急性肾盂肾炎的CT表现及临床意义

The CT featutres and clinical significance of acute pyelonephritis

目的探讨急性肾盂肾炎(APN)的CT表现,以提高对本病的认识。方法回顾性分析12例经临床证实的APN的多层CT平扫及三期增强表现。结果 12例中,单侧肾受累10例,双侧受累2例;多发病灶4例,单发病灶8例。CT平扫病灶均表现为等或略低密度影。增强CT扫描表现为边界不清,楔形低强化区9例,圆形低强化区3例;其中伴有条纹状低强化区8例;合并肾脓肿及包膜下脓肿各1例;全肾或局部增大10例;所有病例患侧肾周围脂肪内见条絮状影及肾周筋膜不同程度增厚。结论 APN的CT表现具有一定的特征性,且CT诊断APN具有较高的敏感度和特异度,结合临床资料,不难作出准确诊断;通过观察肾实质病变的程度、范围,肾周受累情况和并发症,对临床的治疗及预后评估具有重要意义。

Objective To investigate the CT features of acute pyelonephritis（APN）,in order to improve the understanding of APN.Methods The CT scan features and the three phase enhanced performance of 12 patients with APN confirmed by clinic were analyzed retrospectively.Results Among 12 cases,unilateral kidney involved in 10 cases,bilateral kidney involved in 2 cases;multifocal lesions in 4 cases,unifocal lesion in 8 cases.All cases of unenhanced CT scan showed equal or slightly low density lesions.all lesions were ill-defined and hypoenhanced;wedge-shaped and low intensive area in 9 cases,round-shaped and low intensive area in 3 cases,striated and low intensive area in 8 cases in enhanced CT scan findings;renal abscess and subcapsular abscess was complicated in 1 case respectively;global enlargement or focal swelling of kidney in 10 cases.All cases of the affected renal fat around appeared a flocculent shadow or kidney’s fascia thickening of different degree.Conclusion The CT findings of APN have characteristic features,and CT has a higher sensitivity and specificity in the diagnosis of APN,it is not difficut to make accurate diagnosis by combination of typical clinical features.Extent and range of renal parenchymal disease and complications of perirenal involvement were observed and it has important significance for the clinical treatment and prognosis assessment.