肾结核的多层螺旋CT动态增强影像特征

目的分析肾结核多层螺旋CT动态增强的影像表现,并提高其诊断水平。方法 20例肾结核(累及双肾10例)患者均经多层螺旋CT平扫及3期增强扫描(皮质期、实质期、肾盂期)。结果在20例的30个病肾中,肾实质密度不均匀29个肾,不同形态钙化15个肾,集合系统不成比例扩张积液14个肾,呈"花瓣"状排列10个肾,合并输尿管上段管壁增厚5个肾,对侧肾积水3个肾,肾脏形态改变28个肾,肾皮质变薄26个肾。3期动态增强扫描显示皮质期及实质期强化程度减低密度不均匀15个肾,肾盂、肾盏、脓腔壁环状强化10个肾。肾盂期,9个肾无造影剂进入集合系统及脓腔,6个肾造影剂进入肾盂、肾盏、脓腔。结论肾结核多层螺旋CT的影像表现多种多样,多层螺旋CT能很好地显示结核病变部位、范围及双肾功能情况,可为临床准确诊断提供重要依据。

Imaging features of renal tuberculosis on triphasic-enhanced CT scans

Objective To analyze the imaging features of renal tuberculosis（RTB） on triphasic-enhanced CT scans and to elevate its diagnostic level.Methods Twenty patients with clinically,surgically and pathologically proved RTB underwent plain and triphasic-enhanced CT scans.The imaging findings of all patients were analyzed retrospectively.Results Among 30 affected kidneys of 20 cases who included 10 unilateral and 10 bilateral involvement,renal parenchyma with nonhomogeneous density was found in 29,different forms of calcification in 15,disproportional dilatation and hydrops of collecting system in 14,＂petal-like arrangement＂in 10,thickening of upper ureter walls in 5,contralateral hydronephrosis in 3,morphologic changes of the kidneys in 28,and thinning of renal cortex in 26.Triphasic -enhanced CT scans clearly shown the imaging features of RTB lesions in all patients.During cortical and parenchymal phase,the lesions with low enhancement and nonhomogeneous density were found in 15 kidneys,circular enhancement of pelvis,calyx and vomica wall in 10 kidneys.During excretory phase,collecting system and vomica without contrast medium filling were found in 9 kidneys,while pelvis, calyx and vomica with contrast medium filling in 6 kidneys.CT findings of RTB are varied,however,triphasic-enhanced CT scan can clearly show the site and extent of RTB lesions as well as the functional state of the kidneys so that it can provide the important evidence for clinically definite diagnosis.