氯胺酮相关性泌尿系统损害的影像学表现

Radiological Investigations in Ketamine-Induced Uropathy

目的:探讨氯胺酮相关性泌尿系统损害(KIU)的影像学特征。方法:对29例KIU患者影像学特征进行回顾性分析。包括CT图像、超声图像、单光子发射型计算机断层扫描(SPECT)图像、静脉尿路造影(IVU)图像和磁共振尿路造影(MRU)图像。结果:CT图像显示患者膀胱挛缩、膀胱/输尿管壁增厚、黏黏膜强化、输尿管扩张、肾积水,其中9例(31%)膀胱外形呈“雪人征”。超声图像显示肾积水、输尿管扩张、膀胱壁增厚、膀胱挛缩。SPECT影像显示肾小球滤过率下降和肾排泄时间延长。IVU图像显示膀胱挛缩、膀胱形状不规则和肾积水。MRU图像显示肾积水、输尿管扩张、输尿管狭窄和僵直。结论:KIU具有典型的影像学特征,主要表现为膀胱挛缩、膀胱壁及输尿管壁增厚、集合系统扩张积水及肾实质损害。影像学检查,尤其CT检查有助于KIU的确诊、损害程度的判断、治疗效果评价及随访。为预防肾脏发生严重的、不可逆的损伤,即使未出现下尿路的影像学异常表现,也应重视上尿路的检查。

Purpose:To investigate the imaging features of ketamine-induced uropathy(KIU)through review of medical images.Methods:The imaging data of 29 patients with KIU were reviewed,including computed tomography(CT),ultrasound,single-photon emission computed tomography(SPECT),intravenous urography(IVU),and magnetic resonance urography(MRU).Results:The CT findings included small bladder volume;bladder/ureter wall thickening;mucosal enhancement;dilatation of the ureter;and hydronephrosis.Nine patients(31%)were with characteristic imaging of gourd-or snowman-shaped bladders.Ultrasound revealed hydronephrosis,dilatation of the ureter,bladder wall thickening,and small bladder volume.The abnormal findings on emission CT included decrease of glomerular filtration rate and prolonged kidney excretion time.Intravenous urography showed small bladder volume,irregular shape of the bladder,and hydronephrosis.Magnetic resonance urography revealed hydronephrosis,dilatation of the ureter,and ureteral strictures and straightening.Conclusion:KIU has certain characteristics,such as small bladder volume,bladder/ureter wall thickening,dilatation of the ureter,hydronephrosis,and renal damage.Radiological studies,in particular by CT,aid evaluation of the extent of ketamine-induced uropathy.Upper urinary tract examination in patients with ketamine-induced uropathy is extremely necessary to prevent severe and irreversible renal damage,even in patients without positive findings detected in the lower urinary tract.