男性尿道狭窄及尿道周围纤维化的MRI评价

Magnetic Resonance Imaging for Diagnosis of Urethral Stricture and Periurethral Pathologic Fibrosis in Male

【目的】评估MR成像技术应用于尿道狭窄及尿道周围纤维化的价值。【方法】对12例因外伤致尿道狭窄的男性患者采用Simens Sonata 1.5T扫描仪扫描,常规做横轴位和矢状位SE T1和FSE T2加权扫描,经静脉注射造影剂后再做横轴位和矢状位T1加权扫描,部分加做了横轴位和矢状位的短反转恢复(STIR),所有病例均做了常规尿道造影,并都有外科手术评估。【结果】所有患者的常规尿道造影都有尿道狭窄。但是不能明确瘢痕的位置及瘢痕量。MRI证实了所有患者的尿道或尿道周围的瘢痕,与手术结果完全符合。7例患者在手术后进行了MRI复查。发现有5例瘢痕复发,2例未见异常。5例因为症状持续而再次手术,手术结果与磁共振发现吻合。【结论】MRI可以诊断男性尿道及尿道周围的瘢痕,不仅可以显示瘢痕形态,更可以显示瘢痕量。随着扫描技术的不断改进,MRI对于显示尿道及尿道周围的瘢痕有其他诊断方法不可替代的作用。

[Objective]To evaluate MRI in the diagnosis of male urethral stricture and periurethral fibrosis. [Methods]Twelve consecutive patients presented with urethral scars between June 2003 and October 2004. Assessment included history, physical examination and other radiologic evaluations. Patients were scanned with Simens Sonata scanner. The protocol was obtained with axial T1 weighted, T2 weighted, short inversion recovery （STIR）, and sagittal T2 weighted sequences. All had scanned with GD-DTPA intravenous injection. All patients had surgical evaluation. [Results]In all of these patients, a precise diagnosis could not be established by other imaging modalities and a thorough physical examination. MRI demonstrated periurethral fibrosis in 12 patients. All patients had surgical operation. Seven of the 12 patients who underwent repeat MRI, were found persistence or recurrence of fibrosis in 5 ,and no new findings in 2. Five of these patients with persistent symptoms had undergone urethrolysis. Good correlation was observed between the subjective estimate of the amount of scar tissue encountered during urethrolysis and the interpretation of the MR imagings by the radiologist. [Conclusions]Our experience suggests that MRI may help better define the diagnosis of urethral and periurethral pathologic fibrosis in male patients. With improved scanning, MRI will likely have a role in evaluating urethral and periurethral fibrosis, which is difficult to detected by other diagnostic modalities.