儿童原发性输尿管纤维上皮息肉影像诊断

IMAGINAL DIAGNOSIS OF PRIMARY URETERAL FIBROEPITHELIAL POLYSP IN CHILDREN

目的通过分析总结不同影像检查中输尿管纤维上皮息肉的影像征象,探讨提高诊断率的方法。方法回顾性评价在安徽省儿童医院行儿童纤维上皮息肉手术和组织学确诊病例中的静脉尿路造影(Intravenousurography,IVU)、CT及MR影像学检查。分析各种检查的充盈缺损、梗阻以远段输尿管显影以及梗阻段输尿管增粗等征象,评估各征象对输尿管息肉的诊断价值。结果37例儿童(男36例,女1例)手术确诊为纤维上皮息肉,均为单发,左侧输尿管息肉35例,右侧2例。儿童年龄范围为4~15岁,平均年龄(8.3±2.8)岁。临床表现包括间歇性钝性腹痛(75.68%,28/37)和/或血尿(48.24%,16/37)。在37名儿童中,行IVU检查34例,CTU检查32例,MRU检查15例,其中9例同时行以上三种检查,31例同时行IVU及CTU检查。各检查方法对充盈缺损、梗阻以远段输尿管显影、梗阻段输尿管增粗征象的显示:IVU检查分别为67.65%(23/34)、76.47%(26/34)、38.24%(13/34);CTU检查分别为为37.50%(12/32)、34.38(11/32)、84.38%(27/32);MRU检查分别为为38.46%(6/15)、15.38(2/15)、23.08%(3/15)。结论IVU是识别导致儿童UPJ梗阻的纤维上皮息肉的有效筛查工具。CTU梗阻段局部增粗是纤维上皮息肉特征性表现,CT多平面重建(MultiplanarreformationMPR)斜冠状位重建更容易显示梗阻段增粗的输尿管,是CTU质量控制的关键点,常规MR序列难以直接显示输尿管纤维息肉。

Objective To summarize the imaging signs of ureteral fibroepithelial polyps in different imaging examinations,and to recommend a better imaging method for the diagnosis of this disease in children.Methods To retrospectively evaluate Intravenous urography(IVU),CT and MR imaging in children with fibroepithelial polyps undergoing surgery and histological diagnosis in Anhui Children's Hospital.To analyze the signs of filling defects,distal ureteral imaging of obstruction and thickening of ureteral obstruction,and evaluate the diagnostic value of each sign for ureteral polyps.Results 37 children(36 males and 1 female)were diagnosed with unilateral fibrous epithelial polyp,35 cases of left ureteral polyp and 2 cases of right.The age of children ranged from 4 to 15 years old and the mean age of children was(8.3±2.8)years old.Clinical manifestations included intermittent blunt abdominal pain(75.68%,28/37)and/or hematuria(48.24%,16/37),which lasts from 1 month to 5 years.Among the 37 children,34 cases underwent IVU examination,32 cases underwent CT examination,and 15 cases underwent MR examination.Among them,9 cases underwent more than three kinds of examination,and 31 cases were examined by IVU and CT examination at the same time.IVU showed 67.65%(23/34),76.47%(26/34)and 38.24%(13/34)of filling defects,distal ureter imaging of obstruction,and thickening of ureter in obstruction,respectively.CT examination was 37.50%(12/32),34.38(11/32)and 84.38%(27/32),respectively.MR examination were 38.46%(6/15),15.38(2/15)and 23.08%(3/15),respectively.Conclusion IVU is an effective screening tool for identifying fiber epithelial polyps that cause obstruction in children.Local thickening and strengthening of CTU venous stenosis is a characteristic manifestation of fiber epithelial polyps.Multiplanar reformation(MPR)oblique reconstruction is easier to show thickened ureters,which is the key point of CTU quality control.Ureteral fibrotic polyps are difficult to visualize directly with conventional MR sequences.