原发性输尿管移行上皮细胞癌的MR诊断

Diagnostic of MR in ureter transitional cell carcinoma

目的分析输尿管移行上皮细胞癌的 MRI 表现,评价 MRI 对输尿管移行上皮细胞癌的诊断价值。方法用 MR 1.5 T 超导型扫描机,采用 T_2WI 快速自旋回波(FSE)序列、脂肪抑制技术和 MR 尿路造影(MRU)检查。回顾性分析32例输尿管移行上皮细胞癌的 MRI 表现,结合文献进行分析。结果 32例中病变位于上段15例,中段7例,下段10例。32例均有输尿管梗阻,梗阻上段输尿管均有程度不同扩张和肾盂积水;21例病变呈结节状、分叶状、不规则充盈缺损,其中11例病变部位的输尿管迂曲、管壁不光整呈锯齿状,10例病变部位输尿管膨胀;11例病变呈浸润性生长,其中9例腹主动脉旁和肾门旁淋巴结增大。病变累及输尿管长度17～72 mm,平均39 mm。病变横径大小6～50 mm,平均17 mm。MR 信号 T_1WI 为低信号、T_2WI 为高信号23例,T_1WI、T_2WI 均为高信号5例,T_1WI 为低信号、T_2WI 为等信号2例,T_1WI、T_2WI 均为稍低信号2例,脂肪抑制后均为高信号32例。MR 信号均匀19例,不均匀13例。MRI 明确诊断22例,可疑诊断5例,误诊5例。结论 MRI 能明确输尿管病变的部位、形态、范围和周围组织的改变,但定性诊断有待进一步探讨。

Objective To study the feature of MRI in ureter transitional cell carcinoma, to evaluate the diagnostic value in transitional cell carcinoma of ureter with MRI. Methods Heavily T2-weighted fast spin echo pulse sequence, fat suppression pulse and MR urography （ MRU ） were performed. The MRI finding of the ureter transitional cell carcinoma were anlysed in 32 cases and were discssed with the review of literature. Results Fifteen lesions were located at the upper portionof the ureter, 7 at mid portion and 10 at lower portion. Each case presented urinary obstruction, distention and uretal hydrocele. 21 retrograde urleropyelogrhpy of nodular shaperal irregular, 11 irregular the ureteral wall, 10 dilate the ureter in 21 cases. 11 infitrative lesion to grow in location, 9 lymphanode to enlarge in surrounding of major arterial of abdominal and renal out in 11 cases. 17-72 mm length the lesion, 39 mm average, 6--50 mm width the leion, 17 mm average. Hypointense on T1 WI and hyperintense on T2 WI image in 23 cases, hyperintense on both T1WI and T2WI image in 5 cases, hypointense on T1WI and isointense on T2WI image in 2 case, slightly hypointense on both T1WI and T2WI images in 2 case . Ninteen homogeneous and 13 non homogeneous of signal in lesion, 22 reliable and 5 suspicious diagnosis and 5 misdiagnosis in MRI. Conclusion The location, the shape , the spectrum of the tumor and change of surrounding tiessue were clear cuted in MRI, but further research in confirmation of the diagnosis.