Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux

ObjectiveThe objective of this study was to compare the accuracy of dimercaptosuccinic acid (DMSA) renal scan to magnetic resonance urography (MRU) in the identification of renal parenchyma defects (RPD).Materials and methodsTwenty-five children with history of acute pyelonephritis and vesicoureteral reflux underwent DMSA scan and MRU to determine the presence of RPD. DMSA scans and MRUs were each evaluated by two radiologists and agreement achieved by consensus. Discordant DMSA–MRU findings were re-evaluated in a side-by-side comparison and an ultimate consensus reached.ResultsThe ultimate consensus diagnosis was 18 kidneys with RPDs in 15 patients, of which five were classified as mild RPDs, six as moderate RPDs, and seven as severe RPDs. Although DMSA scan and MRU were similar in their ability to diagnose RPDs, MRU was considered to represent the true diagnosis in 11 of the 12 discordant cases in consensus review by four pediatric radiologists. MRU showed a much higher inter-observer agreement with a weighted kappa of 0.96 for both kidneys compared to 0.71 for the right kidney and 0.86 for the left kidney by DMSA scan.ConclusionsOur results suggest that MRU is superior to DMSA scan in the identification of renal parenchyma defects.     

Effectiveness of different diagnostic tools for upper urinary tract urothelial carcinoma

ObjectiveThe results of urinalysis, radiographic studies, urinary cytology examinations, and ureterorenoscopy (URS) biopsies, as well as the results of histopathology can be used to establish a diagnosis of upper urinary tract urothelial carcinoma (UTUC).Materials and MethodsWe enrolled 99 patients who underwent radical nephroureterectomy (RNU) during the period 2003–2007. A total of 65 random urine and 83 URS washing cytology examinations, 48 intravenous urography (IVU), 59 retrograde pyelography (RP), and 81 URS biopsy results were available prior to RNU and were compared with the pathological grades and stages of these surgical specimens.ResultsNinety-three UTUCs were found among the 99 RNU specimens. Initial presentations and urinalysis results could not predict tumor stages. The patient with preoperative pyuria was significantly associated with high-grade UTUC (75.0% vs 52.6%, p = 0.031). Random urine and URS washing cytology results could not predict tumor grades or stages. The sensitivity of 3-day random urine cytology was significantly better than 2-day and 1-day examinations (p = 0.002 and p = 0.019, respectively). The abnormal findings in IVU and RP accounted for 89.4% and 100%, respectively. Non-enhancement of images was significantly associated with high tumor grading (p = 0.01). URS biopsy (n = 72) was positive for malignancy in 52 patients (69.3%). Biopsy grade had a significant correlation with surgical tumor grade (κ = 0.649) and high-grade biopsy results were significantly associated with invasive tumor stage (pT2–T4) (p = 0.004).ConclusionCombining random urine cytology for 3 nonconsecutive days, upper urinary tract images, and URS biopsies provided an accurate diagnosis of UTUC. This study found that preoperative pyuria in urinalysis, non-enhancement in IVP or RP, and high-grade tumor in URS biopsy could predict high-grade tumor in RNU specimens.     

输尿管压迫阴性CT尿路造影技术

迄今为止,所有CT尿路造影(CT urography,CTU)均为在对比剂经肾脏排入尿路后行CT扫描,对扫描获得的横断影像进行后处理,以获取沿输尿管长轴的曲面多层面重组像(curved MPR,CMPR)或最大密度投影像(MIP).此方法的缺点与常规静脉肾盂输尿管造影(IVP)相似:肾功能不良或尿路有梗阻时检查不易成功,而且尿路内高浓度的对比剂可干扰对肾盂输尿管壁的观察[1,2].     

MRU对上尿路积水及其病因诊断价值的探讨

目的 通过磁共振尿路造影(MRU)与静脉尿路造影(IUP)、B超、电子计算机断层扫描(CT)及手术、病理学检查和临床结果对照研究,评价MRU在上尿路积水及其梗阻原因诊断中的价值。 方法 21例患者伴不同程度肾盂输尿管积水共30条,采用GE0.5T磁共振机检查,应用FSE序列重T2WI获得MRU冠状位原始单层图像,所有图像均作最大信号投影(MIP)重建。结果 MRU对上尿路积水诊断符合率达96.7％,与B超及CT类似,优于IUP;梗阻原因诊断符合率达86.7％,优于IUP与CT,但明显优于B超(P<0.01)。 结论 无创、无需对比剂及不依赖肾功能的MRU在上尿路积水和梗阻原因影像学诊断中发挥着重要作用,尤其是在B超不能显示病因、CT可疑阴性结石、IUP显影差或不显影时是最好的替代方法。     

Diagnosis of caliceal diverticulum in two pediatric patients: a comparison of sonography,CT, and urography

Caliceal diverticulum is a rare disorder in which a urine-filled cavity is connected to the renal calix by a narrow isthmus. Treatment of caliceal diverticulum varies depending on the complications, which include recurrent kidney infections, hematuria, and symptomatic calculi. The use of sonography may be insufficient for accurately diagnosing this condition; contrast urography, CT, or both also may be needed. We report the cases of 2 pediatric patients whose initial sonographic diagnosis was renal cystic disease but whose final diagnosis was caliceal diverticulum on contrast-enhanced urography in 1 case and both urography and CT in the other case. The patients received no further treatment but continue to receive follow-up care to monitor for the presence of infections and calculi. Accurate diagnosis of caliceal diverticulum in both cases spared the patients and their families the psychological burden of unnecessary further investigation of renal cystic disease. These cases emphasize the importance of using contrast-enhanced imaging modalities for confirmation when sonographic findings suggest the presence of renal cystic lesions.     

探讨CT尿路造影及三维重建在微创经皮肾镜取石术中的应用价值

目的：探讨CT尿路造影（CTU）和三维重建在微创经皮肾镜取石术（PCNL）中的应用价值。方法：选取本院2011年10月-2013年6月收治的36例择期行PCNL患者,按照随机数字表法均分为对照组和观察组各18例,对照组行静脉肾盂造影,观察组行CTU和三维重建,比较两组患者的手术时间、术中出血量、穿刺成功率、结石清除率和并发症发生率的差异。结果：观察组手术时间明显短于对照组,差异有统计学意义（P〈0.05）;两组患者术中出血量比较差异无统计学意义（P〉0.05）;观察组的穿刺成功率（88.9%）明显高于对照组（66.7%）,结石清除率（94.4%）明显高于对照组（72.2%）,差异均有统计学意义（P〈0.05）;两组患者均无严重并发症发生,并发症发生率比较差异无统计学意义（P〉0.05）。结论：在微创经皮肾镜取石术中应用CTU和三维重建安全有效,能显著缩短手术时间,提高穿刺成功率和结石清除率。     

MSCT肾动脉造影与尿路造影同步显示对尿路梗阻性疾病诊断价值

目的探讨多层螺旋CT血管造影（MSCTA）与多层螺旋CT尿路造影（MSCTU）同步显示对尿路梗阻性病变的诊断价值。方法对36例经超声或IVU拟诊为尿路梗阻的患者行MSCTA、MSCTU同步显示扫描,并通过后处理重组技术获得图像。结果36例尿路梗阻中肾及输尿管畸形3例,副肾动脉压迫肾盂输尿管连接处4例,泌尿系结石16例,泌尿系炎症5例,外源性压迫3例,泌尿系占位5例。结论MSCTA与MSCTU同步显示技术能同时清晰显示血管与集合系统,可提高尿路梗阻性疾病的诊断能力,并有效减少辐射剂量。     

IVU、SCTU及MRU对梗阻性尿路疾病诊断能力比较

目的比较静脉肾盂造影(IVU)、多层螺旋CT尿路造影(SCTU)及磁共振泌尿系水成像(MRU)对梗阻性尿路疾病的诊断能力,为临床选择合理检查方案提供理论依据。方法对62例经手术病理或经临床治疗随访证实的梗阻性尿路疾病患者影像资料进行回顾性分析,本组病例均行IVU检查,25例患者行SCTU检查,49例患者行MRU检查,12例患者同时行上述3种方法检查。结果 8例肾盂-输尿管移行部狭窄,IVU显示2例,7例包括IVU未显示病例MRU可清晰显示,1例CTU显示不清,不能明确诊断;19例输尿管结石病例,IVU显示9例,10例IVU未显示梗阻原因患者行CTU检查均清晰显示,13例行MRU检查,7例显示;15例输尿管肿瘤,7例行CTU检查,12例行MRU检查均显示清晰;11例输尿管外源性压迫或侵犯病例,IVU表现为肾积水,3例行CTU检查,10例行MRU检查均可清晰显示;9例输尿管炎性病变,IVU表现为肾积水,4例行CTU检查,2例显示清晰,2例与肿瘤不易鉴别,7例行MRU检查,均显示清晰。结论 IVU在梗阻性尿路疾病中主要用来筛查,当怀疑梗阻原因是结石引起时,应首选CTU检查,当怀疑梗阻原因是先天狭窄或肿瘤性病变时应首选MRU。