螺旋CT尿路成像在小儿上尿路疾病诊断中的价值

目的 比较螺旋CTN水路成像（CTU）与静脉尿路造影（IVU），磁共振尿路成像（RU）在小儿上尿路疾病检查中的应用，探讨CTU对各种上尿路外科疾病的诊断价值。方法 62例疑上尿路病变儿童均做了CTU检查，31例同时行IVU检查，13例同时行MRU检查作为对照。对上尿路各部位的显影清晰度进行了评分，比较3种检查方法对上尿路各段的显示能力。按病种分类，评价CTU对儿童各种上尿路外科疾病的诊断价值，并与IVU，MRU比较。结果 在尿路形态正常组，CTU和IVU对上尿路各段的显影统计学上差异无显著性意义，且均好于MRU（P＜0．01）。在异常组，CTU对肾盏，肾盂的显示优于IVU和MRU（P＜0．01）；上段输尿管的显影，三者间统计学上差异无显著性意义；中，下段输尿管的显示，CTU，MRU均高于IVU，且统计学上差异有显著性意义（P＜0．01）。CTU对重复肾输尿管畸形，肾发育不良的诊断符合率均为100％。高于IVU和RU;峄上尿路积水的诊断符合率，CTU，MRU均为100％，高于IVU（62．5％）。结论 CTU为诊断小儿上尿路外科疾病提供了确切依据，解决了诊断中的难题，提高了诊断率。如疑有肾发育不良，重复肾输尿管畸，肾输尿管重度损伤等上尿路外科疾病，可首选CTU检查。     

动态静脉尿路造影及MSCT尿路成像联合应用对泌尿系先天性畸形的诊断价值

目的:探讨动态静脉尿路造影(DIVU)及MSCT尿路成像(MSCTU)对泌尿系先天性畸形的诊断价值。方法:46例患者行DIVU检查,对尿路显影不良或需进一步明确诊断的12例再行MSCTU。结果:DIVU及DIVU后MSCTU联合诊断泌尿系先天性畸形46例,其中肾盂输尿管交界处狭窄12例,肾盂与输尿管重复畸形15例,输尿管囊肿7例,腔静脉后输尿管3例,肾融合畸形3例,肾发育不全2例,单侧肾缺如1例,异位肾1例,巨输尿管1例,膀胱憩室1例。结论:DIVU及MSCTU联合应用可明显提高先天性泌尿系畸形的显示率、诊断率。     

动态静脉尿路造影在尿路病变诊断中的临床应用

目的 探讨动态静脉尿路造影(DIVU)对尿路病变诊断价值.方法 随机选择行DIVU检查的110例及同期行传统静脉尿路造影(CIVU)检查的100例疑尿路病变病例进行对比分析,比较2种方法对尿路的显影能力和对尿路病变的诊断价值.结果 DIVU和CIVU对尿路的显影优良率分别为91.8%(101/110)和81.0%(81/100);DIVU和CIVU对尿路病变的诊断符合率分别为95.5%(105/110)和82.0%(82/100).DIVU对尿路的显影能力和对尿路病变的诊断价值明显优于CIVU,2组比较有显著性差异(P<0.05).并且,DIVU组的造影检查时间比CIVU组的明显缩短.结论 DIVU能动态观察全尿路,提高尿路病变诊断的准确率.如疑有尿路畸形、梗阻等病变,可首选DIVU检查.     

MRU及排泄性三维对比增强MRU在上尿路显像中的对比研究

目的对比研究磁共振尿路造影(MRU)及三维对比增强磁共振尿路造影(3D-ceMRU)对上尿路显影能力的差别。资料与方法正常上尿路40侧,中度积水扩张上尿路16侧,重度积水扩张上尿路22侧皆行MRU及3D-ceMRU检查。对肾盏、肾盂及上、中、下段输尿管5个部分的两种扫描方式的图像质量分别进行评分。评分结果进行统计分析。结果正常肾盏及下段输尿管、中度积水扩张的上尿路、重度积水扩张的输尿管的MRU和3D-ceMRU图像质量评分差异无统计学意义(P>0.05);正常肾盂及上、中段输尿管、重度积水扩张的肾盂、肾盏的MRU和3D-ceMRU图像质量评分差异有统计学意义(P≤0.05)。结论 3D-ceMRU能较好地显示正常及轻度扩张的上尿路,而MRU能较好地显示重度积水扩张的上尿路。两种方法均能较好地显示中度积水扩张的上尿路。     

CT尿路造影在泌尿系统疾病的诊断价值

目的：探讨IVU后CT尿路造影（CTU）在诊断泌尿系统疾病及评估IVU不显影肾的肾功能应用价值。方法：对IVU 120min单侧肾不显影或IVU显示泌尿系统形态结构异常，但不能确诊的60例作IVU后CT扫描。结果：CTU对IVU不显影或不能确诊的疾病做出明确诊断；对IVU不显影的梗阻肾的肾功能做出进一步评估。结论：IVU后CT尿路造影把IVU与CT结合为一体，可作为IVU的一种重要补充检查方法，具有重要的临床应用价值。     

延时CT尿路造影对儿童IVU不显影病变的诊断价值

目的:探讨延时尿路CT平扫对儿童IVU不显影病变的诊断价值。方法:2012年6月-2013年5月因泌尿系统病变行IVU检查的单侧或双侧肾脏不显影的31例患儿,行延时120min尿路CT平扫检查,检查结果与手术结果对照。结果:发现肾脏不显影的患儿31例(36侧),肾实质病变16.7%,肾盂病变19.4%,输尿管病变30.6%,反流病变33.3%,IVU/CT结果均与手术病理相符合。延时尿路CT平扫显示肾实质厚度无明显变化2.8%,肾实质变薄66.7%,肾实质菲薄30.6%;肾实质可见较明显强化16.7%,可见强化58.3%,未见明显强化25.0%。结论:延时尿路CT平扫对儿童IVU不显影病变临床诊断及肾功能评估提供依据。     

64层螺旋CT尿路成像与静脉尿路造影对照分析

目的探讨64层螺旋CT尿路成像(CTU)与静脉尿路造影(IVU)对泌尿系病变的应用价值。方法 130例临床疑诊泌尿系病变的患者,先进行IVU,再行64层螺旋CT尿路成像检查,通过工作站进行多种后处理,比较两者结果。结果 IVU诊断正常3例,诊断泌尿系结石95例,其中肾结石50例,输尿管结石44例,膀胱结石1例,输尿管外压病变2例,泌尿系畸形6例,肿瘤7例,感染性病变1例。CTU诊断正常2例,诊断泌尿系结石106例,其中肾结石60例,输尿管结石45例,膀胱结石1例,外压病变4例,泌尿系畸形9例,肿瘤20例,感染性病变17例。对于泌尿系结石、畸形的诊断两种方法无统计学差异(P>0.05),对于泌尿系肿瘤、感染的诊断两者有统计学差异(P<0.05)。结论 64层螺旋CT通过多种后处理方法,既可全景显示泌尿系的形态结构,也可观察局部病变细节,对泌尿系各种疾病的诊断有重要的临床价值;而对于泌尿系单纯结石性梗阻亦可采用IVU。     

64层螺旋CT正常上尿路造影：腹带加压、增加延迟时间及大量饮水对显影的价值

目的:通过比较64层螺旋CT泌尿系统造影,几种方法对正常上尿路显影的效果,探讨最佳显影方法.方法:76例泌尿系统正常者,随机采用以下延迟扫描方法:5M(minute,M)延迟、腹带加压、8M延迟,大量饮水,上尿路分为5段(肾盏,肾盂,近、中、远段输尿管),对每段显影程度予以评分,采用SPSS11.0统计软件行方差分析.结果:①各组对肾盂显影评分无显著差异;②腹带加压对近段输尿管显影显著优于5M组.8M组对输尿管的显影显著优于5M,对中段输尿管的显影显著优于腹带加压.大量饮水对肾盏、输尿管的显影显著优于5M,对肾盏显著优于腹带加压.但8M组与大量饮水的差异无显著性.结论:腹带加压对上尿路显影效果有限,且禁忌症较多不宜使用.8M及大量饮水显影效果较好、简单易行,尤其是增加延迟时间较为安全宜推广应用.     

输尿管结石在静脉尿路造影术中的表现

目的 :探讨输尿管结石的静脉尿路造影 (IVU)表现。方法 :回顾性分析 65例输尿管结石 (直径 <10mm)患者的临床和IVU表现。结果 :所有病例均经治疗或输尿管镜取石证实。结石 5 .1～ 10mm者 3 4例 ;≤ 5mm者 3 1例 ,结石易停留在输尿管生理狭窄部位 ,多为卵圆形。结石近侧输尿管轻度扩张者 5 9例 ,肾盂肾盏扩张积水者 3 9例。结论 :IVU结合平片能很好地显示尿路的形态 ,具有易于发现结石、定位准确等优点 ,在尿路结石检查中仍占主导地位     

肾盏结石在静脉尿路造影中的表现

目的：探讨肾盏结石的静脉尿路造影（IVU）表现。方法：回顾性分析60例肾盏结石（直径≤10mm）患者的临床和IVU表现。结果：所有病例均经药物治疗或体外震波碎石证实，结石易停留在肾盏的生理狭窄部，多为圆锥状。造影剂排空延迟51例，肾盏不规则变形38倒，肾盏积水扩张30例。结论：IVU结合平片能很好的显示肾盂肾盏形态，具有易于发现结石，定位准确等优点，在肾结石检查中占主导地位。     

静脉尿路造影联合CT平扫对上尿路病变的诊断价值

目的评价静脉尿路造影(IVU)后的螺旋CT平扫(IVU+CT)对上尿路疾病的诊断价值。资料与方法195例患者因临床怀疑上尿路疾病、超声(US)未能确诊而行IVU检查,从中实时选出IVU不能作明确诊断的患者作为研究对象,共71例。其中65例行立即或延迟腹部CT平扫,将原始资料传递至影像工作站做后处理,获得多平面重组(MPR)、最大密度投影(MIP)、曲面重组(CPR)和容积再现(VR)图像。比较IVU+CT与单纯IVU对上尿路病变的诊断能力。结果IVU+CT诊断正确62例,诊断符合率达95.4%。同期IVU检查的195例中确诊者124例(63.6%),两者有统计学意义(χ2=29.4,P<0.05)。IVU+CT对上尿路结石的敏感性、特异性分别为97.6%、91.3%,对上尿路病变定性诊断的敏感性、特异性分别为95.2%、100%;与此相对应,IVU的结果分别为59.0%、89.7%、70.8%和43.1%。结论IVU+CT对上尿路病变的定位、定性诊断能提供更多的诊断信息,且相对省时省力,是对IVU的重要补充。     

Feasibility of MR urography in neonates and infants with anomalies of the upper urinary tract

The aim of this study was to evaluate the feasibility and diagnostic potential of dynamic MR urography (MRU) in neonates and infants with sonographically detected abnormalities of the upper urinary tract. Thirty infants (age range 5 days to 3 years, mean age 7.9 months; male:female: 22:8) underwent MRU using T2 and contrast-enhanced dynamic T1-weighted sequences. The results were compared with the findings of ultrasound ( n=30), intravenous urography (IVU, n=19) and/or scintigraphy ( n=25) based on the criteria suggestive of obstructive uropathy. Oral sedation was sufficient to perform MRU with diagnostic quality in 20 of 21 patients younger than 1 year; 9 older patients needed intravenous sedation. Diagnosis of the 66 renal units (58 kidneys, 29 successful examinations) included normal systems (contralateral units), duplex systems, vesico-ureteral reflux, obstructive megaureter, ureteropelvic junction obstruction and accompanying renal parenchymal disease, with complex pathology in 10 patients. Magnetic resonance urography demonstrated anatomy better than IVU, particularly the renal parenchyma, (ectopic) ureters, and poorly functioning dilated systems. Magnetic resonance urography was superior to US in showing ureteral pathology. Tiny cysts in dysplastic kidneys were better seen by US. Gadolinium-enhanced dynamic MRU allowed accurate assessment of obstruction applying IVU criteria. Here MRU matched IVU results, and most of the scintigraphic findings. Magnetic resonance urography can be performed in young infants with diagnostic quality using oral sedation. Magnetic resonance urography correctly depicts anatomy and allows assessment of the urinary tract better than US and IVU, with additional functional information. Magnetic resonance urography thus has the potential to replace IVU for many indications.     

Ultrasound as an alternative to intravenous urography in prostatism

Seventy-five patients, with uncomplicated benign prostatic hypertrophy referred for pre-prostatectomy assessment, were studied to determine whether renal tract ultrasound combined with plain films of kidney, ureters and bladder could provide an acceptable alternative to intravenous urography (IVU). All patients had both IVU and ultrasound. Bladder residual urine volumes were calculated by ultrasound measurements. Fifty-nine (78%) patients had normal IVU and ultrasound. Twelve (16%) had both abnormal IVU and abnormal ultrasound. Four (6%) had positive findings on one examination not detected on the other: two of these occurred with ultrasound and two with IVU. Measurement of residual volume of urine in the bladder by ultrasound and IVU is discussed. The combination of ultrasound and a plain radiograph of the urinary tract provides more information and should replace IVU in the preoperative assessment of patients with uncomplicated benign hypertrophy of the prostate.     

Multi-detector row CT urography: comparison of strategies for depicting the normal urinary collecting system

PURPOSE: To evaluate several protocols for depiction of the urinary collecting system with multi-detector row computed tomographic (CT) urography. MATERIALS AND METHODS: Fifty-one patients with hematuria or a suspicious renal mass underwent CT urography, during which thinly collimated (1-mm) pyelographic phase scanning was performed 8-10 minutes after contrast medium administration. Patients were examined while prone only (n = 17) and while both prone and supine (n = 17) after a 250-mL infusion of normal saline. Each collecting system and ureter was divided into six segments that were assigned opacification scores. All acquisition techniques were compared, and the highest-scoring technique was compared with that in 17 patients who underwent conventional intravenous urography (IVU). Three reconstruction techniques (transverse, coronal, and maximal intensity projection) were also compared. Stratified analysis was performed with the paired two-tailed Student t test to compare opacification scores for both the acquisition techniques and display methods, both individually and in all possible combinations. RESULTS: CT urography with supplemental saline administration, performed with the patient prone or supine, significantly improved mean opacification scores in the distal ureters (right, P =.004; left, P =.006). With this technique, CT urography produced a mean opacification score that was not significantly different from that with IVU in 11 of 12 segments and was significantly better than that with IVU in one of 12 segments (lower left ureter). Mean opacification scores obtained with transverse or coronal displays were equal to or higher than those obtained with maximum intensity projection reconstructions in all segments. CONCLUSION: CT urography with a multi-detector row scanner and supplemental infusion of normal saline reliably displays the opacified urinary collecting system.     

MRU在小儿泌尿道畸形疑难病例诊断中的应用

目的：探讨ＭＲＵ在小儿泌尿道畸形疑难病例诊断中的应用。材料和方法：用重Ｔ２加权ＦＳＥ序列,脂肪抑制技术对１７例４天￣１４岁、ＩＶＵ未显影或（和）ＩＶＵ,ＵＳ诊断不明的病例作ＭＲＵ检查。结果：（１）能作定性诊断的疑难病例９例,包括：多囊性发育不育肾、少见类型的异位输尿管囊肿以及重度积水的巨输尿管各２例;马蹄肾并发输尿管结石与积水、特大型先天性膀胱Ｈｕｃｈ憩室以及脐尿管囊肿各１例。（２）能定位并有肾脏多囊性疾病等鉴别清楚、满足手术需要者５例,皆为盂管交界部梗阻。（３）显示两侧重度尿路积水、提示需作其他相应检查以确定病因者３例,包括：后尿道瓣膜２例,神经原性膀胱１例。结论：ＭＲＵ是无创性确诊小儿泌尿道畸形疑难病例的理想手段,必须强调在全面对比分析ＭＩＰ图像、原始图像、Ｔ２加权轴位像以及在监视器荧屏上三维旋转时的所见后     

低场强MR泌尿系水成像对尿路梗阻性疾病的诊断价值

目的:评价低场强磁共振泌尿系水成像(MRU)对尿路梗阻性疾病的诊断价值。方法:对60例尿路梗阻性疾病患者行MRU及常规MR检查,并与B超I、VU及CT检查结果进行比较。其中输尿管癌12例,输尿管结石19例,输尿管炎性狭窄9例,肾盂输尿管连接部梗阻4例,输尿管先天畸形6例,盆腔肿瘤外压性输尿管狭窄9例,神经源性膀胱1例。结果:MRU能清晰显示尿路梗阻部位,定位诊断符合率100%,结合常规MR定性诊断符合率86.7%,优于B超、IVU及CT检查。结论:MRU结合常规MR对尿路梗阻性疾病具有较高的诊断价值,对儿童、老年人、妊娠妇女及IVU禁忌者可作为首选方法。     

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.     

Compression CT urography: a comparison with IVU in the opacification of the collecting system and ureters

OBJECTIVE: The purpose of this study was to evaluate opacification of the collecting system and ureters using compression computed tomography (CT) urography compared with conventional intravenous urography (IVU). MATERIALS AND METHODS: Fifty consecutive patients underwent compression CT urography as part of a dedicated renal CT. A compression belt was applied prior to nephrographic phase imaging. Excretory phase scans were acquired through the kidneys 3 minutes post injection with the compression belt in place. The compression belt was then released, and scans were obtained through the ureters. Three independent readers then scored opacification of the collecting system and ureters on a scale of 0-2 (0 = no opacification, 1 = partial opacification, 2 = full opacification and distension). Fifty consecutive nonmatched IVUs were scored by segment by the same readers. Comparison of the two modalities was made using the Mann-Whitney U test. Interobserver agreement was assessed by the Kappa coefficient. RESULTS: CT demonstrated significantly better opacification (p < or = 0.02) of the upper and lower pole pelvicalyceal systems and midureters bilaterally. There was no difference in opacification of the proximal and distal ureters by CT compared with IVU. The Kappa coefficient was 0.53. CONCLUSIONS: Compression CT urography yields equal or better opacification of the collecting system and ureters when compared with IVU, and shows promise for the routine evaluation of the renal excretory system.     

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。