IVP、CTU及MRU在儿童重复肾畸形中的诊断价值

Diagnostic Value of IVP,CTU and MRU in Duplex Kidney of Children

目的:探讨静脉肾盂造影(IVP)、CT尿路造影(CTU)、磁共振尿路造影(MRU)在儿童重复肾畸形中的诊断价值。方法:回顾性分析经临床证实的43例儿童重复肾的影像资料,比较IVP、CTU及MRU在显示儿童重复肾方面各自优势与不足。结果:左侧病变25例,右侧病变13例,双侧病变5例。其中有8例合并重复输尿管异位开口,18例伴有输尿管囊肿。IVP可见重复肾多位于上肾段,大多能显影,对于发育型或轻度积水型重复肾功能显示良好。同时可见完全型或不完全型输尿管重复畸形,并伴有输尿管囊肿。CTU可见重复肾的肾盂肾盏明显扩张,重复肾的动脉供血和静脉回流情况,输尿管的迂曲扩张和梗阻部位。MRU对功能不佳或积水严重重复肾可显示其肾脏内部结构,输尿管的形态和走行。结论:IVP可显示功能正常的重复肾,但其对积水型严重的重复肾畸形则无法显示。CTU虽然能很好显示各类畸形,也能反映重复肾功能状态,但是X线辐射相对较大、且对比剂可能造成不良反应。MRU虽然无法了解重复肾功能,但它无需对比剂、能很好显示积水型重复肾畸形,同时避免了X线照射。因此,MRU和IVP联合应用可以优势互补、提高重复肾畸形的诊断率。

Purpose： To assese the diagnostic value of intravenous pyelography （IVP）, computed tomography urography （CTU） and magnetic resonance urography （MRU） in duplex kidney of children. Methods： The image data of 43 patients with duplex renal pelvis and duplex ureter confirmed by operation results were analyzed retrospectively. The image features were analyzed among IVP, CTU and MRU. Results： All patients were diagnosed as duplex kidneys and duplex ureter, among which 25 cases were with left-sided lesions, 13 cases with right-sided lesions and 5 cases with bilateral lesions. There were 8 cases of duplex ureter with ectopic ureteral orifice, 18 cases with ureterocele. Most of the duplicate kidneys were located at the upper renal moieties, with complete or incomplete duplicated ureter and ureterocele demonstrated by IVP. CTU was reliable in detecting the dilated calice and pelvis of duplex kidney, and distinctly depicting the abnormal urinary tract through image post-processing. MRU was the better test in the evaluation of hydronephrosis type of duplex kidney. Conclusion： MRU and IVP have complementary advantages and improve the accuracy of diagnosis. They are ideally suitable for the diagnosis of children＇s duplex kidneys and duplex ureter.