结肠癌泌尿道侵犯的MRI诊断价值

目的 探讨MRI尤其是排泄性MRU在诊断结肠癌侵犯泌尿道的价值。方法 回顾性分析经手术和病理证实的结肠癌侵犯泌尿道患者17例,均行常规MR扫描（包括T1WI、T2WI、MRU）,然后采用三维容积超快速多期动态增强扫描序列（Propeller LAVA）行动态增强扫描,延迟10～20分钟行泌尿道成像,显示不良者延迟4小时再扫描一次。对Propeller LAVA原始图像采用多平面重建（MPR）和最大强度投影（MIP）行泌尿道重建。结果 17例结肠癌侵犯右侧肾盂2例;左侧输尿管12例,其中1例同时侵犯膀胱;右侧输尿管3例。排泄性MRU表现：（1）侵犯输尿管表现为管腔不规则逐渐变狭窄7例,突然狭窄、截断3例,肿瘤部分包绕输尿管8例,完全包绕2例,腔内充盈缺损2例;（2）侵犯肾盂、膀胱均表现为局部管壁增厚,与肿瘤间隙消失,腔内充盈缺损。结论 MRI结合排泄性MRU能清楚显示结肠癌与泌尿道的关系,对结肠癌侵犯泌尿道可提供准确的信息。

The clinical value of MRI in diagnosis of the encroachments made by colon carcinoma upon urinary tract

Objective To explore the clinic value of MRI, especial excretory MR urography in diagnoses of the encroachments made by colon carcinoma upon urinary tract. Methods 17 case of patients were analyzed retrospectively, all the patients were confirmed by surgery or pathology that the colon carcinoma had encroached upon the urinary tract. All the patients accepted firstly the routine MR scan, including T1WI, T2WT and MRU, then accepted Propeller LAVA dynamic enhancement scan, urinary tract imaging at 10 to 20 minutes post-injection, the ill-manifest cases accepted scanning again at 4 hours post-injection. Processing original image with MPR and MIP to recon- struct the urinary tract. Results All the 17 cases of urinary tract encroached by colon carcinoma , 2 were right pelvis, 12 left ureter, 3 right ureter, 1 both bladder and right ureter. The excretory MRU show that: (1)The ureter invasioned by colon carcinoma showed : 7 ureters gradually irregular constriction, 3 showed abruptly narrow or interrupt; 8 ureters were encysted partly by neoplasm and 2 were completely, 2 ureters showed inter-cavity filling defect. (2)pelvis and bladder invasioned by tumor showed local vessel wall thickening, the interspace with the tumor was disappearance, or inter-cavity filling defect. Conclutions MRI combining with excretory MR urography could show the relation between colon carcinoma and urinary tract clearly, it can provide precise infor- mation about the encroachments made by colon carcinoma upon urinary tract.