螺旋CT尿路成像在小儿上尿路疾病诊断中的价值

Clinical study of spiral CT urography in the diagnosis of urinary tract disease in children

目的 比较螺旋CT尿路成像 (CTU)与静脉尿路造影 (IVU)、磁共振尿路成像 (MRU)在小儿上尿路疾病检查中的应用 ,探讨CTU对各种上尿路外科疾病的诊断价值。方法 62例疑上尿路病变儿童均做了CTU检查 ,3 1例同时行IVU检查、13例同时行MRU检查作为对照。对上尿路各部位的显影清晰度进行评分 ,比较 3种检查方法对上尿路各段的显示能力。按病种分类 ,评价CTU对儿童各种上尿路外科疾病的诊断价值 ,并与IVU、MRU比较。结果 在尿路形态正常组 ,CTU和IVU对上尿路各段的显影统计学上差异无显著性意义 ,且均好于MRU(P <0 0 1)。在异常组 ,CTU对肾盏、肾盂的显示优于IVU和MRU(P <0 0 1) ;上段输尿管的显影 ,三者间统计学上差异无显著性意义 ;中、下段输尿管的显示 ,CTU、MRU均高于IVU ,且统计学上差异有显著性意义 (P <0 0 1)。CTU对重复肾输尿管畸形、肾发育不良的诊断符合率均为 10 0 % ,高于IVU和MRU ;对上尿路积水的诊断符合率 ,CTU、MRU均为 10 0 % ,高于IVU(62 5 % ,)。结论 CTU为诊断小儿上尿路外科疾病提供了确切依据 ,解决了诊断中的难题 ,提高了诊断率。如疑有肾发育不良、重复肾输尿管畸、肾输尿管重度损伤等上尿路外科疾病 。

Objective To evaluate the abiliy of excretory CT urography (CTU) in the application of the upper urinary tract in children by comparing with intravenious urography (IVU) and magnetic resonance urography (MRU), and to evaluate the value of CTU in the diagnosis of various diseases on upper urinary tract in children Methods Sixty two children suspected with upper urinary tract disease were imaged by CTU, 31 of them underwent IVU, and 13 of them underwent MRU Each urinary tract was arbitrarily divided into five parts (calice, pelvis, upper, middle, and lower ureters) for scoring of images on a five point scale for opacification by contrast material Opacification scores for the two groups (normal and abnormal) of urinary tracts were then compared Compared with IVU and MRU, CTU was evaluated in the diagnosis of upper urinary tract disease in children Results The score of IVU and CTU was higher than that of MRU for all parts of the normal urinary tracts ( P <0 01). The score of CTU was higher than that of IVU and MRU for calice and pelvis of the abnormal urinary tracts ( P <0 01). Differences in scores for upper ureter were not statistically significant among IVU, CTU, and MRU The score of CTU and MRU was higher than that of IVU for middle and lower ureters ( P <0 01) The accurate rate of CTU in diagnosing renal duplication and renal hypoplasia was 100%, which was higher than that of IVU and MRU. In diagnosing the hydronephrosis, CTU (100%) and MRU (100%) were better than IVU (62 5%); CTU was also more reliable in detecting the ectopic ureteral orifice, ureterocele, and severe renal injury than IVU and MRU Conclusion CTU is a reliable technique for the diagnosis of urinary tract diseases If a child was suspected to have each of the following diseases by ultrasound examination, such as renal duplication, renal hypoplasia, and severe renal injury, CTU could be selected as the first choice