MSCT联合CTU在肾尿路梗阻的诊断价值

影像学检查在泌尿系梗阻性疾病的诊断和鉴别诊断中占有重要的地位[1],静脉肾盂造影(IVP)可以较清晰的显示梗阻的部位及程度,评价肾脏的层泄功能。MSCT在该疾病的诊断中所发挥的作用越来越大,为临床工作提供了大量实用的信息。在静脉注射对比剂后,经延迟扫描和后处理,可以得到CT尿路成像(CTU)图像[2]。本文通过比较MSCT     

Percutaneous upper urinary tract dynamics in equivocal obstruction

Percutaneous pressure flow studies in the upper urinary tract remain the definitive method of distinguishing stasis from obstruction. They are not technically difficult and the results of 2 large series show minimal, minor complication rates. The results in over 200 studies show that a clear-cut answer as to whether or not an obstruction is present is obtained in over 95% of patients, the remainder showing pressures in an equivocal range.     

Contemporary concepts for imaging urinary tract obstruction

Ultrasound is an integral tool in the contemporary assessment of urinary tract obstruction. Pulsed and color Doppler have eliminated many previous false-positives due to blood vessels or non-obstructive hydronephrosis. Limitations of the ultrasound technique still exist and on occasion necessitate the utilization of intravenous urography.     

输尿管镜治疗急性上尿路梗阻性肾功能衰竭临床研究

目的探讨输尿管镜治疗急性上尿路梗阻性肾功能衰竭的安全性及有效性。方法回顾性分析2009年4月至2016年3月解放军281医院收治的急性上尿路梗阻性肾功能衰竭的45例患者的临床资料。本组患者均采用输尿管镜进行治疗,观察治疗效果。结果 44例患者顺利完成手术,1例因输尿管穿孔转为开放手术。所有患者术后肾功恢复正常或接近正常。结论输尿管镜技术治疗急性上尿路梗阻性肾功能衰竭操作简单、创伤小,具有很强的实用性及可操作性,治疗效果满意。     

Decompression of acute urinary tract obstruction by extravasation into a large simple renal cyst

We report a case of pelvocaliceal decompression by extravasation into a preexisting simple renal cyst. This is a rare complication of acute urinary obstruction. The findings and the prognostic implications are discussed.     

Decompression of acute urinary tract obstruction by extravasation into a large simple renal cyst

We report a case of pelvocaliceal decompression by extravasation into a preexisting simple renal cyst. This is a rare complication of acute urinary obstruction. The findings and the prognostic implications are discussed.     

Tc-99m DMSA renal scan in first-time versus recurrent urinary tract infection-yield and patterns of abnormalities

PURPOSE: To determine the yield and patterns of abnormalities noted by Tc-99m DMSA renal imaging in cases of first-time versus recurrent urinary tract infections (UTIs) in children. MATERIALS AND METHODS: We reviewed 101 Tc-99m DMSA studies performed for 52 first-time and 49 recurrent UTIs in 99 children during a period of 1 year. The average age of the patients was 4.4 years, and the female:male ratio was 7:1. Static images of the kidneys were acquired 2 hours after injection of Tc-99m DMSA in anterior, posterior, and right and left posterior oblique views. SPECT was performed in 9% of the cases. The studies were scored as normal or abnormal. RESULTS: The yield of abnormal scans in first-time UTIs was 22 (42%) and in recurrent UTI 27 (55%). Three categories of abnormalities were noted: 1) renal cortical defects (55% of the abnormal scans in first-time UTIs and 59% of the abnormal scans in recurrent UTIs; P = 0.40); 2) dilated pelvicalyceal system (27% of the abnormal studies in first-time UTIs and 63% of the abnormal studies in recurrent UTIs; P < 0.01); and 3) renal swelling showing disproportionate function with size (41% of the abnormal scans in first-time UTIs and 22% of the abnormal scans in recurrent UTIs; P = 0.21). CONCLUSIONS: The high yield of renal abnormalities by Tc-99m DMSA scanning emphasizes the importance of testing all cases of UTI, including patients with a first-time infection. Documentation of the pattern of abnormalities may help in planning for subsequent management of UTIs in these patients.     

磁共振尿路造影在临床泌尿道梗阻中的诊断价值

目的：评估磁共振尿路造影在临床泌尿道梗阻中的诊断价值。方法：回顾性对61例例泌尿系统梗阻患者的的MRU检查所见与手术和病理结果对照分析。结果：61例泌尿系梗阻患者，输尿管癌7例，输尿管结石8例，下腔静脉后输尿管1例，输尿管良性狭窄11例，先天性输尿管狭窄27例，膀胱癌侵及输尿管4例，泌尿系改道手术后再次发生良性梗阻患者3例，所有病例MRU均确定梗阻水平并且清晰显示梗阻端形态和特征。结论：NMR是一种安全、可靠、无创的检查方法，尤对IVU不显影或仅显示扩张的肾盏、肾孟影的重度肾积水病例或对比剂过敏的患者更有诊断价值。     

急性梗阻性自发性尿外渗的CT诊断(附3例报道)

目的：探讨梗阻性自发性尿外渗的CT表现以及在临床诊断中的重要意义。方法：搜集3例急腹症患者,经临床初步诊断泌尿系梗阻或伴有肠梗阻,并行CT检查。结果：3例患者均显示患侧肾脏体积明显增大,皮质较对侧肿胀,除了肾盂、肾盏或输尿管扩张外,伴有肾周间隙、输尿管周围不规则液体密度影,增强扫描可见对比剂渗入腹腔内。结论：CT检查对急性梗阻性自发性尿外渗诊断和鉴别具有重要意义。     

Volume expanded diuretic renography in the postnatal assessment of suspected uretero-pelvic junction obstruction.

Controversy surrounds the role of 99mTc-diethylenetriamine pentaacetic acid renography in suspected uretero-pelvic junction obstruction in early life. Accordingly, we retrospectively reviewed 18 patients (28 hydronephrotic kidneys) with a mean age of 2 mo (range: 1 wk-6 mo) who underwent a total of 36 scans using intravenous volume expansion (10 ml/kg) and furosemide diuresis (1 mg/kg). Initial scans were classified as obstructed, not obstructed or indeterminate using differential renal function, furosemide washout T 1/2 and visual assessment of tracer clearance. Those initially classified as obstructed (n = 8) have been surgically confirmed. In the indeterminate (n = 6) and nonobstructed (n = 14) groups, three and two kidneys, respectively, developed obstruction on progress scans. Mean follow-up in the nonsurgical patients was approximately 9 mo (range: 4-17 mo). A total of 13 kidneys had developed obstruction by renographic criteria, and to date 12 have surgical confirmation. Our data indicate that: (1) scans classified as obstructed correlate well with surgery; (2) an initial classification of indeterminate or nonobstructed does not exclude later development of obstruction; and (3) serial scans correctly stratify children with possible uretero-pelvic junction obstruction.     

Multi-slice computed tomography urography after diuretic injection in children with urinary tract dilatation

PURPOSE: To evaluate the potential use of multi-slice computed tomography urography (MSCTU) after diuretic injection in children with urinary tract dilatation. MATERIAL AND METHODS: MSCTU was performed in 19 patients (11 boys, 8 girls, mean age 5.4 years) with suspicion of urinary tract obstruction and dilatation. Furosemide, 1 mg/kg, was injected 3 min before contrast material administration and followed by a bolus of 30 ml of physiologic saline solution immediately after application of contrast material. Excretory-phase images were obtained through the abdomen and pelvis beginning 10 min after initiation of the injection of contrast material. Maximum intensity projection (MIP) and volume rendering (VR) images were post-processed to obtain urographic views. RESULTS: MSCTU revealed pathology in 16 of 19 patients, while 3 patients had normal findings. Ureteropelvic obstruction was found in 4 patients, obstructive megaureter in 8. Both ureteropelvic obstruction and obstructive megaureter were disclosed in 1 patient, partial ureteral duplication in 1 patient, and both complete ureteral duplication and ureterocele in 2 patients. In all patients, MIP and VR images could satisfactorily show the pathologies of the urinary tract. The estimated effective average doses of MSCTU were higher than IVU. CONCLUSION: Preliminary results of furosemide-enhanced MSCTU demonstrated consistently dilated urinary tracts, obstruction levels, and underlying pathologies better than US and IVU.     

Pitfalls in the ultrasound diagnosis of upper urinary tract obstruction

Evaluation for possible obstruction of the upper urinary tract with ultrasound can be complicated by pitfalls. Representative examples of pitfalls are reviewed and illustrated in this essay. Since both overdiagnosis and underdiagnosis of urinary obstruction can lead to grave consequences, one must be aware of these pitfalls when performing and interpreting renal ultrasound studies.     

MR pyelography and conventional MR imaging in urinary tract obstruction

PURPOSE: To evaluate the possible role of MR imaging in the assessment of patients with urinary tract obstruction by combining conventional MR imaging and MR pyelography (MRP). MATERIAL AND METHODS: Forty-three patients with dilated upper urinary tract were studied with a high gradient strength 0.5 T magnet. Respiratory compensated T1-weighted, SE and T2-weighted TSE sequences were acquired in all patients. MRP images were obtained by using a respiratory compensated 3D T2-weighted TSE sequence. MRP images were reconstructed with a MIP algorithm. In all cases, urography and/or ascending pyelography were also performed. Images were independently evaluated by two radiologists. RESULTS: The dilated tract ureter and the level of the obstruction could be correctly demonstrated in all cases. The cause of the obstruction was correctly demonstrated by examiner 1 in 90% and by examiner 2 in 88%. The interobserver agreement was high with a kappa-value of 0.96. CONCLUSION: In cases of obstructive hydroureteronephrosis MR imaging, combining MRP and conventional sequences, can be proposed as an accurate technique in the assessment of level and cause of obstruction.