层螺旋CT尿路成像对输尿管病变诊断价值.docVIP

64层螺旋CT尿路成像对输尿管病变的诊断价值 作者：麦栩榆 胡茂清 龙昉 龙晚生 张朝桐 梁启堂 庞健 【摘要】 目的 探讨64层螺旋CT尿路成像技术对输尿管疾病的诊断价值。方法 对126例临床怀疑输尿管梗阻患者进行64层螺旋CT容积扫描，将原始数据传至工作站，应用MPR、CPR、MIP、VR进行图像后处理。结果 输尿管结石67例，输尿管先天性变异及畸形26例，输尿管炎性狭窄6例，肾输尿管结核2例，输尿管癌4例，副肾动脉压迫输尿管1例，膀胱疾病累及输尿管8例，邻近器官病变累及输尿管致输尿管梗阻6例，盆腔疾病术后粘连致输尿管梗阻5例，直肠癌术后输尿管瘘1例，以上病例均得到手术、输尿管镜检查和临床证实。结论 MSCTU通过MPR、CPR、MIP、VR技术能清楚输尿管疾病的位置和形态，在输尿管疾病的诊断方面具有独特的优势。 【关键词】 输尿管疾病;多层螺旋CT尿路成像;三维重建 　　[Abstract] Objective To explore the diagnostic value of 64-slice spiral computed tomography urography(MSCTU) in ureter diseases. Methods MSCTU was performed in 126 patients with ureter obstruction suspicious clinically, the volume data of all patients were reconstructed on work station(Vitrea 2) with the techniques of multiple plane reformation(MPR), curved planar reconstruction(CPR), maximum intensity projection (MIP) and volume rendering(VR). Results Among the 126 cases, there were 67 cases of ureteral calculus, 26 cases of congenital variation and deformity, 6 cases of inflammatory stenosis, 2 cases of ureter and kidney tuberculosis, 4 cases of primary ureteral cancer, 1 case of accessory renal artery compression at right ureter, 8 cases of secondary ureter dilatation involved by bladder diseases, 11 cases of ureter obstruction involved by the diseases of adjacent organs and post-operative adhesion, 1 cases of uretero-rectal fistula. All cases were confirmed by surgery, ureteroscopy and clinic. Conclusions With 3D reconstruction techniques(MPR, CPR, MIP and VR), MSCTU can clearly demonstrate the locations and shape of ureter diseases, which has obvious advantage in the diagnosis of ureter diseases. 　　[Key words]Ureter diseases; Multi-slice CT urography; Three-dimension reconstruction 　　输尿管位于腹膜后，行程长，走行迂曲，与周围组织缺乏天然对比，传统的静脉尿路造影(IVU)和超声检查诊断价值有限，随着多层螺旋CT的临床应用，CT尿路成像(MSCTU)这一新技术也日趋成熟，为输尿管疾病的诊断提供了丰富的信息和可靠的依据。作者通过对本院126例临床怀疑输尿管梗阻患者进行64层螺旋CT尿路成像检查，评价其在输尿管病变中的临床应用价值。 　　资料与方法 　　1.临床资料 我院2007年11月至2009年9月共126例临床怀疑输尿管梗阻患者进行了MSCTU检查，男性66例，女性60例，年龄24天～78岁，平均39.5岁。临床症状有不同程度腰痛、血尿、尿频、尿急、尿痛等症状