肾结核的不同影像学检查方法的诊断价值

Diagnostic Evaluations of Different Radiological Examinations in Renal Tuberculosis

目的:探讨不同影像学检查方法对肾结核的诊断价值。方法:24例患者均行B超、IVU和MRU检查,其中10例行CT检查。并与手术及病理结果对照。结果:24例B超均有阳性表现,其中确诊为肾结核者18例(75.0%),典型表现为肾实质内多个不规则液性暗区大部分不与肾盏相通;误诊为肾积水、肾囊肿6例(25.0%)。IVU检查诊断为肾结核者10例,符合率为41.7%。其特征性表现小盏扩张其杯口呈虫蚀状(4例),肾上盏颈部变细(1例),肾下盏外可见一造影剂湖与肾盏相连(1例),输尿管多发狭窄呈串珠样(2例)。MRU诊断肾结核18例,符合率为75.0%,主要表现为肾盏扩张且排列紊乱(14例),肾盏颈部狭窄(4例),肾实质内可见不规则高信号影(6例),输尿管显示僵直及多发狭窄(4例)。结论:肾结核的影像学表现呈多样性,临床医生必须综合多种检查技术,从而对肾结核作出确切诊断。

Objective： To discuss the diagnostic evaluations of different radiological examinations in renal tuberculosis （RTB）. Methods： All patients were examined by B-scan, intravenous urography （IVU） and MRU, and 10 of them were examined by CT. Results were compared with those of operation and pathology. Results： All of the 24 cases showed positive results by Bscan in which 18 cases were diagnosed renal tuberculosis （75.0%） with typical representation of some irregular liquid-hypoecho area in kidney and 6 cases were misdiagnosed hydronephrosis and renal cyst （25.0%）. Ten cases were diagnosed renal tuberculosis （1.7%） by IVU with calyx dilatation and ulceration （4 cases）, cervical part of superior calyx got thinner （1 case）, contrast medium lake connected with inferior calyx （1 case） and stenosis of ureter （2 cases）. Eighteen cases were diagnosed renal tuberculosis （75%） by MRU with calyx dilatation and derangement （14 cases）, cervical part of calyx got thinner （4 case）, irregular high signal in renal parenchyma （6 cases） and ureter rigor and stenosis （4 cases）. Conclusion： Various manifestations of images are shown in renal tuberculosis. Correct diagnosis depends on comprehensive analysis.