多层螺旋CT对马蹄肾的诊断价值

The application value of MDCT in diagnosis of horseshoe kidney

目的探讨多层螺旋CT(MDCT)在诊断马蹄肾的扫描方法及其临床应用价值。方法回顾性分析19例马蹄肾的临床完整资料,均行多层螺旋CT平扫加多时相分期增强扫描检查,并在工作站对获取的平扫及多时相分期增强扫描薄层图象行多平面重组(MPR)、容积再现(VR)及四维透明显示(4D-Raysum)3种方法后重组。结果 19例马蹄肾均为双肾下极连接融合,融合的峡部肾实质相连17例,纤维组织连接2例。伴多支肾动脉供血7例,肾盂输尿管交界部狭窄5例。马蹄肾并发肾盏或肾盂结石6例,输尿管下段结石1例,肾盏肾盂积水10例。1例马蹄肾合并左肾透明细胞癌,行手术病理证实。结论应用多层螺旋CT对马蹄肾进行合理方法扫描并结合多种方法后重组,可以清楚显示马蹄肾的融合的部位、性质及并发症的发生情况,为临床提供更多的影像信息,可做为马蹄肾综合影像学评价的最好检查方法。

Objective To determine the imaging methods and clinical application value of multidetector CT （MDCT） in the diagnosis of horseshoe kidney. Methods Clinical data of 19 cases were analyzed retrospectively, all examinations were performed with a multidetector CT scanne including spiral CT in plain and multiphase enhancement scans, the plain and multiphase enhancement scan raw data transmitted to the workstation and the post-processing including multiplanar recon- struction （MPR）, volume rendering （VR） and 4D-raysum were performed for reconstruction. Results The 19 patients with horseshoe kidney are double kidney lower poles connecting fusion, horseshoe kidneys that are fused with functioning renal parenchymal （n= 17） and fibrous tissue isthmus （n= 2）. Other abnormal appearance in 19 cases included multi-renal arterial （n= 7）, strictures at the ureteropelvic junction （n= 5）. Complications happened in 19 cases including renal calyce- al or pelvic stones （n= 6）, lower ureteral stones （n= 1） and nephrydrosis （n= 10）, and 1 case of horseshoe kidney with left renal clear cell carcinoma is confirmed by surgery and pathology. Conclusion The reasonable application scanning method combined with multiple reconstruction method of multidetector CT can clearly show horseshoe kidney and may pro- vide further information for clinical diagnosis. It is a very useful method in the comprehensive imaging evaluation of horse- shoe kidney.