64排螺旋CT诊断早期原发性输尿管癌的临床价值

目的：探讨早期原发性输尿管癌的64排螺旋CT扫描及三维重建的影像特点和诊断价值。材料和方法：回顾性分析15例经手术病理证实的早期原发性输尿管癌的64排螺旋CT影像表现,分析其特点。全部患者均行平扫加动脉期、实质期及延迟期增强扫描,并行CPR重建,10例同时行MIP重建。结果：①病变部位,肿瘤发生在右侧输尿管7例,左侧输尿管8例,其中输尿管上段2例,中段6例,下段7例。②CT表现,管壁局限性不规则增厚、管腔向心性狭窄8例,管腔内偏心性软组织肿块、残留管腔呈新月状或裂隙状4例,输尿管呈软组织密度影、管腔消失3例。③增强特征,肿瘤呈较明显均匀增强13例,不均匀增强2例。④伴随征象,肿瘤近端的肾盂及输尿管不同程度扩张、积水,5例肾脏输尿管显影延迟。结论：64排螺旋CT容积扫描及三维重建能够多平面、多方位、立体地显示病变,结合轴位CT动态增强扫描,可大大提高早期输尿管癌诊断的正确性,具有较重要的临床价值。

The Clinical Value of 64-row Spiral CT in Diagnosing Early Primary Ureteral Carcimoma

Purpose To analyze the 64-row spiral CT manifestations and evaluate the diagnostic value in early primary ureteral carcinoma.Materials and Methods Fifteen cases of early primary ureteral carcinoma proved by surgery and pathology were reviewd.Unenhanced scan,enhanced scan in arterial phase,parenchymal phase,delayed phase and CPR construction were performed in all patients.MIP were performed in 10 cases.Results ① the localization of lesions:7cases were located at the right ureter and 8 cases at the left.2 cases were located at the upper portion of the ureter,6 at mid portion,and 7 at lower portion;② CT manifestations:8 cases showed irregular thickened wall and central lumen stenosis,4 cases eccentric soft tissue mass in lumen and crescent or linear vestigial lumen,3 cases soft tissue density and obsolescent lumen;③the enhanced features:the tumor was demonstrated apparent and uniform enhancement in 13 cases,inhomogeneous enhancement in 2 cases after administration of contrast medium;④ the accompanied signs:proximate renal and ureteral presented distention,dropsy in different degrees,5 cases appeared delayed development.Conclusion 64-row spiral CT volume scan and 3D reconstruction with multiplane and multiorientation,combined with axial enhanced scan,can show lesions dimensionly and increase the dignostic accuracy in early primary ureteral carcinoma,which has an important value.