核素利尿肾动态显像在儿童神经源性膀胱诊断和随访中的应用

目的观察儿童神经源性膀胱（NB）的利尿。肾动态显像（DR）特征，评价DR在儿童NB诊断和随访中的应用价值。方法临床症状和尿动力学检查确诊为NB的患儿13例，行DR检查共15次，2例为治疗后复查。分析患儿显像结果和临床资料，并对2例随访患儿的前后2次显像结果进行对比。结果在DR显像中，10例（66．7％）膀胱显影差甚至不显影，输尿管可见全程或部分扩张显影。所有患儿均有不同程度肾积水，7例（46．7％）显像中可见肾脏形态缩小，肾脏皮质功能受损严重，利尿。肾图提示有上尿路机械性梗阻，并可见水平下降。单侧肾脏萎缩患儿萎缩肾的血流灌注比率（BPR）显著低于与对侧肾脏（t=-11．19，P〈0．05）。2例复查DR的患儿中，1例上泌尿道功能明显改善，1例无明显变化。结论儿童NB的DR影像显示上尿路各部位具有特征性改变，可以辅助诊断；DR显像可评估肾脏功能损害程度及分肾功能；DR对治疗效果的评价和随访有一定的应用价值。

Application of nuclide diuretic renography in treatment and follow-up for children with neurogenic bladder

Objective To observe the characteristics of diuretic renography （DR） of children with neurogenic bladder （NB） and to evaluate the application value of DR in the diagnosis and follow-up of children with NB. Methods Thirteen children diagnosed as NB by clinical syndromes and urodynamic investigations underwent 15 DR examinations. Two cases were re-examined after treatment. Images and clinical data of these patients were analyzed. Images of two examinations of two follow-up cases were compared. Results According to the DR images, bladders of 10 cases were badly filled or even unvisualized and their ureters were wholly or partly dilatated. All patients had different degree of hydronephrosis and kidneys of 7 patients shrank （ 46.7% ）. Functions of renal cortex were severely damaged. The nephrograms indicated mechanical obstruction of upper urinary tract and some of which showed lower level. The blood perfusion rate （BPR） ratio of the atrophic kidney of patients with single atrophic kidney was significantly lower than that of the contralateral kidney （t=-11.19, P〈0.05）. For two follow-up cases, the functions of upper urinary tract of one case were significantly improved, while the other showed no change. Conclusion The DR imaging of children with NB showed that every part of upper urinary tract has characteristic changes, which can help the diagnosis. DR imaging can evaluate the damage level of renal functions and DR has certain application value for the evaluation of therapeutic effect and follow up.