磁共振尿路造影与螺旋CT泌尿系成像对输尿管病变的诊断价值

目的 探讨磁共振尿路造影（Magnetic Resonance Urography,MRU)与螺旋CT泌尿系成像（Spiral CT Urography,SCTU)对输尿管病变的诊断价值，比较两者的优缺点。方法 24例输尿管病变中，结石9例，肿瘤5例，狭窄9例，畸形1例，均行MRU与SCTU检查。结果 （1）9例结石MR重T2成像上示梗阻端以上肾盂、输尿管扩张，结石呈低或无信号，上方有环状高信号；SCTU图像上，8例阴性结石和1例阳性结石可见其位置、形态、大小及扩张的肾盂、输尿管。（5）5例输尿肿瘤MRU示局部软组织信号强度不等，SCTU示局部管腔内对比剂变细或突然中断、管壁不光整。9例狭窄包括4例炎症性狭窄和5例医源性狭窄，MRU示梗阻端呈悬针样改变，SCTU示狭窄部位管腔逐渐变细、管腔无明显增厚。（3）1例畸形示右侧输尿管下端与对侧输尿管并行，末端有巨大囊肿形成。结论 （1）与普通CT与静脉泌尿系造影IVU相比，螺旋CT与SCTU技术可进行容积扫描，不易遗漏病变，尤其是较小结石，可任意方向旋转观察，最大限度清晰地显示病变。（2）MRU不需造影剂，没有碘造影剂过敏及暴露于放射线的危险，特别适用于肾功能不良者以及儿童、孕妇、老年患者。

Evaluation of MRU and Spiral CT in the Diagnosis of Ureteral Disease

Objective To dicuss the diagnostic value of MRU and spiral CT in ureteral disease.Methods MRU and SCTU were performed in 24 cases with ureteral disease including 9 cases of ureteral calculus,5 carcinomas,9 stenosis,and 1 malformation.Result (1)On SCTU,the location and diameter of 9 ureteral calculus (8 radiolucent,1 radiopaque)enlargement of renal pelvis and ureter were displayed.(2)Irregular uretral wall,local rarefieation or bostruction of contrast medium in ureter were detected in 5 cases of tumou in which rectums were narrowed gradually, in 7 cases of simple ureteral stemosis without thickening of the wall.(3) 1 malformation with double renal pelvis and ureter was demonsstated on MRU urinary tract dilatations at different levels clearly visualized in all the cases of impaired renal function.Conclusion (1)SCTU is supperior to IVU and conventional CT by improving diagnosis of ureteral disease.(2)MR urography would be reneal important imformations which might not be obtained by IVU.