维重建影像资料,观察供肾实质、肾动脉、肾静脉和肾盂、输尿管排泄系统,并与术中所见结果进行对照分析.结果 64层螺旋CT血管成像及三维重建图像基本清晰显示所有供者的双肾解剖结构及毗邻关系情况.肾实质密度及肾动脉管径、形态均正常,其中47例双肾均为单支肾动脉,4例左肾为2支肾动脉,5例右肾为2支肾动脉,5例双肾均为2支肾动脉.53例容积再现结合最大密度投影图像对输尿管排泄系统显示较好,49例表面遮盖成像图像较好地显示了肾动脉主干的起源、管径、形态及与周围组织的解剖关系,肾动脉CT仿真内镜成像能清晰显示腹主动脉、双肾动脉开口及肾动脉管腔.61例供者均行单侧肾切除术,术前血管成像结果与术中所见基本吻合.结论 64层螺旋CT血管成像及三维重建后处理技术能真实反映肾血管的解剖及毗邻关系,在某种程度上完全可以替代数字减影血管造影,可作为术前评估活体供肾血管的有效方法.     

三维重建CT在肾盂输尿管连接处狭窄诊治中的应用

目的：评价三维重建CT技术在肾盂输尿管连接处狭窄患者诊治中的应用价值。方法：对22例肾盂输尿管连接处狭窄患者术前行三维CT重建,根据术前CT重建所显示的肾脏血管及尿路情况,判定肾盂输尿管连接处狭窄是否为肾迷走血管所致,最后与实际手术情况相比较。结果：22例患者中12例经CT重建检查发现存在迷走血管压迫肾盂输尿管连接处,10例未见明显迷走血管压迫征象。经手术证实,三维重建CT对肾迷走血管致肾盂输尿管连接处狭窄的诊断符合率达100％。结论：三维重建CT能准确评价肾脏血管的变异和病变情况,对于术前准确合理地预制定肾盂输尿管成型手术方案及术中准确快速地进行血管处理有着重要的意义。     

MRU对肾移植术后原自体无功能肾、输尿管移行细胞癌的诊断价值(附21例报告)

目的：探讨磁共振水成像(Magnetic resistance urography,MRU)在肾移植术后对原自体无功能性肾、输尿管移行细胞癌的诊断价值。方法：对21例肾移植术后临床诊断为肾盂或输尿管移行细胞癌患者进行MRU检查,同时行逆行肾盂输尿管造影；11例行输尿管镜及病理学检查,并行MRU诊断。16例行经尿道输尿管口环形切开、腰部一处切口的肾输尿管全长切除术。结果：术前21例MRU检查均提示肾盂、输尿管有占位性病变,11例配合输尿管镜得出组织学诊断,术前诊断与手术结果一致。21例中,16例采用肾输尿管全长切除术均获得成功。结论：MRU对肾移植术后IVU不显影的原无功能性肾、输尿管移行细胞癌具有重要的临床诊断价值；输尿管口切除、肾输尿管全长切除术对移植肾同侧原肾发生肾盂输尿管癌一样有效。     

活体供肾术前评估中16层螺旋CT的价值

目的：评价16层螺旋CT三维重建在活体供肾血管、肾实质、泌尿系统评估中的实际应用价值.方法：回顾2004年以来41例活体肾移植供体临床资料,术前均行16层螺旋CT扫描,采集肾动脉期、静脉期以及排泄期的影像数据,采用MIP、VR、MPR和CRP等三维图像后处理技术,评估供体肾动脉、肾静脉、泌尿集合系统和肾实质情况,与术中所见相对照.结果：41例供肾动脉显示,34例双肾单支动脉供血,其中2例左肾动脉、3例右肾动脉分支较早;4例右肾见一支副肾动脉,3例左肾见一支副肾动脉;术中证实有1例右副肾动脉,1例左肾动脉早期分支未能在影像中显示清楚,准确率95.1%.41例供肾静脉显示,37例双肾静脉为单支,4例右侧双支肾静脉;术中证实5例右侧双支肾静脉未能在影像中显示,准确率87.8%;泌尿集合系统显影满意,1例左侧双肾盂双输尿管畸形.结论：16层螺旋CT三维重建能准确显示供体肾脏血管、泌尿集合系统、肾实质解剖及可能的病理情况,给临床肾移植术前评估提供有价值的帮助,可作为供体术前检查的首选方法.     

多层螺旋CT血管造影在血管压迫所致肾盂输尿管连接部梗阻中的诊断价值

目的探讨多层螺旋CT血管造影（CTA）对血管压迫所致肾盂输尿管连接部梗阻（UPJO）中的诊断价值。方法分析手术证实的16例血管压迫所致UPJO患者的CT血管造影图像,观察有无肾脏血管变异,肾盂输尿管连接部周围有无骑跨血管、血管的起源、大小及其与UPJO间的关系。结果16例UPJO中,肾动脉解剖变异12例,肾静脉解剖变异3例。CTA16例见19支血管压迫,其中动脉血管15支,静脉血管4支。单支血管压迫13例,双支血管压迫3例,包括副。肾动脉12例,迷走动脉3例,性腺静脉2例,副肾静脉2例。均与手术病理相吻合。结论多层螺旋CTA不但能够了解肾脏血管解剖及变异,并且在血管压迫所致UPJO的诊断及手术治疗方面具有重要价值。     

64层螺旋CT在肾盂输尿管连接部狭窄中的应用

目的 研究利用64层CT在血管造影(CTA)、尿路造影(CIU)对肾盂输尿管连接部狭窄诊断的应用价值.方法 对15例肾盂输尿管连接部狭窄进行64层螺旋CT平扫及多时相期CT增强扫描.CTA、CTU影像检查.术前评估结果与手术探查结果进行对比.结果 通过CTA及CTO检查包括平扫和增强扫描.15例肾盂输尿管连接部狭窄获得确诊.其中3例平扫发现肾内伴发结石,CTA发现2例异位血管压迫.CTU很好的显示了狭窄的位置和狭窄长度,所有患者行开放或微创手术,影像结果和手术探查一致.结论 64层CT尿路和血管三维重建,可作为肾盂输尿管连接部狭窄术前评估的常规方法.其应用价值值得进一步的研究和分析.     

16层螺旋CT血管造影及三维重建技术在活体供肾动脉解剖学评估中的应用

目的 探讨16层螺旋CT血管造影在活体供肾动脉解剖学评估中的应用价值。方法 36名亲属活体供肾者在肾切取前进行肾动脉16层螺旋CT血管造影及血管三维成像，血管三维成像方法包括容积再现技术（VR）、最大密度投影（MIP）、表面遮盖成像（SSD）、血管内镜技术（CTVE）、多平面重建（MPR）及曲面重建（CPR）。结果 横断面CT及MPR显示所有供者的双肾大小、形态及位置均正常，肾实质密度正常，呈均匀强化。VR、MIP、CPR显示双肾动脉粗细、形态均正常；29例双肾均为单一肾动脉，2例双肾有2支肾动脉，2例左肾为2支肾动脉，3例右肾为2支肾动脉，上述结果均在术中得到证实。11例VR及MIP同时较好地显示双侧肾小盏、肾盂及输尿管上段。SSD均能很好显示肾动脉主干的起源、大小、形态及与周围的解剖关系。CTVE能较好显示腹主动脉、双肾动脉开口及肾动脉血管内腔。结论 16层螺旋CT血管造影可作为活体肾移植术前了解供肾血管及形态的有效方法。     

肾盂输尿管毗邻解剖研究及在腹腔镜手术中的应用

目的探讨肾盂输尿管与毗邻组织器官的关系、重要的解剖标志以及临床意义。方法结合临床资料和8例尸体解剖资料观察:肾下极以上平面肾盂输尿管与肾血管的关系;平肾下极处输尿管与肾下极、腰大肌、周围血管的关系;肾下极至第五腰椎间输尿管与腰大肌、生殖血管、生殖股神经的关系。结果在肾门至肾下极之间肾盂输尿管从后向前走行,到肾下极处达肾前缘,向前倾角为0°～12°,平均8.6°。8例尸体16个肾脏中肾动脉及肾静脉属支在距肾门前缘1cm范围内分出二级血管者有13例,在1～2cm分出二级血管者2例,1例位于2.7cm外分出二级血管。肾动脉后支从肾盂后方入肾脏,二级血管并不以动脉、静脉、肾盂的前后关系出入肾门。输尿管与生殖股神经75%(6/8)发生交叉,交叉点位于第4、5腰椎椎间盘平面2～3cm,距腰大肌外侧缘的水平距离:左侧1.73±0.81cm、右侧1.76±0.53cm。交叉点上方输尿管约83.3%(5/6)位于生殖股神经的外侧,在髂血管分叉处,输尿管均位于生殖股神经的内侧。结论肾盂输尿管毗邻解剖学的研究,为腹腔镜下肾盂输尿管重建手术的顺利进行和广泛开展提供解剖学指导。     

输尿管软镜在上尿路疾病诊治中的应用

对血尿病人的诊断,过去往往停留在B超、静脉肾盂造影、逆行肾盂造影、膀胱镜检查、尿脱落细胞学检查及CT等,这些检查往往未能明确诊断。肾血管造影检查价格昂贵且为有创检查,有些病人也未能明确诊断。输尿管硬镜由于本身的特点,往往只能观察到输尿管的病变,对肾盂、肾盏的病变则鞭长莫及。2003年2月~2007年2月,我们应用输尿管软镜对20例上尿路疾病进行检查治疗,效果良好,报道如下。1临床资料与方法1.1一般资料本组20例,男12例,女8例。年龄23~56岁,平均42岁。左侧9例,右侧11例。肉眼血尿2例,镜下血尿10例,病程1~2个月,无其他临床症状及合并症。常规行B超、静脉肾盂造影、逆行肾盂造影、膀胱镜检查、尿脱落细胞学检查以及CT检查等(其中2例行肾动脉造影检查)均未能明确诊断。尿红细胞形态检查提示主要为正常形态的红细胞。病例选择标准:原因不明的上尿路单侧肉眼血尿;②尿路单侧尿液细胞学检查阳性;③有可能需要行上尿路腔内治疗;④常规行B超、静脉肾盂造影、逆行肾盂造影、膀胱镜检查及CT检查等均未能明确诊断。病例排除标准:严重出血性疾病;②患者不能耐受手术和麻醉;③急性尿路感染者;④尿道狭窄。1.2方法采用连续硬膜外麻...     

外伤性肾盂输尿管交界处断裂5例报告

目的：探讨外伤性肾盂输尿管交界处断裂患者的临床特征。方法：报告5例外伤性肾盂输尿管交界处断裂患者的临床资料。结果：3例早期均误诊,1例肾输尿管吻合术失败,行肾切除术;1例伤后8个月肾输尿管吻合术后肾萎缩,1例延期诊断,术后患侧IVP肾显影良好;1例早期诊断,术后患侧IVU示肾功能良好。结论：尿外渗、肾积水是外伤性肾盂输尿管交界处断裂主要临床表现,CT检查对本病有重要诊断价植。急诊手术探查,争取一期修复,有利于提高疗效。     

"Cobblestone" renal pelvis: radiographic finding in acute renal vein thrombosis.

A unique case of bilateral extension of prostatic carcinoma along the ureters up to the renal pelves is described and the related literature reviewed.     

Acute non-dilating obstructive renal failure in a patient with AIDS

A 30-year-old male who presented with acute renal failure was found to have acquired immunodeficiency syndrome (AIDS). Although sonography and computerized tomography did not show urinary tract dilatation, obstructive renal failure was demonstrated by retrograde pyelography. Relief of obstruction(s) due to encasement of the renal pelves and ureters with histiocytic lymphoma led to immediate return of normal renal function. Although the etiology of renal failure in this patient is highly unusual, the high incidence of lymphoma in patients with AIDS should make tumor-related renal disease a consideration in all such patients with renal dysfunction.     

Magnetic resonance imaging of the dysplastic renal moiety and ectopic ureter

PURPOSE: We determined the role of magnetic resonance imaging (MRI) in symptomatic children with clinically suspected and radiologically occult dysplastic renal moieties and ectopic ureters. MATERIALS AND METHODS: We reviewed clinical, imaging, cystoscopic, surgical and histological findings in 6 symptomatic children 1 to 15 years old with dysplastic renal moieties. RESULTS: After multiple conventional imaging studies failed to delineate urinary tract anatomy MRI provided detailed multiplanar images of dysplastic renal moieties that were diagnostic and predictive of subsequent intraoperative findings. Dysplastic upper pole moieties identified in 4 children were associated with ectopic ureters inserting into the vagina, prostatic urethra, bladder neck and bladder neck ureterocele in each. A solitary kidney with contralateral blind-ending ectopic ureters inserted into the bladder base in 2 cases. Pelvic cystic structures visualized by ultrasound in 3 patients were tortuous distal ureters on MRI. MRI specifically identified ureteral insertion sites that were not evident in 3 of the 5 patients who underwent cystoscopy. CONCLUSIONS: MRI may facilitate diagnosis, guide cystoscopy and aid in preoperative planning in children with poorly functioning renal moieties and ectopic ureters.     

Effects of direct current on renal function

Summary Electric current from an external source was introduced between electrodes operatively placed into the ureters and positioned in the renal pelves of 13 pigs. Urinary excretion via the cathodic kidney showed a marked increase. The renal plasma flow and glomerular filtration rate diminished with increasing voltage, but no significant difference was found between the cathodic and the anodic kidney. The fractional sodium excretion by the cathodic kidney was 80% higher, indicating that the electric current mainly affected tubular function. A possible clinical application for electric fields in the kidneys is discussed.     

Idiopathic myelofibrosis with myeloid metaplasia involving the renal pelves, ureters and bladder.

Myeloid metaplasia associated with idiopathic myelofibrosis most commonly involves the reticuloendothelial organs, such as the spleen, liver and retroperitoneal lymph nodes. We report on a patient with myeloid metaplasia (extramedullary hematopoiesis) of the renal pelves, ureters and bladder. The pathogenesis, clinical characteristics, treatment and prognosis of this condition are discussed.     

多层螺旋CT在活体肾移植供者术前评估中的作用

目的 探讨多层螺旋CT(MELt)在活体肾移植供者术前评估中的作用.方法 对104名活体供肾者术前肾脏MDCT检查的资料进行回顾性分析.均采用64层螺旋CT检查,对双肾进行非增强扫描,注射造影剂后分别行动脉、静脉和排泄期增强扫描,扫描范围从膈顶到耻骨联合.扫描完后重建MDCT图像.根据MDCT图像,记录供者肾脏、输尿管、肾动脉及肾静脉的解剖结构和变异情况,并以供肾切取术中被证实的情况作为标准,对比分析术前MDCT检查对供肾的评估作用.结果 104名供者成功完成MDCT检查,肾脏和输尿管异常者8例.除外1例蹄铁型肾,副肾动脉和肾动脉过早分支的发生率分别为27.2%(28/103)和12.6%(13/103),有双肾静脉者3例,左肾静脉位于腹主动脉之后者3例.共有93名供者成功接受供肾切取术,术中证实,术侧供肾和输尿管异常与术前MDCT检查结果一致;术侧副肾动脉的检出率为80%.直径大于1 mm的副肾动脉和肾动脉过早分支术前均被MDCF检出;肾静脉均与术前MDCT检查结果一致.结论 活体供肾切取前采用MDCT检查能准确显示肾脏的解剖结构和血管变异情况,对供者选择及手术方案的制定具有重要意义.     

Digital subtraction angiography for evaluating patients with renal carcinoma

Intravenous digital subtraction angiography has been performed on 39 patients with renal carcinoma. In 19 patients (group 1) imaging of the renal arteries was done following injection of 40 cc intravenous contrast medium through an antecubital vein. In 20 patients (group 2) 40 cc intravenous contrast medium were injected through a femoral vein and digital subtraction imaging of the inferior vena cava was obtained. In 12 of these patients the renal arteries also were visualized from the same injection of contrast medium. Intra-arterial digital subtraction angiography of the renal arteries also was done in 5 patients in group 2. Intravenous digital subtraction angiography satisfactorily demonstrated main renal arterial anatomy in 29 of 35 patients (83 per cent) over-all but failed to delineate the renal mass in most cases. Excellent visualization of the inferior vena cava was obtained in all 20 patients in group 2. Intraarterial digital subtraction angiography yielded an accurate diagnosis of renal carcinoma in all 5 patients with minimal doses of contrast medium. We conclude that intravenous digital subtraction imaging combined with computerized tomography scanning or ultrasonography yields satisfactory diagnostic and anatomical information for most patients with renal carcinoma.     

Application of perfusion pressure measurement to problems of upper urinary tract dilatation in children

A simplified technique of measuring perfusion pressure in the equivocally obstructed upper urinary tract of children is described. Twelve patients with dilated renal pelves or ureters encountered in an 18-month period have been investigated. The findings in the majority of cases were contrary to those anticipated from the radiological appearances. This test of obstruction has wide application in the management of paediatric urological problems.     

A case of idiopathic retroperitoneal fibrosis causing acute renal failure and markedly responsive to drug therapy]

We report a case of idiopathic retroperitoneal fibrosis in a 66-year-old man. He was admitted to our hospital because of acute renal failure, and emergent hemodialysis was performed. Computed tomography scanning showed a retroperitoneal mass surrounding the abdominal aorta and bilateral common iliac arteries. The mass involved bilateral ureters and acute renal failure was caused by bilateral hydronephrosis. Magnetic resonance imaging demonstrated that the mass was slightly high intensity on T2 weighted image. It was considered to be idiopathic retroperitoneal fibrosis. After inserting ureteral catheters into bilateral ureters, his renal function recovered. The layer of the fibrosis became thin by steroids and traditional Chinese medicine, and bilateral ureteral catheters could be removed two months later. At ten months after the treatment, no ureteral obstruction was observed and renal function is preserved.     

Comparison of spiral CT scan and arteriography for evaluation of renal and visceral arteries

Renal and visceral artery images obtained concurrently with spiral CT and conventional arteriography were compared for 32 patients. Indications for imaging were occlusive disease (n=12), aneurysmal disease (n=9), and renal or visceral artery disease (n=11). Conventional arteriography enabled visualization of 64 renal arteries and 15 accessory renal arteries. Lateral aortograms obtained in 15 patients enabled visualization of 14 superior mesenteric (SMA) and 14 celiac arteries. Spiral CT enabled visualization of 60 renal arteries, 12 accessory renal arteries, 27 SMAs, and 22 celiac arteries. Calcification or a disparity in timing of contrast material injection and scanning prevented visualization of the celiac artery in 10 patients and the SMA in four patients. With conventional arteriography as the standard for comparison, spiral CT had a sensitivity of 67% and a specificity of 95% for depiction of at least 75% stenosis in the main renal artery. By means of the Pearson correlation coefficient, significant correlation (p < 0.001) was confirmed between spiral CT and arteriography for evaluation of stenosis of the main renal artery, SMA, and celiac artery. This early experience suggests that spiral CT may be useful in evaluation of renal and visceral arteries and their relationship to aortic disease.Presented at the Twentieth Annual Meeting of the Peripheral Vascular Surgery Society, New Orleans, La., June 10, 1995.