彩色多普勒血流显像指导下重度肾积水静脉尿路造影多层螺旋CT尿路成像的个性化选择

Individual option of IVU and MSCTU in severe hydronephrosis patients guiding by color Doppler flow imaging

目的基于彩色多普勒血流显像(CDFI)技术探索重度肾积水患者尿路成像个性化选择的方法。方法 125例重度肾积水患者经静脉尿路造影(IVU)检查后行多层螺旋CT尿路成像(MSCTU),根据CDFI提示肾血流灌注的不同分4个组:第1组为血流灌注正常(35例);第2组为血流灌注减少(36例);第3组为血流灌注明显减少(44例);第4组为未见血流灌注(10例)。结果第1、2组中IVU、MSCTU检查显影差别均无统计学意义(P>0.05);第3组两者间显影差别有统计学意义(P=0.027),第4组两者均未见显影。结论 CDFI能指导重度肾积水对检查方法的个性化选择,CDFI提示肾内血流正常或减少时,首选IVU检查;肾内血流明显减少时,首选MSCTU检查;肾内无血流信号时,肾多不显影,建议选择CT平扫、多平面重建及曲面重建检查。

Objective To investigate the value of individual option of intravenous urography（IVU） or muhislice spiral computed tomography urography（MSCTU） in severe hydronephrosis patients guiding by color doppler flow imag- ing（CDFI）. Methods 125 severe hydronephrosis patients were applied on MSCTU examination after IVU. According to the blood flow perfusion of kidney in CDFI, 125 patients were divided into four groups as below： group 1 （n=35） were normality of renal blood flow perfusion, group 2 （n=36） showed reduction, group 3 （n=44） were distinct reduction, while no blood flow perfusion of kidney in group 4（n=lO）. Comparison effect was performed using Matched pair design four table of exact probability method. Results There was no statistically significant difference of renal visualized rate between IVU and MSCTU in group 1 and group 2 （P〉0.05）, and the discrepancy had statistics significance （P= 0.027） in the group 3, no visualization of IVU and MSCTU was found in the group 4. Conclusion CDFI can guide the individualized selection of the examination method for severe hydronephrosis, we can select IVU examination when CDFI demonstrates normality or reduction of renal blood flow perfusion; MSCTU is the first choice when CDFI shows distinct reduction; Plain CT Scan with muhiplanar reformation（MPR） and curved planar reformatting （CPR） techniques are the optimal chioce when CDFI displays no blood flow perfusion.