排泄性三维对比增强磁共振尿路造影联合MRU在上尿路结石诊断中的应用价值

Application Value of 3D-excretory Contrast-enhanced MR Urography Combined with MR Urography in Diagnosis of Upper urinary Tract Calculi

目的:探讨排泄性三维对比增强磁共振尿路造影(3D-ceMRU)联合MRU在上尿路结石诊断中的价值。方法:对45例上尿路结石患者行MRU及3D-ceMRU扫描,与临床最终诊断对照后,比较3D-ceMRU联合MRU与IVU、BUS在上尿路结石诊断中的价值,评价3D-ceMRU及MRU对患侧上尿路的显影情况并做对比分析。结果:3D-ceMRU联合MRU诊断上尿路结石患者41例,诊断正确率为91.4%,定位诊断率为100%,与IVU和BUS相比,差异无统计学意义(P>0.05)。正常和轻度积水的上尿路3 D-ceMRU和图像质量优于MRU(P<0.01);而中-重度积水的上尿路MRU图像质量优于3D-ceMRU(P<0.01)。结论:3D-ceMRU和MRU相结合能直观、清晰地显示结石的部位及上尿路形态,具有较高的定位、定性诊断准确性,是诊断上尿路结石的可靠方法。

Objective：To evaluate the clinical application value of 3D-excretory contrast-enhanced magnetic resonance urography（3D-ceMRU） combined with magnetic resonance urography（MRU） in diagnosing upper urinary tract calculi. Methods：Forty-five patients with upper urinary tract calculi were performed by MRU and 3D-ceMRU. 3D-ceMRU was performed by 3D SPGR, and 3D reconstruction from multiple images were acquired by maximum intercity projection（MIP） algorithm. Contrast to the clinical final diagnosis, the accurate rate in diagnosis of upper urinary tract calculi by 3D-ceMRU combined with MRU was analyzed comparatively by that of IVU and BUS. Two readers independently scored each affected upper urinary tract for visualization degree which was compared between 3D-ceMRU and MRU. Results：3D-ceMRU combined with MRU checked out 41 cases of upper urinary tract calculi, its diagnostic accuracy was 91.4%, and the accuracy diagnosis of the location was 100% in these patients, there was no significant difference among the diagnostic accuracy of IVU, BUS and it （P〉0.05）. The scores of 3D-ceMRU were higher than MRU in the nondilated and mildly dilated upper tracts （P〈0.01） ,but the scores of MRU were higher than 3D-ceMRU in the moderately dilated and markedly dilated upper tracts （P〈 0.01）. Conclusions：The combination of 3D-ceMRU and MRU can directly and clearly show the site of the stone and shape of the upper urinary tract, it has excellent accuracy in the diagnosis of upper urinary tract calculi.