CT诊断结石梗阻性肾积水并发感染的研究

Research on CT in diagnosis of calculous obstructive hydronephrosis complicated with infection

目的:探讨计算机断层扫描(CT)对结石梗阻性肾积水并发感染的诊断价值,为临床治疗提供依据。方法:收集经手术病理确诊的结石梗阻性肾积水并发感染的患者107例,以手术病理结果为对照,比较CT、B超诊断肾积水及其程度、梗阻结石及其部位的准确性,并分析CT图像中提示感染的征象。数据用SPSS17.0软件进行统计处理。结果:CT诊断肾积水的检出率为98.1%,对肾积水程度的诊断与手术病理结果比较差异无统计学意义(P>0.05)且一致性较好(Kappa=0.912,P<0.001)。CT诊断梗阻结石及其部位的检出率均为100%。提示感染的CT征象:平扫表现为肾盂壁增厚,肾窦脂肪间隙模糊,肾包膜粗糙、增厚,肾实质低密度灶,肾周间隙低密度灶,肾积脓;平扫表现正常,增强扫描表现为局灶性或弥漫性楔形或窄条纹状低增强改变。结论:CT对于结石梗阻性肾积水并发感染具有较高的诊断价值,能给临床治疗提供可靠的影像学依据。

Objective To evaluate the value of computed tomography（CT） in diagnosis of calculous obstructive hydronephrosis complicated with infection,so as to provide evidence for clinical treatment.Methods 107 patients of calculous obstructive hydronephrosis complicated with infection which was confirmed by operation and pathology were collected.The accuracy of CT and B ultrasound in diagnosis of hydronephrosis and its degree,obstructive calculus and its location were compared with the results of surgery and pathology.The signs of infection in CT images were analyzed.Data were processed with SPSS17.0.Results The detection rate of CT in diagnosis of hydronephrosis was 98.1%.There was no significant difference between CT in diagnosis of the degree of hydronephrosis and the results of surgery and pathology（P〉0.05） and the consistency was better（Kappa=0.912,P〈0.001）.The detection rate of CT in diagnosis of obstructive calculus and its location was all 100%.The signs of infection in CT images：in plain CT scan images,renal pelvic wall thickening,blurred renal sinus fat space,rough and thickening renal capsule,hypodense of renal parenchyma,hypodense of perirenal space,pyonephrosis;While normal in plain CT scan images,focal,diffuse,wedge or narrow stripe low enhanced changes were showed in enhanced CT scan images.Conclusion CT is of high diagnostic value in diagnosis of calculous obstructive hydronephrosis complicated with infection and can provide reliable imaging evidence for clinical treatment.