磁共振尿路成像技术在诊断新生儿先天性肾盂输尿管连接部梗阻中的应用

Clinical applications of magnetic resonance urography technique in diagnosing congenital ureteropelvic junction obstruction in the newborn

目的探讨磁共振尿路成像(MRU)技术在诊断新生儿先天性肾盂输尿管连接部梗阻(CUJO)中的应用价值。方法回顾性分析2010—2011年在我院行MRU检查的新生儿影像资料及手术结局。MRU检查序列包括3D尿路成像、常规轴位快速恢复快速自旋回波T2WI和稳态采集快速成像。所有图像在AW4.2工作站经最大密度投影、容积再现和Reformat重建出3DMRU图像。结果共21例患儿行MRU检查,均为孕期B超发现胎儿肾积水、出生后复查B超肾积水加重或临床症状加重就诊。MRU诊断双肾积水1例,右肾积水伴肾盂输尿管移行部狭窄7例,左肾积水伴肾盂输尿管移行部狭窄13例。21例患儿均接受手术治疗,其中腹腔镜下左肾盂成形术加膀胱镜探查术13例,右肾盂成形术加膀胱镜探查术6例,经脐单孔腹腔镜右肾输尿管切除术1例,双肾盂成形术加膀胱镜探查术1例。术后诊断均与MRU诊断相符。结论 MRU技术因具有无射线损伤、多角度、多方位、多参数成像等特点,已成为新生儿CUJO诊断、鉴别诊断及外科手术方案制定中不可缺少的重要检查手段,具有良好的发展前景。

Objective To evaluate the magnetic resonance urography （MRU） on the diagnosis of congenital ureteropelvic junction obstruction（CUJO）in the neonatess. Methods MRU imaging data and surgical results of the newborns who underwent surgery at the Beijing Military General Hospital from 2010 to 2011 were retrospectively studied . The sequences of MRU included 3D MRU, conventional axial fast recovery fast spin-echo（FRFSE） T2WI and fast imaging employing steady acquisition（FIESTA）. The 3D-MRU were reconstructed on AW4.2 workstation with maximum intensity projection（MIP）, volume rendering（VR） and Reformat methods. Results A total of 21 patients were enrolled, and fetal hydronephrosis were diagnosed using ultrasound during pregnancy and became more severe after birth with or without clinical signs. MRU showed 1 case with bilateral hydronephrosis, 7 cases with right-side hydronephrosis and ureteropelvic junction obstruction, and 13 cases with left-side hydronephrosis and ureteropelvic junction obstruction. All patients underwent surgical treatment, including thirteen left laparoscopic pyeloplasty and cystoscopy, six right laparoscopic pyeloplasty and cystoscopy, one umbilical one-trocar laparoscopic nephroureterectomy of the right kidney, and one bilateral laparoscopic pyeloplasty and cystoscopy. All postoperative diagnosis were consistent with the MRU diagnosis. Conclusion As a multi-angle, multi-faceted, multi-parameter imaging technique with no radiation exposure, MRU has become an important method on the diagnosis, differential diagnosis and the preparation of surgery of neonatal CUJO.