氯胺酮相关性膀胱炎的影像学表现

The Radiological Findings of Ketamine-Induced Cystitis

目的总结氯胺酮相关性膀胱炎(KIC)的CT、膀胱造影及IVP表现。方法回顾性分析41例长期吸食氯胺酮且出现严重膀胱刺激征患者的CT、膀胱造影及IVP资料,探讨KIC的影像学特点。结果25例行CT检查,均见膀胱挛缩,呈"葫芦征"、"鸟嘴征"改变,壁不规则增厚,双侧壁及(或)前壁增厚16例(64.0%),膀胱全壁增厚5例(20.0%),膀胱壁结节状增厚2例(8.0%),右侧壁及后壁各1例(4.0%),平均增厚约10.4 mm(10.4±4.8,4~25 mm),平扫密度平均为39.4 HU(39.4±3.4,35~46 HU),增强扫描密度平均为54.4 HU(54.4±4.9,50~66 HU),并见明显强化不规则增厚的膀胱黏膜线。发现不同程度上尿路扩张11例(44.0%),其中的10例输尿管下段管壁增厚,另外1例双侧输尿管全程增厚及双肾实质损伤。3例(12.0%)合并膀胱结石。32例行膀胱造影,29例(90.6%)膀胱边缘不光滑,严重者囊袋状向外突出,多数容量明显减小,小于100 ml 26例(81.3%),6例大于100 ml,发现输尿管反流10例(31.3%)。15例行IVP检查,膀胱壁边缘不光滑,7例(46.7%)输尿管扩张,2例(13.3%)输尿管出口狭窄。结论KIC具有一定的影像学特征,CT、膀胱造影、IVP三者结合有助于提高对KIC的全面观察,提高诊断准确率。

Objective To summarize the imaging features of Ketamine-induced cystitis,including computed tomography（CT）,cystography and intravenous pyelography（IVP）.Methods The radiological findings were analyzed in 41 patients,all with a history of ketamine abuse,who presented with severe cystitis.Results①CT scanning performed in 25 patients.CT revealed marked,cystospasm shaped like a gourd or a beak,generalized bladder wall thickening,average 10.4mm（10.4±4.8,4-25 mm）,which showed bilateral wall and（or）anterior wall thickening in 16 cases（64.0%）,diffuse incrassation in 5 cases（20.0%）,nodular thickening in 2 cases（8.0%）,and one case（4.0%）each of thickening in the right side and back wall.The average CT attenuation of bladder walls were 39.4 HU（39.4±3.4,35-46 HU）on plain CT images and 54.4HU（54.4±4.9,50-66HU）on enhanced images and mucosal enhancement.11 cases（44.0%）were found to have upper urinary tract dilation,there 10 cases accompanied by lower ureteral wall thickening and the other one had renal parenchymal damage.3 patients（12.0）had complicated cystitis with bladdestones.②Cystography performed in 32 patients,found bladder deformity with pocket like processes,most of them had small bladder volume and 26 cases（81.3%）less than 100ml.10 cases（31.3）found vesicoureteral reflux.③IVP performed in 15 patients.7 cases（46.7）had upper urinary tract dilation and 2 cases（13.3%）had ureterostenosis.ConclusionKIC had typical imaging features.It is helpful to use CT、cystography and IVP in combination,for the comprehensive observation and diagnosis of KIC.