多层螺旋CT尿路造影在肾结核诊断中的应用价值

目的 探讨多层螺旋CT尿路造影(CTU)在肾结核诊断中的应用价值.方法 经术后病理证实的肾结核患者30例.男16例,女14例.平均年龄44(19～73)岁.左肾结核17例,右肾结核13例.临床表现尿路刺激症状者18例、腰痛18例、血尿6例、发热者2例、体检偶然发现2例、左阴囊肿大为主要症状者1例.术前均采用螺旋CT薄层增强扫描及三维重建技术诊断,评估CTU检查的应用价值.结果 30例患者中,CTU诊断肾结核29例(97%).其中肾实质内多发囊性低密度灶肾盂无扩张积液25例,结核钙化18例,肾盂输尿管管壁增厚、输尿管管腔狭窄17例,肾皮质变薄12例,膀胱挛缩充盈不良2例.IVU诊断肾结核9例(30%),肾盂、肾盏未能显影20例.1例CTU示左输尿管下段结石、左肾盂及输尿管扩张积液,IVU示左输尿管结石、左肾积水,术后病理检查证实左肾结核.结论 CTU具有快速薄层扫描、容积重建及图像后处理功能,对于中晚期IVU 不显影的肾结核有较高的诊断价值.

Evaluation of multi-slice spiral CT in the diagnosis of renal tuberculosis

Objective To evaluate the diagnostic value of multi-slice spiral CT urography (MSCTU)in kidney tuberculosis. Methods Thirty cases(16 men and 14 women)of kidnev tuberculosis diagnosed by clinic and pathology were retrospectively analyzed.The patients' mean age was 44 years(range,19-73 years).Of them,17 cases were on the left and 13 on the right.Eighteen cases had irritation symptoms,18 cases had low back pain,6 cases had hematuria,2 cases had a fever; renal tuberculosis was incidentally detected in 2,1 case had left scrotal swelling.The enhancement scanning and three-dimensional reconstruction of multi-slice spiral CT were conducted in all patients. Resuits Among the 30 cases,29 cases of renal tuberculosis were diagnosed with CTU(97%).The low density area in renal parenchyma was seen in 25 cases without expansion and fluidify of pelvis,tubercle calcification was seen in 18 cases,the thickening of renal pelvis and ureter wall was seen in 17 cases,the thinning of cortex of kidney was seen in 12 cases,and the contracture of bladder and poor filling was seen in 2 cases.IVU diagnosed 9 cases of renal tuberculosis(30%).Twenty cases of renal pelvis,calyceal failed to show contrast filling. Conclusion MSCTU has advantages in the diagnosis of renal tuberculosis compared with IVU.