三聚氰胺致儿童泌尿系结石的临床与影像

目的：探讨食用含三聚氰胺奶粉儿童的泌尿系结石的临床特点和影像学特征。方法：回顾性分析8例儿童泌尿系结石的临床和影像学资料。结果：患儿均有明确食用含三聚氰胺奶粉史,其临床表现主要为不同程度哭闹、发热、呕吐、尿少、尿频、血尿等。8例中有7例患儿年龄〈3岁,占同组患儿的87.5%。B超及CT均可发现结石,单发结石1例,多发结石7例。但在腹部X线平片上结石不显影。结论：食用含三聚氰胺奶粉可引起儿童泌尿系统结石,临床症状无特异性,发病年龄偏小,但结石影像表现具有一定特点。     

多层螺旋CT成像技术对输尿管微小结石的临床应用价值

目的 探讨多层螺旋CT（MSCT）在输尿管重建中显示输尿管结石的临床应用价值。资料与方法 实验组：27个取自患者的泌尿系结石，分别经设置不同扫描参数的单层螺旋CT（SSCT）和MSCT扫描。比较在设置不同扫描参数下SSCT和MSCT的结石检出率，检验不同扫描层厚与检出结石数的关系。临床组：35例腹部平片（KUB）阴性但临床高度怀疑输尿管结石患者均行B超和MSCT扫描及输尿管重建。输尿管重建方法有：曲面重建、最大密度投影和表面遮盖成像。结果 实验组MSCT 5mm和10mm层厚扫描，然后分别以0．62．5mm和1．25mm层厚重建所得的图像，其质量及其显示出的结石数与MSCT相应同等薄层扫描（0．625mm和1．25mm层厚扫描）所得的结果完全一致。临床组35例40个输尿管结石，B超发现23例25个，检出率为62．5％；MSCT薄层重建结合输尿管重建后结石检出率为100％。并能清楚显示结石位置、大小及输尿管梗阻扩张的程度及范围。结论 MSCT常规平扫结合薄层重建特别是CT尿路造影（CTU）可提高结石检出率及评价输尿管有元梗阻及其程度。必要时增强扫描可评价患侧肾功能。     

食用含三聚氰胺奶粉引发婴幼儿泌尿系结石的护理体会

婴幼儿泌尿系结石是小儿泌尿系疾患中较为少见的疾病,是一类具有多种病理改变的疾病.2008-09-14～2008-10-31我科共收治71例,经B超检查确诊的因食用三聚氰胺污染奶粉所致的婴幼儿泌尿系结石患儿,对每例患儿均进行了及时有效的治疗,至2008-10-31,大部分患儿痊愈出院,现将护理体会总结如下.     

多层螺旋CT对显示泌尿系微小结石的实验研究

目的 :评价多层螺旋CT(MSCT)在不同扫描条件下对泌尿系结石的显示率。方法 :5 1个不同大小取自患者的泌尿系结石 ,将结石分为 3组。A组 :大于 5mm(15个 ) ,B组 :3～ 5mm(9个 ) ,C组 :小于 3mm(2 7个 )。分别经设置不同扫描参数的单层螺旋CT(SSCT)和MSCT扫描。比较不同扫描参数设置下SSCT和MSCT的结石检出率 ,检验不同扫描层厚与检出结石数的关系。结果 :所有序列对A、B组的检出率均为 10 0 % (2 4/ 2 4) ,C组检出的结石数与扫描层厚呈明显负相关(MSCT :r=-0 .947,P <0 .0 1;SSCT :r =-0 .999,P <0 .0 1) ,检出的结石数随着扫描层厚变薄而增多。MSCT 5mm和 10mm层厚扫描 ,然后分别以 0 .62 5mm和 1.2 5mm层厚重建所得的图像 ,其质量及其显示出的结石数与MSCT相应同等薄层扫描 (0 .62 5mm和 1.2 5mm层厚扫描 )所得的结果完全一致。结论 :MSCT因其有效的薄层重建能力、超快的扫描速度以及极高的空间分辨率 ,在检测泌尿系小结石方面较SSCT具有明显优势。运用MSCT检测泌尿系结石值得临床广泛应用。     

86例输尿管结石的B超诊断分析

喀什地区是泌尿系结石的高发区,尤以输尿管结石最为常见,通过对86例经临床诊断为输尿管结石的资料进行总结,比较B超和X线对于不同部位的输尿管结石的检出率,探讨B超对输尿管结石的检出率和诊断价值。1资料和方法1.1资料2003年~2005年行B超检查,临床诊断的输尿管结石的86例,年龄     

克罗恩病合并泌尿系结石的多层螺旋CT检查价值

目的：比较分析多层螺旋CT对克罗恩病（CD）与非CD病例合并泌尿系结石的检出率及其价值。方法：回顾性分析308例病理证实的CD病例和300例非CD病例的影像学资料,计算多层螺旋CT对CD与非CD病例合并泌尿系结石的检出率,比较两种疾病泌尿系结石发病率的差异。结果：CT对CD与非CD病例的泌尿系结石的检出率分别为13%和1.3%,二者之间差异具有统计学意义（χ2=30.745,P=0.000）。结论：CD病例的泌尿系结石发病率高于一般非CD人群,多层螺旋CT能在显示肠道病变的同时显示泌尿系结石,具有较好的临床价值。     

婴幼儿泌尿系结石93例治疗分析

2008年7～10月，我院共收治婴幼儿泌尿系结石93例，疗效满意。现报告如下。 1临床资料 1．1一般情况93例中，男57例，女36例；年龄3～32个月，平均13个月。均有三聚氰胺污染的婴幼儿配方奶粉喂养史。其中双侧肾积水16例，单侧肾积水23例；双侧肾结石37例，单侧肾结石33例；双侧输尿管结石4例，单侧输尿管结石14例；     

静脉肾盂造影在当代泌尿系疾病诊断中的临床价值探讨

目的探讨静脉肾盂造影对当代泌尿系疾病的诊断价值，为临床提供可靠的诊断依据。方法对121例需作静脉肾盂造影的病人。常规腹部准备后，按常规摄腹部平片1张，并于注射76％泛影葡胺造影剂后分别于7min、15min、30min、45min各摄肾片1张，除去压迫带后摄全腹片1张。将拍摄到的X光片进行分析，作出初步诊断，并和B超检查结果进行对比。结果121例中结石46例，其中肾结石10例，输尿管结石12例（其中包括肾盂输尿管交界处结石），膀胱结石3例；肾占位6例；肾积水7例；膀胱占位8例；炎症（特异或非特异性）5例；发育及位置异常2例；肾盂血肿2例；未发现异常20例。结论（1）静脉肾盂造影对泌尿系先天发育异常的检出率较高，有其特殊的重要价值，而对肾盂积水原因的检出率较低。（2）静脉肾盂造影对泌尿系肾占住病变原因的检出率明显低于B超，而对膀胱占位则和B超具有同样的检出效果。（3）静脉肾盂造影对泌尿系炎症和外伤的诊断有一定价值，可以适当选用。     

多层螺旋CT阴性法胰胆管成像与MRCP结合MRI诊断胆总管结石的对比分析

目的：探讨螺旋CT阴性法胰胆管成像（N-MSCTCP）对比MRCP结合MRI对胆总管结石的诊断价值。方法：收集临床疑诊胆道梗阻行腹部螺旋CT（MSCT）及MRCP检查的患者136例,MSCT扫描数据经后处理重建获得N-MSCTCP图像。两位医生采用盲法分别对N-MSCTCP及MRCP结合MRI图像作出梗阻定位及定性诊断。以ERCP及手术结果为标准,分别统计分析2种诊断方法对胆总管结石的诊断能力。结果：N-MSCTCP及MRCP结合MRI诊断方法诊断胆总管结石总的准确度分别为82.4%~84.6%和91.2%~92.6%。MRCP结合MRI检出胆总管微小结石阳性率明显高于N-MSCTCP（二者检出率分别为83.9%~87.1%和35.5%~45.2%）,差别有统计学意义（Fisher精确检验,P〈0.05）。两位阅片者间的诊断一致性很好（K〉0.75）。结论：对于胆总管结石N-MSCTCP与MRCP结合MRI均有较高的诊断准确度,而对于微小结石的检出MRCP结合MRI更有优势。     

婴幼儿肠套叠的MSCT诊断

目的总结婴幼儿肠套叠的MSCT表现,并分析其诊断价值。方法回顾分析本院经临床证实的98例婴幼儿肠套叠的MSCT表现。结果 98例经MSCT诊断肠套叠的病例均经临床证实,诊断准确率100%。4例经MSCT诊断有空气灌肠整复禁忌症,均行手术治疗;94例患儿行空气灌肠整复,79例整复成功（整复率84.0%）。结论 MSCT对婴幼儿肠套叠的诊断率准确高,对临床选择肠套叠复位方式具有重要指导意义。     

三聚氰胺致泌尿系统结石的CT表现

目的 总结三聚氰胺致泌尿系统结石的CT表现.方法 同顾性分析19例有服用三聚氰胺污染奶粉史患儿的CT及B超表现.结果CT共发现双肾盂、双输尿管结石1例;一侧肾盂结石、对侧输尿管结石1例;双肾结石2例;单侧肾结石6例;双侧输尿管结石1例;单侧输尿管结石2例;肾盂扩张1例;5例未见异常.膀胱内未见结石.9例为结石合并梗阻,1例只发现尿路梗阻而无结石.CT扫描中发现最小结石为0.3 cm×0.3 cm,最大为肾盂肾盏铸型的鹿角状结石.结石中密度较低的CT值为40～70 HU,最高密度值为410 HU,平均CT值为160 HU.结论CT平扫对三聚氰胺致泌尿系统结石显示效果好,可作为B超诊断困难时的进一步枪查方法 .     

体外冲击波碎石术配合中药排石的疗效观察

目的 观察ESWL治疗后用自拟中药配方配合排石的临床疗效。方法 1250例患尿路结石的患者接受了ESWL治疗,治疗后用自拟中药配方配合排石。结果 与不用自拟中药配方患者对比排石时间缩短了3～5d,痛感明显减轻,血尿时间缩短。结论 ESWL治疗配合中药排石可提高排石率,缓解疼痛,是一种有效的治疗方法。     

老年性食管裂孔疝囊并囊内结石的X线诊断(附7例报告)

目的:探讨老年性食管裂孔疝并疝囊内结石的X线诊断要点及其形成机制。方法:回顾性研究7例老年性食管裂孔疝合并结石的气钡双重造影X线表现特点。结果:由于老年性疝囊两端的A环、C环在长期慢性炎症的刺激下纤维化而狭窄,使疝囊膨胀表现为"吹气球征",7例疝囊上下两端狭窄。7例疝囊内结石未服用产气粉前表现为与疝囊同等大小且边缘光滑的充盈缺损,充盈缺损的长轴与食道长轴方向基本一致,呈现"食管疝囊铸型征"。钡剂沿着充盈缺损的疝囊周壁进入膈下胃腔,多方位旋转显示疝囊轮廓边缘十分光滑且完整,其内充盈缺损与疝囊壁之间存在薄而完整的钡线影。3例充盈缺损的上缘表现为"尖顶征",4例"圆顶征"。服用产气粉后,表现为结石与疝囊形成"套圈征"。结论:老年性食管裂孔疝并疝囊内结石在X线表现上有其特有的征象,能够做出准确诊断。     

非增强螺旋CT低剂量扫描在泌尿系结石诊断中的可行性

目的探讨非增强螺旋CT低剂量扫描在诊断急性腰腹痛或怀疑泌尿系结石中的可行性。方法选择30例临床急性腰腹痛或怀疑患有泌尿系结石而未进行过螺旋CT扫描的患者进行常规剂量和低剂量扫描,扫描层厚10 mm,重叠重建1 mm,并进行MPR等后处理。对获得的图像进行诊断敏感性及准确性分析。结果图像经两名经验丰富的放射科医师进行了评估,所有低剂量扫描图像均获得成功。低剂量螺旋CT扫描中30例患者检出35枚结石,敏感性100%,准确性96.5%。结论研究表明,低剂量螺旋CT扫描对于泌尿系结石的诊断是安全并且敏感的,同时较常规剂量扫描明显减少了患者所接受的辐射剂量。     

CT evaluation of urinary lithiasis

Unenhanced CT has been demonstrated to be the most accurate and efficient diagnostic imaging means to evaluate urinary lithiasis, with capability of directing management, and has become well accepted by radiologists, urologists, and emergency department physicians such that it is now the standard of practice. It is the duty of the radiologist to be aware of proper technique and the details of interpretation. The radiologist also has a duty to be aware of the limitations of unenhanced CT for detection and evaluation of various nonstone disorders, particularly with poor patient selection, and to extend the examination if appropriate. Controversies and future developments include cost containment with care for the selection of patients. Further attempts to reduce radiation exposure should be made. Optimal CT technique is not needed in general merely to detect urinary lithiasis. A consensus should be developed regarding use of CT in pregnant patients. Further improvements in the digital scout view would be useful for following patients.     

Computed tomography appearance of the Lapra-Ty and Weck hem-o-lok clips in patients who recently underwent laparoscopic urologic surgery

The nonmetal suture securing Lapra-Ty clip (LTC) and vessel ligating Weck hem-o-lock clip (WKHL) are useful tools for the laparoscopic surgeon. We report the postoperative computed tomography (CT) scan appearance of these clips. The CT imaging of patients who underwent urologic surgery demonstrate the WKHL and LTC to be radiopaque. Urologists and radiologists should be aware of the radiographic appearance of the LTC and WKHL given the ease with which they could be confused with urinary lithiasis when applied near the urinary system.     

Pattern of uptake and excretion of (18)F-FDG in the lactating breast.

Excretion of radiopharmaceuticals into breast milk poses a potential risk to infants and clear recommendations regarding interruption times are required. There are few data available regarding the impact of (18)F-FDG on this issue. With increasing use of PET for oncologic imaging and its potential advantages to nursing mothers because of its short physical half-life compared with other commonly used tumor imaging agents such as (67)Ga and (201)Tl, evaluation of the excretion pattern of this agent in breast milk is important. METHODS: We have evaluated the uptake of FDG in the breasts in 7 women, 6 of whom were lactating and 1 of whom was in early postpartum but had not commenced breast-feeding. Milk samples were obtained from 4 of the lactating women, including serial samples from 1. RESULTS: Significantly increased breast uptake was identified in all lactating breasts but not in 1 breast consistently refused by the nursing infant or in the woman who had not begun breast-feeding after delivery of her child. No qualitative change or semiquantitative estimate of radiotracer uptake in the breast was seen after expression of breast milk. Decay-corrected activity measurable in breast milk ranged from 5.54 to 19.3 Bq/mL/MBq injected. Using a standard model of breast-feeding, the calculated maximum cumulative dose to the infant, 0.085 mSv with no interruption of breast-feeding, is well below the recommended limit of 1 mSv. CONCLUSION: High uptake of FDG in the lactating breast appears to be related to suckling. There is, however, little secretion of activity into breast milk. Accordingly, a higher radiation dose is received by the infant from close contact with the breast than from ingestion of radioactive milk.     

Opacification of the genitourinary collecting system during MDCT urography with enhanced CT digital radiography: nonsaline versus saline bolus

OBJECTIVE: The purpose of this study was to determine whether a saline bolus during CT urography improves urinary collecting system opacification and whether the addition of enhanced CT digital radiography (CTDR) improves urinary collecting system visualization with or without a saline bolus. MATERIALS AND METHODS: One hundred eight CT urography and enhanced CTDR examinations were reviewed. Fifty-four patients were given a saline bolus during CT urography, and 54 patients underwent CT urography without a saline bolus. Urinary collecting system opacification was evaluated by group (saline vs nonsaline), imaging technique (CT urography alone vs CT urography plus enhanced CTDR), number of enhanced CTDR images, and site of nonopacified urinary segments. Using a multivariate logistic regression model, we determined significance of variables and odds of complete opacification. RESULTS: In the saline group, 248 nonopacified sites were identified on CT urography alone and 95 sites with CT urography plus enhanced CTDR. In the nonsaline group, 185 nonopacified sites were identified on CT urography alone and 59 sites with CT urography plus enhanced CTDR. Combining both groups, 433 nonopacified sites were identified with CT urography alone and 154 sites with CT urography plus enhanced CTDR. Multivariate logistic regression showed significance for group (p = 0.010), imaging method (p < 0.0001), number of enhanced CTDR images (p = 0.048), and site of segment opacification (p < 0.0001). The renal pelvis shows the greatest odds and the distal ureter the lowest odds for complete opacification by group or imaging method. CONCLUSION: The addition of a saline bolus offers no improvement, whereas the addition of enhanced CTDR offers significant improvement in collecting system opacification during CT urography.     

Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients

The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value.