肾动态显像分次处理法定量评价肾脏局部功能

目的 :明确正常情况下及不同肾脏疾病时 ,肾脏各部分对 99m　Tc DTPA浓聚及清除速度的差别与特点 ,以定量评价肾脏各部分的局部功能状态。方法 :对 18例正常对照、74例不同肾病患者进行了肾动态显像 ,并应用常规肾动态处理软件及ROI技术分别对全肾、肾皮质、肾盂肾盏作了定量分析 ,获得肾脏各部分的Tb、C1/2及 2 0min残留率。结果 :在无肾脏疾病的正常对照组 ,全肾与肾皮质、肾盂肾盏部分之间的定量分析指标均无明显差别 ,在疾病组 ,肾脏各部分的指标则有不同程度的改变 ,尤其是在糖尿病、慢性肾炎及肾盂肾炎的患侧肾差异更明显 ,表现为肾盂肾盏部分的Tb延长。全肾、肾皮质和肾盂肾盏的Tb均值在糖尿病分别为 5 .8min、4.5min和 6.8min(P <0 .0 1) ;慢性肾炎为 7.9min、6.3min和 9.1min(P <0 .0 5 ) ;肾盂肾炎为 6.0min、4.0min和 7.6min(P <0 .0 5 ) ;在高血压病患者三者无显著差异。而在 13例有上尿路排泄不畅的患者 ,三种处理方法时 ,Tb、C1/2及 2 0min残留率均有差异 (P <0 .0 5～ 0 .0 0 1)。结论 :定量评价肾脏各部分的功能对于正确反映和认识肾功能受损程度及其部位有参考价值 ,尤其适用于尿路排泄不畅患者的肾功能估计     

An unusual vascular impression on the renal pelvis

In a female patient who presented with the complaint of dysuria, angiography was required to distinguish a vascular impression on the renal pelvis from a possible tumor or calculus. Neither intravenous urography nor retrograde pyelogram clarified the smooth filling defect sufficiently to rule out the possibility of a urothelial tumor.     

An unusual vascular impression on the renal pelvis

In a female patient who presented with the complaint of dysuria, angiography was required to distinguish a vascular impression on the renal pelvis from a possible tumor or calculus. Neither intravenous urography nor retrograde pyelogram clarified the smooth filling defect sufficiently to rule out the possibility of a urothelial tumor.     

肾结核的多层螺旋CT动态增强影像特征

目的分析肾结核多层螺旋CT动态增强的影像表现,并提高其诊断水平。方法 20例肾结核(累及双肾10例)患者均经多层螺旋CT平扫及3期增强扫描(皮质期、实质期、肾盂期)。结果在20例的30个病肾中,肾实质密度不均匀29个肾,不同形态钙化15个肾,集合系统不成比例扩张积液14个肾,呈"花瓣"状排列10个肾,合并输尿管上段管壁增厚5个肾,对侧肾积水3个肾,肾脏形态改变28个肾,肾皮质变薄26个肾。3期动态增强扫描显示皮质期及实质期强化程度减低密度不均匀15个肾,肾盂、肾盏、脓腔壁环状强化10个肾。肾盂期,9个肾无造影剂进入集合系统及脓腔,6个肾造影剂进入肾盂、肾盏、脓腔。结论肾结核多层螺旋CT的影像表现多种多样,多层螺旋CT能很好地显示结核病变部位、范围及双肾功能情况,可为临床准确诊断提供重要依据。     

Percutaneous removal of renal caliceal calculi: An alternative approach

An alternative method is presented for the removal of caliceal calculi refractory to standard techniques. The involved calyx is punctured directly and dilatation performed to the stone without negotiating a wire into the renal pelvis. The stone is then removed under direct vision. This technique has been successfully used in 3 patients without complication.     

Obliterative pyelitis

A patient with severe undiagnosed and untreated pyelitis developed mural masses in the renal pelvis and in the infundibulum of the upper pole calyx. The masses were presumed to be inflammatory. The patient developed a severe stricture of the renal pelvis and complete occlusion of the upper pole calyx. This is an example of obliterative pyelitis, as described in the era before antibiotics were available.     

Obliterative pyelitis

A patient with severe undiagnosed and untreated pyelitis developed mural masses in the renal pelvis and in the infundibulum of the upper pole calyx. The masses were presumed to be inflammatory. The patient developed a severe stricture of the renal pelvis and complete occlusion of the upper pole calyx. This is an example of obliterative pyelitis, as described in the era before antibiotics were available.     

肾盂内翻性乳头状瘤（附10例报告）

目的：探讨罕见的肾盂内翻性乳头状瘤的诊断治疗。方法：结合10例肾盂内翻性乳头状瘤复习国外文献，对诊断及治疗原则进行讨论。结果：肾盂内翻性乳头状瘤多以血尿就诊，IVU检查肾盂充盈缺损，CT片示肾盏占位性病变。3例行内窥镜检查见有蒂灰色实性团块，病理诊断为内翻性乳头状瘤，7例行肾，输尿管，膀胱部分切除，3例内窥镜下局部切除，电灼术，随访三年无变化。结论：此属良性病变可能与长期慢性炎症刺激以及对化学性致癌物质敏感不同导致，虽为良性，但易同时或异时并发泌尿系恶性肿瘤，治疗以内窥镜治疗首选，术后随访十分重要。     

Hydrocalyx presenting as lumbar pain. A case report and review of the literature

Hydrocalyx is an obstructed renal calyx from infundibulo-pelvic diminution or stenosis which leads to dilatation of the calyx. It becomes clinically important when associated with flank pains, haematuria, infection, renal impairment or stone formation. On intravenous urography the finding of a cystic dilatation of a calyx that communicates with the renal pelvis supports the diagnosis. This case is A 50-year-old man with recurrent flank pains who was diagnosed with left hydrocalyx on a Computed Tomography Urography (CT Urography). He opted for conservative management. Management of hydrocalyx can be conservative for patients without significant renal damage or symptoms and surgical with nephron sparing intent for those who have severe symptoms and complications.     

肾结核的CT诊断（附32例报告）

目的探讨肾结核CT表现及其鉴别诊断。方法经手术病理证实的32例肾结核患者均经CT平扫与对比增强扫描,对其CT表现进行了回顾性分析。结果肾髓质单发或多发囊腔23例（71.9%）,常呈囊状低密度影并围绕肾盂似＂花瓣＂样排列;肾盏、肾盂、输尿管壁不规则增厚23例（71.9%）,伴管腔狭窄或扩张;各种钙化16例（50%）,以及肾脏体积增大17例（53.1%）或缩小5例（15.6%）,肾外形分叶伴积水20例（62.5%）及肾功减退17例（53.1%）,以及自截肾1例（3.13%）。结论肾结核在CT平扫和增强扫描像上具有较特征性的CT表现,对肾结核的诊断具有很重要的价值。     

Evaluation of spontaneous renal extravasation of contrast media in the excretory urogram

Spontaneous renal extravasation is the term used to refer to the radiological demonstration of contrast medium outside the collecting system without previous trauma, ureter catheterization, operation on the kidney or its vicinity, and without external compression during urography. In a review of 1300 intravenous urograms, 13 cases of extravasation of contrast medium were found to satisfy the above criteria. Differences in the radiological appearance may cause problems with regard to evaluation and classification. From a therapeutic point of view it is important to distinguish between two forms: transient sinus extravasation due to minute tears in the calyceal fornix after an increase in intrapelvic pressure and persisting rupture of the previously impaired renal pelvis, which may require surgical intervention.     

Computed tomography of renal tuberculosis and its pathological correlates

Computed tomographic studies of eight patients with proven renal tuberculosis demonstrated a spectrum of findings related to the extent and the severity of kidney involvement. In early or focal disease, obstruction of a single major calyx or a group of minor calyces was noted (four cases) with no excretion of contrast material into the affected calyces (three cases) and cortical thinning. Tuberculosis of the renal pelvis (five cases) was manifested by either pelvic dilatation secondary to ureteropelvic junction obstruction (three patients) or diffuse pelvic contraction (two patients). In far advanced disease (four cases) the kidneys were small and exhibited atrophy with replacement of parenchyma by one or more low density areas. Calcifications (37.5%) were identified in the parenchyma and within the calyces. Computed tomography may provide the first clue in suggesting the inflammatory nature of a renal mass and excluding a neoplastic process. Computed tomography is also of value in determining the full extent of extrarenal involvement and the amount of residual functioning parenchyma, both of which are critical in proper treatment planning.     

Doppler-duplex ultrasound in renal colic

Objective: To determine the role of intrarenal Doppler ultrasound (US) in patients with renal colic and to establish the usefulness of this diagnostic method. Materials and methods: In 121 patients with renal colic and 70 healthy individuals, 382 kidneys were examined with color duplex US. Mean intrarenal-arterial resistive index (RI), and the difference of mean RIs (dRI) between both kidneys were determined. In 64 patients, RI and dRI were compared with urographic findings (time of delay pyelogram between both kidneys). Results: In the 70 healthy individuals, RI was 0.62 ± 0.045 and dRI 0.018 ± 0.01. In the 121 patients with renal colic, RI (0.71 ± 0.06) was significantly superior (P < 0.001) with respect to the opposite kidney, with a dRI of 0.09 ± 0.055. In a correlation performed in 64 patients with urographic findings among color doppler US, with a RI ≥ 0.70 and/or dRI ≥ 0.06 as an indicative value of obstruction, sensitivity and specifity were 91.8% for patients with delayed pyelogram (n = 37 patients), and 48.1% for patients with nondelayed pyelogram (n = 27 patients) with a specificity of 92.8% with respect to the group of normal patients. In the group of patients with delayed pyelogram, RI was significantly superior (P < 0.05) in patients with an evolution time greater than 24 hours, in patients with proximal ureteral obstruction and in patients who had signs of pyelonephritis. There were no significant differences in the group of patients with nondelayed pyelograms. Conclusion: Color Doppler US is useful to fundamentally evaluate the consequences of the obstruction on renal function. Other factors such as evolution time of the symptomology, obstruction level, or existence of pyelonephritis can alter the US-Doppler values.     

彩色多普勒超声对预测胎儿肾盂分离转归的应用价值

目的应用彩色多普勒超声动态观察胎儿肾盂分离状态,为预测胎儿肾盂分离的转归、避免不必要的终止妊娠、及早治疗泌尿系统先天畸形,提供有价值的信息。方法选择2008年10月—2010年1月在我院就诊的单胎孕妇,符合纳入排除标准者,首次超声提示胎儿肾盂分离[采用Stocks等[1]标准,孕33周以前肾盂前后径(APD)≥4 mm,孕33周以后APD≥7 mm作为肾盂分离的标准]共119例。从首次发现胎儿肾盂分离开始,孕妇每隔4周进行1次超声检查复查;出生后1年内,每月复查1次超声,观察胎儿的转归。将所有数据录入计算机,用SPSS11.5软件处理。结果 (1)可复组与不可复组胎儿肾脏APD值差异有统计学意义。(2)通过绘制受试者工作特征曲线(ROC曲线),得出对于妊娠≥33周孕妇预测其胎儿肾盂分离转归有意义的APD界值为15.5 mm。结论 APD值≥15.5 mm时,发展为不可复性肾积水的可能性大。     

B-scan ultrasound in the evaluation of renal failure.

Twenty-three patients with blood urea nitrogen (BUN) over 70 and thought clinically to be in renal failure were examined by ultrasound. A correct diagnosis of kidney size and the presence or absence of hydronephrosis or polycystic kidney was made in all but one instance. One kidney in a patient with end-stage renal failure was not seen ultrasonically but was subsequently demonstrated on a retrograde pyelogram. In 10 patients, excretory urography (on 4 occasions with tomography) failed to demonstrate the kidneys adequately. It is suggested that ultrasound should either be the first or second imaging technique in the investigation of patients who present in renal failure of unknown cause.     

肾盂癌19例CT诊断临床分析

目的探讨CT检查对肾盂癌的诊断价值。方法回顾性分析经CT检查及手术病理证实的19例肾盂癌患者的CT表现和临床资料。结果根据CT表现分为肾盂内肿块型10例,肿块浸润型6例,肾盂壁厚型3例;CT分期为Ⅰ～Ⅱ期8例,Ⅲ期7例,Ⅳ期4例。结论 CT检查在肾盂癌的诊断及鉴别诊断中有一定的价值,是诊断肾盂癌的主要检查方法。     

Transitional cell carcinoma of the kidney

Transitional cell carcinoma is an uncommon disease of the renal pelvis, the diagnosis of which depends largely upon radiological investigation. Thirty-eight such tumours in 37 patients have been reviewed to establish the examination of choice. High-dose excretion urography, tailored to the presenting problems, is the primary investigation and the results fall into five main groups. Each presents different differential diagnostic problems. Discrete filling defects within the pyelogram (group I) may be overlooked, but, when seen, can be diagnosed on urography alone. Filling defects with dilated calyces (group II) are easily seen and readily diagnosed. Calyceal obliteration (group III) presents more difficulty in diagnosis and may require retrograde pyelography and selective renal angiography. Hydronephrosis with renal enlargement (group IV) is easily confused with uncomplicated primary pelvic hydronephrosis and will usually require antegrade pyelography for diagnosis. Reduced function without renal enlargement (group V) cannot be diagnosed on excretion urography and requires both retrograde pyeloureterography and selective renal angiography.     

肾盂移行上皮细胞癌影像诊断价值比较研究

目的：探讨4种检查方法在肾盂移行上皮细胞癌诊断中的价值。方法：对经手术病理证实的32例肾盂移行上皮细胞癌,术前经IVP、超声、MRI、螺旋CT检查,分析其敏感性。结果：静脉肾盂造影21例中直接诊断肾盂移行上皮细胞癌8例,可疑肾盂移行上皮细胞癌3例,占52.4%。超声检查20例中直接诊断肾盂移行上皮细胞癌8例,发现肾窦分离提示肾盂移行上皮细胞癌可能5例,占65.0%。MRI检查21例中直接诊断肾盂移行上皮细胞癌13例,提示肾盂移行上皮细胞癌可能5例,占85.7%。螺旋CT检查28例中直接诊断肾盂移行上皮细胞癌19例,提示肾盂移行上皮细胞癌可能6例,占89.3%。增强19例中11例轻度不均匀强化,6例均匀强化,2例无明显强化。结论：肾盂移行上皮细胞癌的生长位置主要影响静脉肾盂造影的诊断,肿瘤的生长方式是主要影响超声的诊断。无论在肾盂移行上皮细胞癌癌灶的发现还是定性方面,螺旋CT和MRI的敏感性和诊断价值优于超声和静脉肾盂造影,CT与MRI无明显差异。     

The importance of renal localization with MIBG scintigraphy

Although I-123 metaiodobenzylguanidine (MIBG) imaging is a well-validated technique for identification and evaluation of a pheochromocytoma, accurate interpretation can be confounded by tracer retention within the renal pelvis. The authors report two cases of abnormal MIBG accumulation in which renal localization was essential. In the first case, renal localization revealed uptake inferomedial to the left kidney in what was proved to be an extra-adrenal paraganglioma. In the second case, MIBG uptake in a similar location on the right was caused by uptake in the renal pelvis, a physiologic finding. When the location of MIBG uptake in the upper abdomen is uncertain, a renal scan should be obtained to exclude the possibility of radiolabeled MIBG tracer retention within the collecting system, a potential false-positive diagnosis of pheochromocytoma.