5种影像学检查方法对下腔静脉后输尿管诊断价值比较.doc

5种影像学检查方法对下腔静脉后输尿管诊断价值比较 　作者：黄科峰，赵国宏，席涛，张婷，薛宝山，陶飞，韩俊玲，黄金山，王刚，孟安启，吴勇军，周保成 【摘要】 目的 探讨IVP、RP、B超、CT及MRU诊断下腔静脉后输尿管的临床价值。方法 总结经手术证实的8例下腔静脉后输尿管的IVP、RP、B超、CT及MRU资料，比较五种影像检查方法的准确性及临床实用价值。结果 B超仅能作为筛选方法，IVP及RP可提示本病，RP后立即CT薄层扫描及MRU可明确诊断，诊断率均为100%。结论 RP后立即CT薄层扫描及MRU两种检查方法均较简便、快捷、准确，具有很高的临床应用价值。当逆行输尿管插管失败时，MRU更具实用价值。 【关键词】 输尿管；静脉尿路造影；逆行尿路造影；磁共振尿路成像；B超检查；X线计算机体层摄影术 Abstract： Objective To investigate the clinical value of intravenous pyelography (IVP), retrograde pyelography (RP), B-type ultrasonic inspection, computerized tomography (CT) and magnetic resonance urography (MRU) in the diagnosis of postcaval ureter.Methods The analysis was done on the basis of 8 cases of postcaval ureter diagnosis through IVP, RP, B-type ultrasonic inspection, CT and MRU, by means of comparing the accuracy and the clincal value of the above five imaging scan methods.Results B-type ultrasonic inspection could only serve as a screening technique, IVP and RP could give a clue to the disease, while CT of thin layer scaning soon after RP and MRU could provide a clear diagnosis with an accuracy of 100%. Conclusion CT of thin layer scan soon after RP and MUR is convenient, fast and accurate, being worthwhile to be recommended in the clinical practice. When the retrograde intra-ureteral cannula failed, MRU is of more pratical value. Key words： postcaval ureter; intravenous pyelography; retrograde pyelography; B-type ultrasonic inspection; computerized tomography; magnetic resonance urography 下腔静脉后输尿管是一种泌尿系的发育畸形，临床少见。本组8例，均经手术证实。现将术前5种影像检查方法（IVP、RP、B超、CT及MRU）的结果分析如下，以比较各种检查方法的临床价值。 1 材料与方法 1.1 一般资料 本组8例中男5例，女3例。年龄23~60岁，平均41岁。临床症状均以右腰部酸痛不适为主。其中合并右肾结石伴肾绞痛2例，血尿2例，尿频、尿急、尿痛2例，右肋脊角叩痛3例。静脉尿路造影（IVP）8例，逆行尿路造影（RP）7例，B超检查8例，CT检查8例，磁共振尿路成像（MRU）检查4例。 1.2 检查方法 采用西门子欢悦螺旋CT机，RP后立即行右输尿管CT薄层（层厚2~3 mm）扫描。MRU采用1.5T西门子超导型扫描系统，体部线圈，厚层冠状面重T2加权水成像，快速自旋回波，TR4 500 ms，TE985 ms，层厚80~100 mm，感兴趣区包括双肾、输尿管、膀胱等脏器。薄层冠状面重T2加权水成像，快速自旋回波序列，TR1 900 ms，TE105 ms，层厚3 mm，感兴趣区与厚层冠状位一致，屏气扫描，屏气时间4.5~160 s。IVP、RP及B超均按常规方法检查。 2 结果 2.1 B超 8例均发现右肾