静脉增强肾皮质期MSCTU对非结石性尿路梗阻的诊断

Corticomedullary Phase Enhancement of Multi-slice CT Urography (MSCTU) Diagnosis in Ureteral Non-stone Obstructive Diseases

目的:探讨多层螺旋CT静脉增强肾皮质期尿路成像(MSCTU)对非结石尿路梗阻的病因诊断价值。方法:对72例MSCT平扫结石阴性的梗阻性肾积水患者行肾脏三期扫描即肾皮质期、实质期及肾盂期扫描,将肾皮质期原始图像数据重建后传输至工作站进行图像后处理,获得多种3D重组图像再做出诊断,将诊断结果与临床或手术病理结果进行对照。结果:肾皮质期MSCTU图像结合轴面图像诊断输尿管结核16例,肾盂输尿管连接处狭窄18例,肾输尿管重复畸形1例,原发性输尿管癌15例,邻近部位恶性肿瘤侵犯输尿管7例,输尿管炎症5例(其中2例手术病理证实为输尿管息肉),梗阻性膀胱6例,结石排出后尿路扩张2例,肾输尿管重复畸形合并输尿管囊肿1例,血管压迫1例。均显示梗阻的部位,病变的形态、大小及尿路扩张情况。诊断敏感度100%,诊断符合率97.2%。结论:静脉增强肾皮质期MSCTU图像结合轴面图像对非结石性尿路梗阻疾病能准确定位和定性。

Objective：To evaluate the value of three-phase scanning of contrast enhanced MSCTU in diagnosing the non-stone obstructive ureteral diseases. Methods： 72 cases suspected of non-stone obstructive ureteral diseases were performed three phases scanning of contrast enhanced MSCT,including corticomedullary phase, parenchymal phase and pyelographic phase. Source images of corticomedullary phase were sent to the work station for postprocessing. CT findings were compared with that of surgical pathological findings. Results：Corticomedullary phase scanning of MSCTU detected several ureteral non-stone obstructive diseases as follows：ureteric tuberculosis （n= 16） ,congenital UPJ stenosis （n= 18） ,ureteral duplication （n= 1）, primary ureteric cancer （n= 18）, secondary ureteral tumors （n= 7）, ureteritis （n= 5） （with 2 ureteric polyp proved by pathology）,obstructive bladder （n=6）,ureteral dilation after stone released （n=2）,ureterocele and ureteral duplication （n= 1）, retrocaval ureter （n = 1 ）. The sensitivity of MSCT was 100 %, and accuracy 97.2 %. Conclusion： Corticomedullary phase scanning of enhanced MSCTU played important role in the diagnosis of non-stone obstructive ureteral diseases.