双能量减影在泌尿生殖系统检查中的应用

泌尿生殖系统的X线检查,如泌尿系平片（KUB）,静脉肾盂造影（IVP）,逆行尿路造影（RUV）,输卵管造影等,是诊断泌尿生殖系疾病的重要手段,检查前患者虽大都做了肠道清洁准备,但仍有许多患者肠腔内气体较多,严重干扰了诊断.直接数字X线摄影（DR）的高级临床应用软件-双能量减影用于泌尿生殖系统检查,尤其是造影检查,能有效去除肠腔气体重叠影,提高影像质量及诊断效果.本组随机抽取我院自2004年8月～2005年3月间,DR设备使用以来的100例泌尿生殖系统检查病例,对双能量减影的应用效果进行分析.     

原发性输尿管癌的影像学诊断

目的：分析２７例输尿管癌的临床和影像学资料，提出其影橡学检查的程序和鉴别诊断。方法：男２７例，女７例；年龄２８～７０岁。２７例均有腹平片及排泄性尿路造影，其中１６例逆行尿路造影，８例ＣＴ检查。结果：９例腹平片患侧肾影增大，２０例患侧肾不显影。７例排泄性和１５例逆行尿路造影显示充盈缺损。８例ＣＴ检查显示输尿管壁不规则增厚３例，结节状２例，３例凸入膀胱形成肿块。结论：排泄性尿路造影能发现患侧肾功能异常或显示肿瘤，逆行尿路造影是诊断输尿管肿瘤的有效方法，ＣＴ扫描能显示肿瘤及与邻近结构的关系     

数字X线机用于静脉肾盂造影检查方法

目的：探讨应用数字透视、摄影（DR）技术进行静脉肾盂造影的检查方法。方法：对应用东芝DBA-300数字X线机做138例静脉肾盂造影与应用常规X线机做100例静脉肾盂造影结果对比分析。结果：应用数字透视与摄影技术相结合所做静脉肾盂造影除14例因病人肾功不好肾盂显影不好外均获得满意的全尿路充盈影像，而应用常规造影技术直接摄影的造影方法仅43例可获得全尿路充盈影像。结论：应用数字X线机做静脉肾盂造影，以其先进的数字透视与摄影技术使检查方便、快捷，在短时间内完成检查可获得高质量的全尿路充盈影像。     

数字成像X线摄影与常规静脉肾盂造影图片质量对比分析

目的分析数字X线摄影（DR）在静脉肾盂造影中的应用价值。方法随机选择常规静脉肾盂造影检查组病人和DR组各50例。常规组用岛津500mA X光机，注射造影刺后7、15、30min照片；DR组使用GE TH-600数字X光机，电视监视下即时曝光，曝光方式选用单脉冲或1-4帧／秒连续采集，存储，筛选图像后处理。由Kodak EK-160激光打印机与Kodak X-2000型洗片机连接打印出图像。结果常规组图像比较差的占45．6％：DR组图像较差的占22％。常规组全尿路显示清晰占32％，DR组占82％。结论DR组在静脉肾盂造影中图像质量明显优于常规X线检查，可实时显示泌尿系结构和病变，大大提高诊断正确性。     

超声导向经皮肾盂穿刺造影的临床应用

超声导向经皮肾盂穿刺造影的临床应用罗岚１张征宇２王炼１程绍华１超声显像检查和泌尿系Ｘ线造影是目前泌尿外科使用最普遍的影像方法，由于各自的局限性，有时均不能确定病变部位。１９９２年以来，我们对１８例Ｂ超明确诊断为肾积水，静脉肾盂造影和尿路逆行造影失败或...     

多层螺旋CT尿路造影在泌尿系统病变诊断中的价值

目的：探讨多层螺旋CT尿路造影（MSCTU）对泌尿系病变的诊断价值。方法：收集经KUB、IVU检查单侧输尿管显示欠佳或不显影患者38例，健康志愿者4例，行CT平扫、肾脏增强双期扫描及尿路造影，将平扫及尿路造影资料传送至工作站，进行最大强度投影（MIP）、多平面重建（MPR）及容积重建（volume-rendering），获得完整尿路影像。结果：所有病例在14-2s内完成全尿路扫描。24例输尿管结石，重建图像能清晰显示结石位置及上段积水情况；2例肾肿瘤及1例输尿管切开取石术后患者显示输尿管内多发血块；2例术后输尿管粘连及肿胀至输尿管梗阻；1例结肠癌淋巴结转移侵犯输尿管；3例肾盂输尿管重复畸形清晰显示输尿管汇合部位；1例尿瘘可见尿湖位于输尿管中段，肾盂瘘口与之相连；1例先天性巨输尿管和1例腔静脉后输尿管完整显示其形态和走行。结论：多层螺旋CT具有超高速、大范围、薄层扫描能力，应用于尿路造影有其独特优势，可作为临床一种新的辅助诊断手段。     

克隆病X线征象与病理对照分析（附26例分析）

目的：总结26例克隆病X线表现,提高对本病的认识和诊断水平。方法：回顾性分析20年间26例经手术病理证实的克隆病,并结合大体病理标本和X线征象进行对照分析。结果：克隆病发病部位回肠最多,其次是空肠和结肠。病理标本与X线胃肠钡餐造影显示节段性局限性环形狭窄占77%,狭窄肠腔多在1cm之内;小肠扩张肠段形成“假结肠征”占61%,扩张肠管横径在5-13cm;病变区裂隙状、尖刺状溃疡均可见,粘膜皱襞变平或消失占54%;本组4例继发肠套迭。结论：克隆病病理改变与X线钡餐造影征象相对应,根据其胃肠钡餐造影、钡剂灌肠造影检查的特征性改变完全可以诊断本病。     

数字遥控X线机对儿童静脉肾盂造影的诊断价值

目的探讨应用数字遥控X线系统进行儿童动态静脉肾盂造影检查的临床价值。方法患儿平卧于检查床上,应用数字遥控X线机点泌尿系平片一张,注入造影剂后去除常规加压取头低足高15~20°,电视监视下待机摄取最佳显示体位最佳时机片,对20例儿童应用以上数字遥控X线系统动态法与20例应用计算机X线摄影系统常规法泌尿系造影的临床诊断结果进行对照分析。结果应用数字遥控X线系统动态静脉肾盂造影均能动态观察尿路全程显影情况,并提前结束检查11例,正常结束检查6例,延迟结束检查3例。且参照有关影像质量标准及临床诊断需要进行评估,满意达标率达97%。而应用计算机X线摄影系统常规法泌尿系造影有6例由于各种原因未能清楚显示尿路全程显影情况。正常结束检查15例,延迟结束检查4例,有1例未能完成整个造影检查。影像满意达标率仅达90%。结论用数字遥控X线系统动态静脉肾盂造影法在实际工作中能更好地针对儿童泌尿系统病变进行多角度动态观察,最大限度地保证照片的质量,对输尿管的全程显示率优于常规尿路造影,适当缩短和延长造影时间,对儿童泌尿系统疾病的诊断具有重要诊断价值。     

小儿膀胱横纹肌肉瘤的影像表现和鉴别诊断

目的:探讨小儿膀胱横纹肌肉瘤(rhabdomyosarcoma,RMS)的X线造影和CT表现特征,提高对本病的认识。方法:回顾性分析10例经手术病理证实的膀胱RMS的临床影像资料,全部病例均行静脉尿路造影和/或膀胱造影检查,其中4例行CT扫描。结果:造影显示膀胱内葡萄簇状充盈缺损8例,膀胱三角区大的分叶状充盈缺损影2例,6例膀胱壁毛糙。4例CT检查均显示膀胱腔内典型葡萄簇状低于腹壁肌肉密度软组织肿块,局部膀胱壁增厚,增强扫描病灶呈轻中度强化。结论:膀胱RMS影像表现具有一定特征,结合患儿年龄及临床特征多可做出正确诊断。     

计算机X线摄影质量控制

计算机X线摄影(Computed Radiography,CR)具有操作简单、数字影像清晰度高、曝光宽容度大、后处理功能强等优点,现已在临床广泛应用.我院自2002年引进美国柯达CR-900系统以来,开展了一系列质量控制工作.如针对IP对CR影像质量的影响、CR伪影的认识和处理、激光打印机对CR影像质量的影响等问题开展工作,积累了一些直接认识和体会,现小结归纳如下.     

Can ultrasound replace the intravenous urogram in preliminary investigation of renal tract disease? A prospective study

The intravenous urogram has long been the mainstay of urinary tract imaging in adult practice. It has been shown recently that in many clinical situations the routine use of intravenous urography is no longer justified and in some situations avoidance of adverse contrast reactions, reduced examination time and significant cost reduction. In order to assess the clinical and financial aspects of a change in practice in our department, a prospective study was undertaken over a total of 10 weeks when 328 patients who were referred for intravenous urography were also examined independently by ultrasound combined with the plain abdominal radiograph. The results were compared and in 81.4% of cases the two techniques yielded identical information. Ultrasound plus a plain abdominal radiograph provided more diagnostic information in a further 12.5% of cases, whilst intravenous urography was more informative in only 6.1%. The findings of the study are discussed by considering the main clinical groups and comparing the relative yields of ultrasound and urography. A scheme of routine urinary tract investigations using ultrasound and the plain abdominal radiograph is proposed. We estimate a 58% reduction in number of urographic examinations while retaining diagnostic accuracy. The financial and planning implications for our department are discussed.     

Urinary tract infection in children. A reappraisal of its radiologic investigation

In a prospective study, 100 children with either an acute or a previous history of urinary tract infection were investigated by intravenous urography, micturition cystourethrography, and ultrasonography. The results from the three diagnostic modalities were compared: The urinary tracts in 59 patients were normal, and revealed some abnormality in 41. Ultrasonography proved to be superior to intravenous urography in outlining renal contours and in detecting subtle cortical changes secondary to urinary tract infection (such as slight increases in cortical thickness and edema or cortical scarring). The mucosa of the renal pelvis and bladder was more easily assessed by ultrasound than by intravenous urography. Both modalities were "equally" accurate in detecting important congenital malformations of the urinary tract. Ultrasound failed to detect 24 of 28 ureters demonstrating reflux on voiding cystourethrography. We propose that carefully performed abdominal ultrasonography can replace intravenous urography in the initial investigation of urinary tract infection in children. It should be done in association with a radiographic or radionuclide voiding cystogram. Intravenous urography would then become a complementary examination for abnormal or problematic patients.     

What is left of i.v. urography?

Since its introduction into clinical practice in the early 1930s, intravenous urography (IVU) was the primary imaging technique for the investigation of urinary system disorders for many years, until the advent of digital cross-sectional-imaging techniques gradually started to undermine many of its indications. Intravenous urography has been superseded for some indications such as renovascular arterial hypertension, prostatic dysuria, renal failure, palpable abdominal masses and recurrent urinary tract infection in women. Intravenous urography has been reduced, in the sense that it is no longer a primary examination, for other clinical indications such as renal colic, renal trauma, uroseptic fever, asymptomatic haematuria, medical haematuria, obstructive uropathies and follow-up of various disorders. Intravenous urography is indicated and often mandatory in congenital anomalies of the urinary tract, prior to endourological procedures, possible fistulas, renal transplantation, tuberculosis and ureteral pathology. In conclusion, IVU is still the examination of choice where there is a need to visualize the entire urinary system and to evaluate the state of the papillae and calyces. Computed tomography urography and MR urography are the imaging modalities ready in the near future to replace IVU.     

磁共振泌尿系造影的相关技术和临床应用探讨

目的评价磁共振泌尿系造影（ＭＲＵ）的成像技术对揭示尿路梗阻部位及原因的价值和限度，并推广应用半傅立叶转换快速自旋回波序列（ＦＡＳＥ）行ＭＲＵ检查的技术方法。方法１８例尿路梗阻、８例非尿路梗阻性疾患及５例健康志愿者，应用ＦＡＳＥ技术行ＭＲＵ检查。无尿路梗阻者１３例检查前口服速尿２０ｍｇ。所有图像后处理均采用最大信号强度投影（ＭＩＰ）技术。结果尿路梗阻病人均能显示梗阻部位和程度，诊断敏感率达１００％，诊断正确率为８３％（１５／１８）。口服速尿增强ＭＲＵ提供了良好的肾脏形态和尿路解剖结构。结论ＭＲＵ是一种方便快捷的技术，可提供高分辨尿路图像     

Imaging of hematuria

Hematuria may have a number of causes, of which the more common are urinary tract calculi, urinary tract infection, urinary tract neoplasms (including renal cell carcinoma and urothelial tumors), trauma to the urinary tract, and renal parenchymal disease. This article discusses the current status of imaging of patients suspected of having urologic causes of hematuria. The role of all modalities, including plain radiography, intravenous urography or excretory urography, retrograde pyelography, ultrasonography, and multidetector computed tomography (MDCT) in evaluation of these patients is discussed. The article highlights the current status of MDCT urography in imaging of patients with hematuria, and discusses various-often controversial-issues, such as optimal protocol design, accuracy of the technique in imaging of the urothelium, and the significant issue of radiation dose associated with MDCT urography.     

Intravenous urographic technique

In these times of rapid advances in radiographic imaging, intravenous urography should be performed in an optimal way. The urographic examination should involve consultation between the referring physician and the radiologist. Necessary patient information should be accessible. McClennan said "patient selection for urographic studies should be efficacious with the radiologist exerting appropriate control so that the urogram is truly a consultative imaging service integrated into the total patient management." We share this view, and it is an extension of the philosophy of practice emphasized by other leaders in uroradiology. Cost containment, new imaging technologies, risk/benefit considerations, and evolving patterns of patient care have had a significant influence on genitourinary tract imaging. In addition, current debate about contrast media, digital radiography, efficacy, and utilization will undoubtedly have an influence on imaging during the next decade. Utilization of intravenous urography has decreased significantly in the past 15 years. Our volume of examinations has declined approximately 50% since 1970. This decline in our practice is attributed to several complex factors such as previous overutilization of screening urography for hypertension; the impact of US and CT for evaluation of obstruction, retroperitoneal disease (adenopathy and fibrosis), renal failure, and renal masses; concern about contrast medium-induced renal failure; and fewer repeat studies because of improved quality of intravenous urography in general radiology practice. In addition, overutilization of urography in patients with hematuria, prostatism, history of urinary tract infection, etc, continues to be debated in the medical community. In our integrated group practice, we have also observed overutilization of "high-tech" procedures in lieu of urography for evaluation of suspected urinary tract disease. Swings of the pendulum are inevitable in diagnostic imaging because of evolving technology and the art of medical practice. Although some differences of opinion about the details of urographic technique and indications for urography may exist, most would agree on the philosophy of producing a high-quality urographic examination. That philosophy focuses on producing the highest quality examination in each patient so that a diagnosis of normal or abnormal can be made accurately and confidently. Failure to demonstrate the entire urinary tract is a common cause of diagnostic error and one that can largely be eliminated by careful attention to the technical details of the examination.     

MR urography for the preoperative evaluation of living renal donors

The purpose of this study was to assess the image quality and diagnostic value of MR urography in detecting abnormalities of the urinary collecting system relevant for the preoperative evaluation of living renal donors. Study subjects were selected from the existing intravenous urography (IVU) reports: 18 consecutive patients with a duplication or another abnormality of the collecting system and 20 consecutive patients with normal anatomy. They underwent a respiratory-triggered 3D T2-weighted fast spin-echo acquisition after oral administration of furosemide, without and with abdominal compression. The MR images were evaluated by two independent blinded observers. The IVU was used as the standard of reference. Image quality of the MR urograms with compression was overall better than those without compression, and the former were regarded as adequate for the evaluation of small filling defects and deformities of the pelvis and calyces in 76-81% of the kidneys and 74-79% of the patients. Both observers correctly diagnosed all 13 kidneys with a partial or complete duplication. The image quality of MR urography was inadequate to evaluate the calyces and pelvis for small filling defects or deformities in approximately 25% of the patients; however, the technique was accurate in the detection of abnormalities of the urinary collecting system relevant for the preoperative evaluation of living renal donors.     

影像学检查对结石所致上尿路梗阻的诊断价值

目的 评价数字化X线摄影尿路造影[静脉尿路造影(IVU)、逆行尿路造影(RU)和经皮顺行尿路造影(PAu)]、螺旋CT(SCT)、磁共振成像(MRI MRU)对上尿路结石致梗阻的诊断价值方法62例经手术与病理证实的上尿路结石患者均经IVU，其中，26例又经RU，1例经PAU，23例经SCT，以及15例经MRI MRU检查。对不同检查方法的诊断准确率进行了比较。结果 尿路造影对七尿路结石所致梗阻定位、定性及梗阻与扩张程度的诊断准确率分别为98．4％，96．8％，100％；SCT分别为95．7％，100％，95．7％；；MRI MRU分别为86．7％，60％，93．3％。结论 在上尿路结石致梗阻的诊断中，尿路造影和SCT应作为主要检查手段，而MRI MRU可作为一种补充检查。     

Striation of the renal pelvis and ureter in bilharziasis

The intravenous urograms of 80 patients aged 16 to 29 (mean 23) with urinary bilharziasis were reviewed to determine the frequency of striation of the renal pelvis and ureter. Another 345 patients aged 16 to 29 (mean 22) with various abdominal and urological symptoms, had intravenous urography during the same period and were used as a reference group. Striation of the upper urinary tract was demonstrated in 21% of the patients with urinary schistosomiasis but in only 3% of the reference group. Striation constitutes an early radiological change in this disease.     

无压式大剂量动态静脉尿路造影在诊断泌尿系疾病中的临床应用

目的探讨无压式大剂量动态静脉尿路造影在诊断泌尿系疾病中应用价值。方法 85例临床考虑泌尿系疾病并经静脉尿路造影患者作为本组观察对象,其中43例行无压式大剂量动态静脉尿路造影,所有病例均在透视监视器的观察下实时点片;另42例行常规静脉尿路造影作对照。结果两种方法比较,无论从检出率、不良反应、造影效果和时间上,前者都优于后者。结论无压式大剂量动态静脉尿路造影可动态观察尿路全程显影情况,有效缩短传统的造影过程,减少患者因压迫而引起的痛苦,具有一定的临床应用价值。