IVP后CT扫描诊断先天性输尿管畸形

Immediate CT scanning in the diagnosis of congenital abnormalities of the ureter after IVP

目的：探讨IVP／CT诊断先天性输尿管畸形的价值。材料与方法：IVP提示重度肾盂积水，或60min后肾收集系统（CS）不显影，显影极谈；或已显影的CS及输尿管变形、移位者立即行CT扫描，计47例。结果：UPJ／UVJ梗阻（31例）。CS囊状扩张（22例）：肾盂内均为水样密度，肾盏内呈水样密度（6例）或形成液体界面（16例）；肾实质为环形或弧形高密度影（22例）。9例UPJ梗阻CS充盈造影剂。5例UVJ梗阻均伴有输尿管扩张可资鉴别。肾实质部分较充满尿液的CS小的多，此为慢性尿路梗阻导致肾盂积水的特征。完全性输尿管重复畸形（16例）。上（半）肾CS：形成液体界面（EUC9例）、充盈造影剂（EVEO6例）或为多囊状扩张（EVEO1例）。上（半）肾输尿管均全程扩张（＞2．0cm），其末端于膀胱内形成压迹样充盈缺损（EUC9例）或于膀胱外异位开口（7例）。结论：诊断先天性输尿管畸形，显示其形态学特征，IVP／CT是一种快速而准确的方法。

Objective: To evaluate the value of IVP/CT(immdiate CT scan after IVP) in the diagnosis of congenital abnormalities of theureter: Materials and Methods: CT scan were performd on 47 cases immediately after IVP examination. Some of these cases showed signsof severe hydronephrosis by IVP, some shawed absence or unsatisfactory filling of contrast medium(CM) in the collecting system(CS) 60 minafter IVP, and the others showed deformity and migration of CS and ureter filled with CM. Results: UPJ/UVJ obstruction (31 cases). Markedcyst - like dilation of CS(22 cases): with attenuation values approximatly equating to that of waer in all pelvics and calyces(6 cases), orwith interfares between urine and CM - stratification phenomena in calyces(16 cases). Renal parenchyma on IVP/CT showed high densitywith ring - like or are - like in shape surrounding the calyces (22 cases). In 9 cases of UPJ obstruction there were only mild dilation of theCS filled by CM.Five cases with UVJ obstruction accompanied with dilated areter could be differentiated from UPJ obstruction.Renalparenchma appeared much smaller than the urine - filled CS, which was a typical IVP/CT feature of hydronephrosis resulting from chronicobstructive uropathy. Complete duplication anomalies of the ureter(16 cases). CS of uppe - pole moiety of the kidney: developing interfacesbetween urine and CM(EUC9 cases), filled by CM(EVEO 6 cases), or being multiple cyst - like dilation(EVEOl case) .The upper - polemoiety areters dilated(> 2. 0cm) down to the obstructing lesions. The terminal portion of the uretrs developed an indentation - like fillingdefect within the bladder(EUC 9 cases) or extraesical ectopia of the orifice(7 cases). Conclusion: IVP/CT is a quick and accurate methodin the diagnosis of congenital abnormalities of the ureter, providing their morphologic characteristics.