螺旋CT诊断输尿管结石的应用价值(附25例报告)

目的　探讨螺旋CT对输尿管结石的诊断价值。　方法　对 2 5例临床表现急性腰腹痛、镜下血尿 ,可疑输尿管结石 ,B超、KUB、IVU未显示结石的患者 ,行螺旋CT检查 ,将获得的容积图像三维立体重建成像处理。　结果　 2 4例螺旋CT图像显示出输尿管结石 ,确诊率 96 %。 3例CT三维立体成像显示结石引起肾盂、输尿管扩张及结石周围组织水肿等继发性变化。　结论　螺旋CT诊断输尿管结石安全、快捷、准确     

多层螺旋CT三维重建成像技术在输尿管梗阻诊断的价值

目的:探讨多层螺旋CT三维重建成像技术对输尿管梗阻诊断的临床价值。方法:回顾性分析临床输尿管梗阻病变30例临床资料,所有病例均行螺旋CT增强扫描。扫描图像减薄,层厚2.5mm,层间距2.5mm。所有数据传入工作站进行三维重建,并对重建后输尿管图像与CT轴位平扫图像及X线平片对比分析。结果:三维重建泌尿系图像清晰显示输尿管空间结构。结论:多层螺旋CT三维重建技术获得的图像能以最优形式清晰、立体地显示输尿管解剖结构及空间位置关系,对诊断输尿管梗阻原因具有重要价值。     

多层螺旋CT在肾盂癌诊断中的价值

目的:探讨多层螺旋CT在肾孟癌的诊断和鉴别诊断中的应用价值.方法:经手术病理证实的20例患者,其中移行细胞癌16例,鳞状上皮癌4例,术前均行多层螺旋CT平扫和增强扫描,由两名主治医师以上职称共同阅片,将扫描图像进行平扫、动脉期、静脉期和分泌期及延迟期多期分析,与病理对照.结果:肾孟内肿决型15例,浸润肾实质型4例,肾孟壁增厚型1例.增强扫描动脉期18例肿瘤轻度不均匀强化,静脉期和分泌期11例病灶强化程度几乎没有改变,与相邻肾实质相比肿瘤呈低密度,15例延迟增强扫描见肾孟内充盈缺损.其中2例出现尿漏.1例肾孟内见型略高密度影,术前诊断凝血块,术后病理为乳头状移行细胞癌.结论:多屡螺旋CT平扫加增强扫描可提高肾孟癌的诊断正确率,平扫有利于和结石的鉴别,多平面重建更清晰显示病变位置及形态,增强扫描更有利于病变的定性诊断.     

多层螺旋CT扫描结合三维重建对原发性输尿管癌诊断价值(附11例报告)

目的:探讨多层螺旋CT扫描结合三维重建对原发输尿管癌的诊断价值。方法:收集经手术病理证实的原发输尿管癌患者11例。所有患者常规行全尿路CT平扫及增强扫描,延迟8～120分钟行多次全尿路扫描,薄层重建数据应用AW4.3软件进行MPR、CPR、MIP及VR重建及三维成像,CPR选取动脉期、MIP及VR选取延迟期效果较好。结果:CT全部检出病灶。平扫显示病灶为输尿管腔内软组织肿块、管壁增厚及不同程度的扩张积水,增强扫描动、静脉期可见病灶呈不同程度强化。MPR从不同角度显示病变本身及病变与周围组织器官的关系。CPR通过动脉期重建对输尿管完整显示使病变整体形态范围变得更清晰。MIP、VR在延迟期能立体多方位显示输尿管充盈情况、局部梗阻形态等。结论:多层螺旋CT扫描结合三维重建基本上对原发输尿管癌做出正确诊断,提高小病灶检出率,为临床手术治疗提供可靠的信息,是很好的影像学检查方法。     

64层螺旋CT胆道三维成像对肝胆管结石病的诊断价值

目的探讨64层螺旋CT胆道三维重建技术对胆管结石疾病的诊断价值和对手术的指导意义。方法对65例肝胆管结石疾病患者，利用64层螺旋CT平扫、双期增强扫描以及最大密度成像、曲面重建、最小密度成像等方法行胆道三维重建，进行结石病的定位、定性及诊断，并与手术及病理结果进行比较。结果60例患者获得清晰的胆道三维重建图像，可以良好显示结石部位和形态，肝内外胆管扩张的程度和形态，以及肝脏组织有无萎缩和代偿性肥大等病变。重建胆管与周围组织解剖图像清晰，能准确确定梗阻部位以及梗阻的原因，区别肿瘤、结石或炎症。与手术结果比较，64层螺旋CT胆道三维成像对Ⅰ型、Ⅱ型、E型、胆总管型结石诊断符合率分别77．8％、80％、100％、100％。结论64层螺旋CT胆道三维成像是一种安全、敏感、无创性胆管疾病检查技术，能清晰显示胆管与周围组织的三维解剖关系。结合平扫、增强扫描，对肝胆管结石病及其他胆道疾病的诊断有极高的临床应用价值。     

输尿管结石的CT诊断（附75例报告）

目的：探讨CT扫描诊断输尿管结石的价值。方法：应用CT对75例可疑为输尿管结石患者进行平扫和增强扫描,并依据临床症状、体征采用三种不同的扫描方式。结果：75例患者检出输尿管结石78枚,72例为单侧单发,3例为单侧多发。结论：应用诊断输尿管结石优于常规方法,明确输尿管内高密度影极为关键,出现“淹没征”和“双影证”是诊断的可靠征像。     

64层螺旋CT平扫曲面重建技术对急性输尿管结石的诊断价值

目的：探讨64层螺旋CT曲面重建（CPR）技术对急性输尿管结石的诊断价值。方法：35例疑为输尿管结石的患者,男24例,女11例,年龄23-79岁,均行B超和64层螺旋CT平扫检查,将CT原始资料传送至工作站,用多平面重建（MPR）及CPR技术进行图像后处理,比较CT与B超诊断输尿管结石的阳性率。结果：35例输尿管结石患者中,CT诊断输尿管结石32例（91．4％）,B超诊断输尿管结石20例（57．1％）,CT对输尿管结石的诊断率高于B超（r=7．56,P〈0．01）;CPR使扩张的肾盂、输尿管全程显示在一幅图像上,便于全面观察结石的形态、大小和位置。结论：64层螺旋CT的CPR技术方便快捷、诊断准确率高,不需使用对比剂,尤其适用于肾绞痛患者的检查。     

CT重建技术在胆管内良恶性梗阻诊断中的应用

目的 探讨16层螺旋CT多平面重建（MPR）和曲面重建（CPR）在胆管内良恶性梗阻诊断中的临床应用价值。方法 收集15例胆管内良恶性梗阻病例,行16层螺旋CT平扫及增强,将肝实质期图像采用1.25 mm薄层重建,将数据传至工作站后,先对胆总管行MPR重建,获得胆总管走行最佳图像,然后在MPR图像的基础上行CPR重建,把不在同一个平面上的胆总管显示在同一个平面上,对梗阻部位及性质进行诊断,并与手术、病理对照。结果 15例胆管内良恶性梗阻病例,胆管癌4例,胰头癌4例,胆总管结石5例,胆总管炎性狭窄2例。MPR、CPR定位诊断100%,定性诊断准确率为93.3%,良、恶性梗阻的鉴别诊断准确率为100%。结论 16层螺旋CT MPR和CPR图像后期处理技术,对胆管内良恶性梗阻病变的定位、定性具有很高临床应用价值。     

多层螺旋CT对上尿路梗阻性疾病的诊断价值

目的:探讨多层螺旋CT在上尿路梗阻性疾病诊断中的应用价值。方法:对60例上尿路梗阻性疾病的患者行多层螺旋CT平扫加增强检查。结果:60例均获得明确诊断,其中输尿管结石12例,输尿管良性狭窄7例,肾盂输尿管连接部梗阻19例,肾结核9例,巨输尿管2例,输尿管癌5例,输尿管外压迫6例。病因诊断由输尿管镜或开放手术证实。结论:对上尿路梗阻患者,尤其当超声和IVU未能明确诊断梗阻原因时,可以行多层螺旋CT平扫加增强的检查以判断梗阻原因,有助于确诊。     

多层面螺旋CT泌尿系成像的临床应用价值

目的：探讨多层面螺旋CT泌尿系成像(MSCTU)对泌尿系疾病的诊断价值。方法：对以肾绞痛、IVU不显影或血尿为主诉的64例行CT平扫、肾脏增强双期扫描及尿路造影，将资料传至工作站，采用最大强度投影、多平面重建及容积重建等后处理技术，重建泌尿系图像。结果：64例肾盂和膀胱全部显示(100％)，输尿管全程显示者64例(110侧)。其中泌尿系结石16例(25％)；非结石病变48例(75％)，对上尿路梗阻原因诊断正确率100％，并可充分而直观地显示病变立体形态及其与周围组织的关系。结论：MSCTU重建图像清晰，对泌尿系肿瘤、结石或其他上尿路梗阻性疾病有着独特的临床应用价值。     

Helical CT and ureteral colic

The advantages of nonenhanced helical CT for the diagnosis of ureteral calculi include rapid scan time and patient throughput, safety (no contrast, less radiation), cost-effectiveness, high accuracy, minimal invasiveness, and ability to suggest of alternative diagnoses for flank pain--urologic and otherwise. Size measurement and location in the ureter, the two most important determinants of therapy, are precise with CT. It is particularly good for imaging small or radiolucent calculi, and calculi located at the ureterovesical. Secondary signs of obstruction and the soft-tissue rim sign are additional aids to the routine diagnosis of ureteral calculi. CT numbers indicate the fragility and therefore the likelihood of successful treatment of a calculus. Postprocessing options may help guide management decisions and may help plan interventions. The authors' experience after 30 months of using helical CT exclusively in the work-up of ureteral colic has been extremely favorable. Without hesitation, the authors believe that nonenhanced helical CT is the study of choice for the work-up of ureteral calculi.     

输尿管阴性结石的常用影像学诊断方法比较

目的：探讨输尿管阴性结石的合理、有效诊断方法。方法：对72例输尿管阴性结石患者的常规B超、排泄性尿路造影（IVU）、逆行肾盂造影（RGP）和CT平扫结果进行比较分析。结果：B超检查72例,提示结石56例,误诊2例,漏诊14例;IVU检查65例,确认结石3例,提示各种可能为结石的征象32例;RGP检查38例,确认结石27例,疑诊3例,失败8例;CT检查42例,检出结石41例。结论：对B超和（或）IVU提示的结石可疑部位行CT平扫是诊断输尿管阴性结石的准确、无创、相对价廉的可行方法。     

Unenhanced helical computed tomography in the evaluation of acute flank pain

OBJECTIVE: The diagnostic value of unenhanced helical computed tomography (CT) for the evaluation of acute flank pain is investigated in a prospective study. PATIENTS AND METHODS: In 125 patients aged 18-86 years, we performed unenhanced helical CT in addition to abdominal plain film, abdominal ultrasound and urinalysis as a diagnostic measure for acute flank pain. Ureteral calculi were confirmed or, respectively, excluded by retrograde ureteropyelography in 80 cases. In the other cases, diagnosis was verified by clinical course and/or stone asservation. RESULTS: In 91 of 125 patients the flank pain was caused by a ureteral calculus. In 67 of 91 patients with urolithiasis, stones could be collected for analysis. Helical CT was able to precisely identify 90 ureteral calculi. Abdominal plain films led to 8 false-positive and 48 false-negative findings. Thus, sensitivity of plain radiography, ultrasound and urinalysis was 47, 11 and 84% with a specificity 76, 97 and 32%, respectively. CONCLUSIONS: Unenhanced helical CT reaches a distinctively increased diagnostic value (sensitivity 99%, specificity 97%) in the evaluation of acute flank pain as compared to plain radiography, ultrasound and urinalysis.     

Clinical characteristics of ureteral calculi detected by nonenhanced computerized tomography after unclear results of plain radiography and ultrasonography

PURPOSE: Prospective non-enhanced computerized tomography (CT) was performed for patients presenting with renal colic and showing negative or equivocal results on plain x-ray of the kidneys, ureters and bladder (KUB) as well as ultrasonography (US) to evaluate the usefulness of plain CT. We also evaluated the clinical characteristics of urinary calculi detected under such conditions. MATERIALS AND METHODS: Between January 2000 and June 2002, 560 patients presented with acute unilateral renal colic. Of these patients 238 negative or equivocal for ureteral calculus on KUB and US underwent non-enhanced CT. The diagnostic value of plain CT in patients with negative or equivocal KUB and US was determined, and results and other clinical findings were compared. Clinical characteristics of ureteral stones detected by plain CT were compared with those of stones diagnosed by KUB and US. RESULTS: By plain CT 143 (60.1%) and 6 (2.5%) cases of pain were determined to have been caused by ureteral stones and other pathogeneses, respectively. No definitive diagnosis was obtained in 89 (37.4%). Stone size detected by plain CT was significantly smaller than controls (3.77 vs 6.37 mm, p <0.0001) and tended to be located in the middle or lower ureter (76.2% or 109 of 143 vs 52.2% or 168 of 322, p <0.0001). Symptoms spontaneously improved in 137 (95.8%) after conservative therapy while 6 underwent intervention, a rate significantly lower (p <0.0001) than controls (32.9% or 106 of 322). CONCLUSIONS: Non-enhanced CT is a useful modality for diagnosis of patients presenting with acute renal colic but whose results are negative or equivocal on KUB and US. Excretory urography is rarely needed because stones undetected on KUB and US tend to be small and in the middle or lower ureter, and spontaneous passage is expected.     

一种新型输尿管管路封堵器在输尿管镜钬激光碎石术中的应用初探

目的：研究英诺伟TMIVX-SCIO输尿管管路封堵器在输尿管镜钬激光碎石术中的临床疗效并评价其安全性。方法：对23例单侧输尿管结石患者于输尿管镜工作通道内安置英诺伟TMIVX—SCIO输尿管管路封堵器,完全超越结石后操作体外手柄使叶片折叠成球状防止结石上移,而后使用钬激光碎石,并使用封堵器叶片折叠球将结石碎片拖出输尿管开口。所有患者术后留置双J管两周。结果：1例息肉包裹的肾盂一输尿管连接处结石于安置输尿管管路封堵器前出现结石漂移至患侧肾下盏,改用输尿管软镜以钬激光碎石。术中无患者出现输尿管穿孔或输尿管黏膜撕脱。术后无患者出现发热及菌血症。术后4周影像学随访,除1例结石漂移入肾下盏的患者结石尚未排空外,余22例无明显结石残留,结石清除率为95．7％。结论：输尿管管路封堵器能显著减少输尿管碎石术中结石漂移、提高结石清除率,临床应用价值高、治疗成本低且使用安全,对于输尿管上段结石尤其适用,可望成为输尿管镜手术中重要附属器械之一。     

输尿管镜下弹道-超声碎石清石系统治疗嵌顿性输尿管结石

目的：评价经尿道输尿管镜下EMS第三代弹道-超声碎石清石系统治疗嵌顿性输尿管结石的临床疗效。方法：回顾性分析2008年10月～2011年4月,经尿道输尿管镜下弹道-超声碎石清石系统治疗16例嵌顿性输尿管结石的临床资料。结果：16例中输尿管上段结石3例,输尿管中、下段结石13例,大小为0．7cm×0．5cm～4．0cm×2．0cm。16例均为嵌顿性结石,镜下可见结石表面伪膜包裹及输尿管炎性息肉形成。B超和CT均呈现不同程度的肾盂、输尿管扩张,其中中度肾积水3例、重度肾积水13例。EMS第三代碎石清石系统采用超声-弹道-超声或弹道-超声联合模式均获得成功,碎石时间20～180min,无输尿管穿孔、黏膜撕脱、严重出血等并发症。术后住院2～8天,平均4．6天。术后1～3个月B超及KUB检查,结石排净,积水消失或明显减轻。结论：采用EMS第三代弹道超声联合模式治疗复杂、嵌顿性输尿管结石,安全可靠,成功率高。     

计算机断层扫描螺旋尿路成像与仿真内窥镜技术的临床应用

目的 探讨螺旋CT尿路成像（SCTU）与CTVE）的检查方法、成像技术以及在泌尿外科疾病中的应用价值,提高诊断水平。方法 应用螺旋CT对46例泌尿系统疾病患者（包括肾肿瘤2例,肾盂旁囊肿2例,输尿管结石6例,输尿管狭窄4例,输尿管肿瘤2例,重复肾重复输尿管畸形1例,膀胱肿瘤28例,膀胱子宫内膜异位症1例）行容积扫描,所得数据在工作站利用软件进行后处理,获得泌尿系立体图像;并对6例输尿管疾病、29例膀胱疾病患者进行了CT仿真内窥镜（CTVE）成像。所有图像均与B超、静脉尿路造影、逆行肾盂造影、常规CT扫描、膀胱镜检查等比较。并将术中所见或病理结果作为诊断的金标准。结果 所有患者均取得了高质量的泌尿系图像,除1例膀胱肿瘤（肿瘤直径为4mm）漏诊外,其余患者均得到了明确诊断,并与手术或病理结果相符合。结论 SCTU与CTVE是较可靠的非侵入性检查手段,具有一定的优越性,可作为泌尿系常规检查方法的有益补充。     

螺旋CT尿路三维重建诊断上尿路梗阻性病变(附37例报告)

目的　探讨螺旋CT尿路三维重建技术在上尿路梗阻性疾病诊断中的应用价值。　方法　对 37例上尿路梗阻患者进行螺旋CT薄层扫描和尿路三维重建 ,必要时行CT血管造影。　结果　 37例均获明确诊断 ,其中输尿管癌 8例 ,膀胱癌 2例 ,输尿管结石 9例 ,输尿管良性狭窄 7例 ,先天异常 7例 ,盆腔肿瘤 4例 ,除盆腔肿瘤外均行手术治疗证实诊断 ,术中所见与螺旋CT扫描结果一致。　结论　螺旋CT尿路三维重建具有三维成像、分辨率高、检查时间短、侵袭性小等优点 ,可能成为诊断上尿路梗阻性病变最有价值的检查方法。     

Investigation of upper tracts after resolution of symptoms due to ureteric calculi

OBJECTIVE: To determine whether patients with proven ureteric calculi on IVU require repeat IVU after resolution of symptoms and passage of calculus on plain X-ray. METHODOLOGY: IVU reports for a 12-month period were obtained and notes and X-rays of those patients with ureteric calculi were reviewed. Presentation, management and subsequent imaging after resolution of symptoms were determined for each patient. All X-rays were reviewed by a uroradiologist. RESULTS: Fifty-eight patients were investigated for the study. All initial IVUs showed upper tract dilation or obstruction. Forty-three eventually passed their calculi spontaneously and of these, 18 had KUB, all of which showed passage of the calculus and 25 had repeat IVU, 22 of which were normal. The 3 abnormal IVUs showed persisting calculi which were visible on the plain film. Fifteen patients required surgical intervention and all had repeat IVU, of which 5 were abnormal. CONCLUSION: This study suggests that following resolution of symptoms due to ureteric colic, patients who pass their calculi spontaneously can be followed up by KUB. Only those with persistent calculi on KUB or those who have had surgical intervention require repeat IVU.