螺旋CT及其泌尿系成像对输尿管病变的诊断价值

目的 探讨螺旋CT及其泌尿系成像（spiral CT urography,SCTU)技术对输尿管病变的诊断价值。方法 27例输尿管病变患者中，结石9例、肿瘤5例、狭窄9例、畸形1例、炎症1例及输尿管瘘2例。均行螺旋CT泌尿系检查。注射对比剂后10－15min行螺旋CT容积扫描，在工作站利用软件进行图像后处理，获得泌尿系立体图像。其中15例同时行螺旋CT平扫，10例行静脉泌尿系造影。结果 （1）螺旋CT平扫8例阴性结石清晰可见。（2）SCTU图像上，8例阴性和1例阳性结石可见其、形态、大小及扩张的肾孟和输尿管；5例输尿管肿可见局部管腔内对比剂柱变细或突然中断，管壁不光整；7例单纯狭窄可见狭窄部位管腔逐渐变细，管壁无明显增厚。2例迷走血管压迫致狭窄者均位于肾孟输尿管交界处；1例重复肾并输尿管畸形者显示双肾孟、双输尿管；输尿管瘘者显示瘘口位置、走行。结论 与普通CT及静脉泌尿系造影（IVU）相比，螺旋CT及其SCTU技术有明显优越性，可使静脉管病变诊断准确率明显提高。

Evaluation of spiral CT in the diagnosis of ureteral diseases

Objective To discuss the diagnostic value of spiral CT in ureteral diseases. Methods Spiral CT urography (SCTU) was performed in 27 cases with ureteral diseases, including 9 cases of ureteral calculus, 5 carcinomas, 9 stenosis, 1 malformation, 1 inflammation and 2 fistula. Of the 27 cases,15 also underwent non-enhanced spiral CT scan and 10 received intravenous urography(IVU). Results (1) Eight cases of radiolucent ureteral calculus were clearly showed by nonenhanced spiral CT. (2) On SCTU, the location and diameter of 9 ureteral calculus(8 radiolucent, 1 radiopaque) and enlargement of renal pelvis and ureter were displayed. Irregular ureteral wall, local rarefication or obstruction of contrast medium in ureter were detected in 5 case of tumor.Ureteral lumen was narrowed gradually in 7 cases of simple ureteral stenosis without thickening of the wall. Two cases with ectopic vessel compression were clarified at the boundary of ureter and pelvis. 1 malformation with double renal pelvis and ureter was demonstrated. The location and direction of ureteral fistula were notified. Conclusion SCTU is superior to IVU and conventional CT in improving diagnostic accuracy of ureteral disease.