小儿盆腔及泌尿生殖系横纹肌肉瘤的超声诊断

目的:探讨小儿盆腔及泌尿生殖系横纹肌肉瘤(RMS)的超声表现及其诊断价值。方法:回顾性分析36例经手术及病理证实的原发于盆腔及泌尿系RMS的临床及超声资料。患儿采取相应憋尿的形式经腹探查。结果:36例患者主要临床表现为尿频、排尿困难、血尿、排便困难、腹部疼痛或发现包块、阴道或尿道口脱出肿物。膀胱RMS14例,多发生于膀胱颈三角区呈形态不规则的菜花状的实性低回声块。盆腔RMS12例起自盆腔,为实性不均匀的低回声包块,形态不规则,边界清晰,常包绕或与盆腔大血管关系密切,并可发生早期转移。前列腺RMS7例,为前列腺区的较大的不均匀的实性低回声肿物,将膀胱顶起位置抬高,环绕尿道,内伴有不同程度的坏死无回声区。阴道RMS2例表现为阴道处实性低回声块,子宫有不同程度的受累。尿道RMS1例示尿道内实性低回声块,致尿路梗阻。结论:超声能够明确小儿横纹肌肉瘤的位置、起源、形态、内部结构以及与周围组织的关系,揭示继发的上尿路病变,且无创伤无射线伤害。     

原发性输尿管息肉的X线表现

目的:提高对输尿管息肉X线表现的认识。方法:收集病理证实的原发性输尿管息肉13例,所有病例均行IVP检查,9例进行逆行性尿路造影。结果:85%(11/13)病变位于输尿管中上段、肾盂输尿管交界部及肾盂,IVP和逆行性尿路造影显示梗阻段输尿管扩张,其内可见充盈缺损影,其形态在不同时间的照片上可发生变化。结论:输尿管息肉的X线表现有一定的特征性,IVP和逆行尿路造影是发现和诊断输尿管息肉的常用方法,尤其是逆行尿路造影能够提高诊断的准确性。     

输尿管囊肿的影像学诊断(附4例报告)

目的探讨静脉尿路造影(IVP)、B超和CT对输尿管囊肿的诊断价值。方法回顾性分析经手术和病理证实的4例输尿管囊肿的影像学表现。结果输尿管囊肿IVP表现为膀胱内边界清晰的充盈缺损,膀胱内“眼镜蛇头”征为输尿管囊肿的典型表现。输尿管囊肿B超显示囊肿呈类圆形无回声暗区,形态可随排尿而改变。B超并可发现较小的输尿管囊肿。结论IVP、B型超声均可作为输尿管囊肿的首选检查方法,对本病具有很高的诊断价值。     

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。     

小儿前列腺囊的X线诊断

目的 探讨小儿前列腺囊的影像学特点及诊断方法。资料与方法 对16例经手术证实或经膀胱镜、尿道镜等检查证实的前列腺囊患儿资料进行回顾性分析。16例中13例经排泄性膀胱尿道造影(VCUG)检查确诊,2例经B超检查确诊,1例在尿道成形术中发现。结果 13例VUG在后尿道后方中线处均显示对比剂充盈的类圆形囊腔,大小不等,囊壁较光滑。结论 VCUG检查是诊断小儿前列腺囊的首选方法。     

盆腔脂肪增多症的影像学诊断

目的：提高对盆腔脂肪增多症的影像学诊断水平。方法：回顾性分析了我院5例盆腔脂肪增多症患者的X线、CT和MRI检查结果，并结合本病的临床特点和文献进行了探讨。结果：5例患者均行膀胱造影，见膀胱颈部拉长，膀胱抬高；4例行静脉肾盂造影(IVP)检查，示双侧输尿管双侧肾盂扩张积水；2例患者行钡灌肠检查，可见直肠伸直，远段乙状结肠伸直抬高；3例行CT检查，示膀胱和直肠周围有大量脂肪密度影；3例行MRI检查，见盆腔内有大量短T1、长T2不均质信号，膀胱呈“倒葫芦”状，MRU可见膀胱变形颈部拉长；所有患者均行B超检查，示双肾盂双输尿管积水。结论：盆腔脂肪增多症行X线、CT和MBI检查有其特征性的表现，合理运用影像学检查手段可减少对本病的误诊，认识这些影像学特征有助于提高对本病的诊断。     

小儿输尿管息肉的影像特点

目的总结小儿输尿管息肉并发肾积水的临床及影像特点。方法回顾性分析13例输尿管息肉合并肾积水患儿的临床资料，全部患儿均行腹部X线平片、排泄性尿路造影（IVP）及双肾、输尿管彩色超声（US）检查，10例行双肾及输尿管增强CT平扫（6例行三维重组）。结果临床表现为腰痛或腹痛者9例，间断血尿者3例。影像学检查均发现肾盂积水，IVP发现5例梗阻段输尿管扩张、增粗，其内可见充盈缺损影；CT检查可见输尿管占位病变的全貌，6例管腔内存在不规则的软组织影；US检查见2例输尿管内中、低混合回声的肿物。结论小儿输尿管息肉以US及CT检查为诊断的重要手段。了解其影像学特点，结合临床症状，可以提高术前诊断的准确性。     

多层螺旋CT尿路造影在泌尿系先天畸形的诊断价值

泌尿系先天畸形种类繁多,影像检查以往主要依靠B超、静脉肾盂造影(intravenous pyelography,IVP),对显示其解剖、形态和功能方面的改变存在局限性。CT尿路造影(CTurography,CTU)是经静脉注入对比剂后,由于肾脏的分泌功能使得对比剂在肾盏、肾盂、输尿管和膀胱内充盈,利用CT对受检部位进行连续扫描,将获得原始图像经计算机处理后     

输尿管息肉的影像学诊断

目的分析输尿管息肉的影像学表现,提高对输尿管息肉的诊断水平。资料与方法回顾性分析经手术病理证实的5例单纯输尿管息肉的影像学资料（X线、CT、MRI）。5例患者均行静脉肾盂造影,3例行逆行肾盂造影．2例行CT平扫和增强,2例行MR平扫。结果4例静脉肾盂造影发现病变,表现为管腔内边缘光滑的充盈缺损,1例病变侧肾脏输尿管未显影。3例逆行肾盂造影发现病变。2例CT检查发现增强后期扩张输尿管内低密度充盈缺损。2例MR平扫LWI发现高信号管腔内低信号充盈缺损。结论输尿管息肉的影像学表现具有一定特征性。X线检查是输尿管息肉首选方法．CT、MRI可作为辅助诊断手段,对碘过敏及肾功能不良等不能使用碘对比剂的患者,首选MRI。     

原发性输尿管癌的影像学诊断(附31例报告)

目的　探讨影像学对原发性输尿管癌的诊断价值。方法　静脉肾盂造影 逆行肾盂造影 2 1例 ,超声检查 2 5例 ,CT检查 14例。结果　输尿管癌在静脉肾盂造影和逆行肾盂造影表现为不规则充盈缺损 ;超声显示为大小不等、形态不规则实性结节 ,突向膀胱的肿瘤可呈菜花状 ;CT显示为大小不等、密度不均、形态不规则软组织肿块。结论　静脉肾盂造影、逆行肾盂造影、B超、CT互相结合 ,可提高输尿管癌的诊断水平     

小儿盆腔及泌尿生殖系统横纹肌肉瘤超声诊断及病理分析

目的:探讨超声检查在儿童盆腔及泌尿生殖系统横纹肌肉瘤的诊断价值及病理类型分析.方法:对30例原发盆腔及泌尿生殖系统横纹肌肉瘤的超声检查结果结合病理类型进行分析.结果:膀胱横纹肌肉瘤11例,1例为葡萄簇型,其余10例均为胚胎性.前列腺横纹肌肉瘤3例,3例病理结果均为胚胎性.阴道横纹肌肉瘤1例,病理结果为葡萄簇型.盆腔横纹肌肉瘤15例,2例为腺泡状,其余13例均为胚胎性.本组盆腔及泌尿生殖系统横纹肌肉瘤超声基本表现为肿瘤边缘清楚,无包膜回声,形态规则或不规则形,内部为基本均质的低回声,部分肿瘤内部可见液化坏死.结论:超声检查可作为盆腔及泌尿生殖系统横纹肌肉瘤影像学检查的首选方法.     

儿童盆腔横纹肌肉瘤CT 表现

目的：探讨儿童盆腔横纹肌肉瘤的CT影像学表现特征。方法回顾性分析9例经病理证实的儿童盆腔横纹肌肉瘤的CT表现,包括肿块的部位、形态、大小、密度、强化方式及强化程度。结果9例中病变主要位于膀胱直肠隐窝8例,后腹膜1例,均表现为巨大不规则软组织肿块,其中8例肿块边界欠清呈分叶状,1例边界清楚有包膜。肿块内可见偏心性带状、团状低密度区,2例肿瘤内混杂出血。肿块易侵犯邻近组织,周围均未见明确肿大淋巴结。CT增强扫描病灶动脉期均表现为轻中度不均匀强化,边缘强化程度较其中心强化明显,静脉期、延迟期呈持续性强化。结论发生于盆腔的儿童RM S在C T影像学表现中有一定的特征性和临床鉴别诊断意义。     

前列腺横纹肌肉瘤的影像学表现分析(附3例报道并文献复习)

目的 探讨前列腺横纹肌肉瘤的影像学表现.资料与方法 回顾性分析3例前列腺横纹肌肉瘤患者的临床及影像学资料并作文献复习.结果 3例表现为前列腺明显增大,伴软组织肿块形成,CT和MR增强后均有明显强化,肿瘤内部有不规则坏死区.DSA造影可见新生肿瘤血管和明显的肿瘤染色征.对盆腔邻近组织、结构仅1例主要表现为膀胱受压,其余均表现为不同程度侵犯,膀胱和精囊腺是极易受侵犯的器官.1例发生肺和盆腔转移.结论 前列腺横纹肌肉瘤常见于青少年,CT和MR能显示前列腺肉瘤的表现以及对邻近结构的侵犯情况.     

Computed tomography of prostatic and bladder rhabdomyosarcomas

Rhabdomyosarcoma represents the most common soft tissue sarcoma in children. The CT findings in five patients with pelvic rhabdomyosarcoma are reported. In the three male patients the primary tumor originated in the prostate gland whereas in the two female patients the bladder was the primary site. The CT findings in the prostatic tumors included an enlarged, inhomogeneous prostatic mass with invasion of the perirectal fat. In two of these patients there was thickening of the levator ani muscle and one showed tumor invasion through the ischiorectal fossa and sciatic and obturator foramina into the pelvic musculature and bone. In the two patients with bladder tumors, one showed a large mass adjacent to the lateral aspect of the bladder and ascites, suggesting an ovarian primary tumor. The other patient with sarcoma botryoides (a subtype of rhabdomyosarcoma) had a diffusely thickened bladder. Two patients have had a follow-up CT demonstrating tumor regression posttherapy. The characteristically large size of these masses and propensity for local invasion in a young patient are typical features of pelvic rhabdomyosarcoma.     

多层螺旋CT尿路成像在泌尿生殖瘘中的诊断价值

目的 探讨泌尿生殖瘘的多层螺旋CT尿路成像(multi-slice spiral CT urography,MSCTU)表现.资料与方法 搜集4例经手术证实泌尿生殖瘘病人的临床及影像资料,详细分析其MSCTU特征.结果 4例泌尿阴道瘘均表现为阴道不同程度扩张,其内充满水样密度影.3例膀胱阴道瘘表现为膀胱与阴道间存在窦道性交通,对比剂自膀胱流入阴道.MSCTU显示1例输尿管阴道瘘的输尿管内对比剂注入阴道.结论 MSCTU是目前诊断泌尿生殖瘘的最佳手段,可为制定手术计划提供更多的信息.     

Magnetic resonance imaging for diagnosis and follow-up of genitourinary, pelvic, and perineal rhabdomyosarcoma.

Magnetic resonance (MR) imaging, ultrasound, and computed tomography (CT) were performed for diagnosis and follow-up of rhabdomyosarcoma (RMS) arising from the genitourinary tract in five children, pelvic musculature in one, and the perineum in three others. MR imaging performed at 1.0 T included the following: spin-density-, T1-, and T2-weighted images in all nine patients; gadopentatate dimeglumine (Gd-DTPA)-enhanced T1-weighted images in five; and short TI inversion recovery (STIR) images in two children. Longitudinal T1-weighted images were of additional help in localizing the primary tumor at diagnosis and detecting local spread. Residual or recurrent disease within the bladder was best detected by spin-density images. Gd-DTPA enhancement improved contrast in two studies, but paramagnetic artifacts obscured intravesical lesions in three other studies. STIR images disclosed pelvic and retroperitoneal lymphadenopathy. MR imaging is recommended as the key method of diagnosis and follow-up of pelvic RMS.     

Magnetic resonance imaging for diagnosis and follow-up of genitourinary,pelvic, and perineal rhabdomyosarcoma

Magnetic resonance (MR) imaging, ultrasound, and computed tomography (CT) were performed for diagnosis and follow-up of rhabdomyosarcoma (RMS) arising from the genitourinary tract in five children, pelvic musculature in one, and the perineum in three others. MR imaging performed at 1.0 T included the following: spin-density-, T1-, and T2-weighted images in all nine patients; gadopentatate dimeglumine (Gd-DTPA)-enhanced T1-weighted images in five; and short TI inversion recovery (STIR) images in two children. Longitudinal T1-weighted images were of additional help in localizing the primary tumor at diagnosis and detecting local spread. Residual or recurrent disease within the bladder was best detected by spin-density images. Gd-DTPA enhancement improved contrast in two studies, but paramagnetic artifacts obscured intravesical lesions in three other studies. STIR images disclosed pelvic and retroperitoneal lymphadenopathy. MR imaging is recommended as the key method of diagnosis and follow-up of pelvic RMS.     

Pelvic lipomatosis: diagnosis and characterization by magnetic resonance imaging

While the number of reported cases of pelvic lipomatosis has been relatively small, this entity's prevalence is probably underestimated. Disease progression can cause hydroureteronephrosis and renal failure, and clinical follow-up is mandated after diagnosis. Diagnosis is based on detection of characteristic findings in conventional radiographs and computed tomographic (CT) images. We report here the magnetic resonance imaging (MRI) features of pelvic lipomatosis in 5 male patients, 2 of whom ultimately required placement of a ureteral stent to alleviate mechanical obstruction. Multiplanar MRI not only allows diagnostic confirmation comparable to that possible with CT but also provides delineation of cephalad displacement of the bladder base, elongation of the bladder neck and posterior urethra, and elevation of the prostate gland. The MR images show characteristic medial and superior displacement of the seminal vesicles and show fatty tissue separating the prostate gland from the rectum. The noninvasive nature and low biological risk of MRI are desirable features, particularly when serial evaluation of pelvic anatomic distortion is necessary.     

儿童扩张的前列腺囊影像学诊断

目的：探讨儿童扩张的前列腺囊影像学特点。方法回顾性分析13例儿童临床诊断为扩张的前列腺囊病例,其中6例行排泄性膀胱尿道造影(VCUG)检查,5例行 MRI 检查,2例行 VCUG 及 MRI 检查。结果8例 VCUG 均在排尿时后尿道后方膀胱后下方见类圆形或长圆形囊腔影,3例囊腔可见管状影与后尿道相通,另5例囊腔影与尿道影重叠,囊腔与后尿道相通管道显示不清。7例 MRI 检查,均在膀胱后方中线区见上下走行长圆形囊状长 T1长 T2信号,穿过前列腺中心。5例囊腔可见条形高信号与后尿道高信号相通,5例发现睾丸炎、附睾炎、阴囊炎,1例发现右肾缺如。结论VCUG 和 MRI 检查是儿童扩张的前列腺囊重要检查方法,两者各有优缺点。