IVP后CT检查在肾和输尿管病变中的诊断价值

Diagnostic value of CT following IVP in renal and ureteral disease

目的:探讨静脉肾盂造影(IVP)后CT检查对肾和输尿管病变的诊断价值。方法:对43例IVP检查后显影不满意的患者60min后行CT扫描检查,扫描结束后在工作站上采用曲面重建(CPR)、多平面容积重建(MPVR)、最大密度投影(MIP)等方法重建成CT尿路造影(CTU)。结合手术病理结果和临床诊治结果分别判定其对病变的检出率、准确率及临床应用价值。结果:本组研究中43例IVP显影不满意的肾和输尿管病变的患者,CT加CTU对病变的检出率为100%。其中,肾和输尿管结石28例(65.1%),肾及输尿管结核4例(9.2%),输尿管肿瘤3例(7.0%),慢性炎症2例(4.6%),输尿管破裂1例(2.3%),重复肾盂输尿管畸形2例(4.6%),先天性巨输尿管1例(2.3%),先天性输尿管狭窄1例(2.3%),腹膜后纤维化1例(2.3%)。CT加CTU的整体诊断正确率为93%(40/43)。结论:IVP后CT检查对IVP显影不佳的肾及输尿管疾病有很高的检出率和诊断正确率,有较高的临床使用价值。

Objective： To investigate the value of CT after intravenous pyelography （IVP） in the diagnosis of renal and urcteral diseases. Methods： 43 patients showed unsatisfactory results after IVP underwent CT examinations. CTU reconstruction methods were made with CPR, MPVR and MIP. Then analyzed the renal and ureteral performances, evaluated the detection rate, accuracy rate and clinical application value of CT and CTU in diagnosing renal and ureteral diseases. Results： All the 43 cases were patients with renal and ureteral diseases and showed unsatisfactory results after IVP, the detection rate of CT and CTU was 100%. Among them, 28 eases （65.1%） were renal uterteral urolithiasis, 4 cases （9.2%） were renal and ureteral tuberculosis, 3 eases （7.0%） were renal and ureteral neoplasm, 2 eases （4.6%） were chronic inflammatory diseases, 1 case （2.3%） was rupture of the ureter, 2 eases （4.6%） were duplication deformity, 1 case （2.3%） was congenital megaureter, 1 case （2.3%） was congenital ureterostenosis, 1 ease （2.3%） was retroperitoneal fibrosis. The total accuracy rate of CT and CTU was 93% （40/43）. Conclusion： CT examination after IVP shows high detection rate and accuracy rate in diagnosing renal and ureteral diseases which can not perform in IVP, and it has a high clinical application value.