多层螺旋CT尿路造影对上尿路梗阻性疾病的诊断价值

目的 探讨多层螺旋CT尿路造影（MSCTU）在上尿路梗阻性疾病诊断中的价值。资料与方法 搜集经静脉肾盂造影（IVU）或其他影像学检查提示上尿路梗阻而原因不明的患者58例，均行MSCTU检查，在图像工作站对获得图像进行最大密度投影（MIP）、多平面重建（MPR）及容积再现（vRT）等三维后处理，获得泌尿系立体图像。结果 58例中上尿路结石20例，先天性畸形14例，输尿管癌11例，输尿管炎性狭窄3例，输尿管息肉2例，副肾血管压迫肾盂输尿管交接处2例，邻近器官疾病导致上尿路梗阻2例，以上病例均经手术或输尿管镜检查证实。另有4例无法确诊，诊断准确率为93．10％。结论 MSCTU通过MPR、MIP、VRT技术多角度观察能够更加清晰地显示出导致上尿路梗阻的病变及其形态，在上尿路梗阻病变诊断方面有独特的优势。

Clinical Evaluation of MSCTU in the Diagnosis of Upper Urinary Tract Obstruction

Objective To evaluate the clinical value of MSCTU in diagnosing the upper urinary tract obstruction. Materials and Methods MSCTU was performed in 58 patients with upper urinary tract obstruction indicated with IVU or other imaging. The volume data of all patients were reconstructed with the 3D reconstruction techniques including maximum intensity projection (MIP), multiple plane reformation(MPR), and volume rendering technique(VRT).Results Among the 58 cases, there were 20 cases of ureteral calculus, 14 cases of congenital deformities, 11 cases of primary uretal cancer, 3 cases of inflammatory stenosis, 2 cases of uretal polypus, 2 cases of ectopic vessel compression at the boundary of ureter and pelvis, 2 cases of ureter involved by adjacent organs. All cases were confirmed by surgery or ureteroscopic findings. There were still 4 cases not to be confirmed, the rate of correct diagnosis was 93.10%. Conclusion With 3D reconstruction technique (MPR, MIP and VRT), MSCTU can clearly demonstrate the lesions and its shape. MSCTU has obvious advantage in the diagnosis of upper urinary tract obstruction.