螺旋CT及三维重建尿路成像在肾发育不良诊断中的应用

Spiral CT urography in diagnosing renal hypoplasia in children

目的 寻觅诊断小儿肾发育不良最好的检查方法。方法 对 7例正常排尿的间歇期有会阴部滴尿的患儿 ,均经超声、单光子发射计算机断层肾动态显像 (SPECT)、静脉尿路造影、(IVU)和CT尿路成像 (CTU)检查。并对照术后诊断 ,比较CTU、IVU、超声、SPECT对肾发育不良的诊断符合率。结果 7例患儿的发育不良肾CTU均清晰显示 ,左侧 3例 ,右侧 4例。增强后实质期图像示病变侧腰大肌前方明显强化的肾样小结节 ,分泌期图像可显示集合系统及输尿管腔 ,MPR、3D、4D像直观、立体 ,显示了发育不良肾的大小、位置、轮廓及其输尿管走行。CTU诊断符合率 10 0 %。ECT检查仅 1例显示发育不良肾 ,诊断符合率 14 .3% (1/ 7)。IVU、B超均未能显示发育不良的肾和输尿管。CTU的诊断符合率明显高于SPECT、IVU及B超。结论 如疑有肾发育不良或经超声初步检查仅发现一个肾 ,应行CTU检查 ,以明确是否为单侧肾发育不良。

Objective To evaluate CT urography ( CTU ) in the diagnosis of renal hypoplasia in children and compare it with IVU,ECT and ultrasounography. Methods Seven children presented normal voiding with intermittent vulva wetting and underwent spiral CT,ultrasounography,ECT and IVU studies.Results All 7 cases were diagnosed as renal hypoplasia and the ectopic ureteral orifice was clearly visualized on CTU while ultrasound or IVU failed to confirm.Only one hypoplastic kidney was detected by ECT.The hypoplastic kidneys were 1.5?cm to 3.5cm in diameter.Conclusions CTU is more reliable in detecting the renal hypoplasia and its ectopic ureteral orifice than ECT,IVU or ultrasounography.CTU offers the best modality in diagnosing renal hypoplasia.If only one kidney could be detected by ultrosonography,CTU should be performed to differentiate renal hypoplasia from solitary kidney.