IVP联合IVP后泌尿系三维重建CT在诊断小儿重复肾畸形中的价值
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摘要
目的:探讨静脉肾盂造影(IVP)联合IVP后泌尿系三维重建CT在诊断小儿先天性重复肾畸形中的临床应用价值。方法:40例经术后病理证实的小儿先天性泌尿系重复肾畸形患者,在术前1周内分别行常规泌尿系超声检查、IVP及IVP后CT扫描检查,CT图像后处理采用曲面重建(CPR)、多平面容积重现(MPR)、最大密度投影(MIP)、容积再现技术(VRT)等方法,比较三种成像方法的诊断准确性及对重复肾畸形分型的价值。结果:超声检查确诊31例,诊断准确率77.5%;IVP检查确诊26例,诊断准确率65.0%;IVP联合IVP后CT检查确诊38例,诊断准确率95.0%。而在对已确诊的40例重复肾患者分型中,超声检查分型正确率为70%;IVP分型正确率为55.0%;IVP联合IVP后泌尿系CT检查分型准确率达92.5%;IVP联合IVP后三维重建CT诊断准确率及分型准确率高于超声检查及单纯IVP检查(P<0.05)。结论:IVP联合IVP后三维重建CT技术对小儿泌尿系重复肾畸形有较好的诊断准确性及分型准确性,可指导临床治疗方式。
Objective:To investigate the value of intravenous pyelography(IVP)combined with CT-3 Dreconstruction following IVP in the diagnosis of duplex kidney in children.Method:Children with congenital urinary system anomaly in 40 cases with pathologically confirmed duplication of kidney were performed routine urinary system ultrasonography,IVP and CT scan following IVP within one week before surgery,CT images postprocessing by curved planar reformation(CPR),multiplanar reformation(MPR),the maximum intensity projection(MIP),volume rendering technique(VRT)methods.We compared the diagnostic accuracy and the value of typing of duplex kidney amone three imaging methods.Result:Thirty-one cases were diagnosed by ultrasound,the diagnostic accuracy rate was 77.5%;26 cases were diagnosed by IVP examination,the diagnostic accuracy rate was 65.0%;38 cases were diagnosed by CT following IVP combined with IVP,the diagnostic accuracy rate was95.0%.While in 40 cases with duplex kidney for diagnosed type,ultrasound classification accuracy rate was70%;IVP classification accuracy rate was 55.0%;IVP combined with CT following IVP classification accuracy rate was 92.5%;IVP combined with three-dimensional reconstruction of CT following IVP diagnostic accuracy and classification accuracy was higher than that of ultrasound and IVP examination alone(P<0.05).Conclusion:IVP combined with three-dimensional reconstruction of CT following IVP has good diagnostic accuracy and classification accuracy in children with urinary system duplex kidney disease,which can guide the clinical treatment.
Objective:To investigate the value of intravenous pyelography(IVP)combined with CT-3 Dreconstruction following IVP in the diagnosis of duplex kidney in children.Method:Children with congenital urinary system anomaly in 40 cases with pathologically confirmed duplication of kidney were performed routine urinary system ultrasonography,IVP and CT scan following IVP within one week before surgery,CT images postprocessing by curved planar reformation(CPR),multiplanar reformation(MPR),the maximum intensity projection(MIP),volume rendering technique(VRT)methods.We compared the diagnostic accuracy and the value of typing of duplex kidney amone three imaging methods.Result:Thirty-one cases were diagnosed by ultrasound,the diagnostic accuracy rate was 77.5%;26 cases were diagnosed by IVP examination,the diagnostic accuracy rate was 65.0%;38 cases were diagnosed by CT following IVP combined with IVP,the diagnostic accuracy rate was95.0%.While in 40 cases with duplex kidney for diagnosed type,ultrasound classification accuracy rate was70%;IVP classification accuracy rate was 55.0%;IVP combined with CT following IVP classification accuracy rate was 92.5%;IVP combined with three-dimensional reconstruction of CT following IVP diagnostic accuracy and classification accuracy was higher than that of ultrasound and IVP examination alone(P<0.05).Conclusion:IVP combined with three-dimensional reconstruction of CT following IVP has good diagnostic accuracy and classification accuracy in children with urinary system duplex kidney disease,which can guide the clinical treatment.
引文
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5 戴石,张晓军,张新荣.IVP、CTU及MRU在儿童重复肾畸形中的诊断价值[J].中国医学计算机成像杂志,2015,21(6):571-574.
6 李志勇,林飞飞,孙洁,等.IVU和MRU对儿童重复肾畸形的诊断价值[J].中国临床医学影像杂志,2012,23(4):274-276.
7 李玉华,罗辉,孙成哲.彩超诊断重复肾重复输尿管畸形8例[J].中国临床研究,2012,25(8):789-813.
8 Van Der Molen A J,Cowan N C,Mueller-Lisse U G,et al.CT urography:definition,indications and techniques.A guideline for clinical practice[J].Eur Radiol,2008,18(1):4-17.
9 Stacul F,Rossi A,Cova M A.CT urography:the end of IVU?[J].Radiol Med,2008,113(5):658-669.
10 殷晓鸣,杨屹.重复肾畸形患儿82例临床特点及诊治情况[J].中华实用儿科临床杂志,2016,31(23):1803-1805.
11 Thambidorai C R,Anuar Z.Magnetic resonance urography in duplex kidney with ectopic ureteral insertion[J].J Indian Assoc Pediatr Surg,2011,16(3):115-117.
12 Caoili E M,Cohan R H,Korobkin M,et al.Urinary tract abnormalities:initial experience with multi-detector row CT urography[J].Radiology,2002,222(2):353-360.
13 Brenner D J,Hall E J.Computed tomography--an increasing source of radiation exposure[J].N Engl J Med,2007,357(22):2277-2284.
14 汪玲,李强,仲伟,等.CT检查中碘对比剂对DNA损伤的初步分析[J].中华医学杂志,2017,97(21):1643-1646.
2 GongH,Gao L,Dai X,et al.Prolonged CT urography in duplex kidney[J].BMC Urol,2016,16(1):21.
3 Gonzalez F,Canning D A,Hyun G,et al.Lower pole pelvi-ureteric junction obstruction in duplicated collecting systems[J].BJU Int,2006,97(1):161-165.
4 Croitoru S,Gross M,Barmeir E.Duplicated ectopic ureter with vaginal insertion:3D CT urography with i.v.and percutaneous contrast administration[J].AJR Am J Roentgenol,2007,189(5):272-274.
5 戴石,张晓军,张新荣.IVP、CTU及MRU在儿童重复肾畸形中的诊断价值[J].中国医学计算机成像杂志,2015,21(6):571-574.
6 李志勇,林飞飞,孙洁,等.IVU和MRU对儿童重复肾畸形的诊断价值[J].中国临床医学影像杂志,2012,23(4):274-276.
7 李玉华,罗辉,孙成哲.彩超诊断重复肾重复输尿管畸形8例[J].中国临床研究,2012,25(8):789-813.
8 Van Der Molen A J,Cowan N C,Mueller-Lisse U G,et al.CT urography:definition,indications and techniques.A guideline for clinical practice[J].Eur Radiol,2008,18(1):4-17.
9 Stacul F,Rossi A,Cova M A.CT urography:the end of IVU?[J].Radiol Med,2008,113(5):658-669.
10 殷晓鸣,杨屹.重复肾畸形患儿82例临床特点及诊治情况[J].中华实用儿科临床杂志,2016,31(23):1803-1805.
11 Thambidorai C R,Anuar Z.Magnetic resonance urography in duplex kidney with ectopic ureteral insertion[J].J Indian Assoc Pediatr Surg,2011,16(3):115-117.
12 Caoili E M,Cohan R H,Korobkin M,et al.Urinary tract abnormalities:initial experience with multi-detector row CT urography[J].Radiology,2002,222(2):353-360.
13 Brenner D J,Hall E J.Computed tomography--an increasing source of radiation exposure[J].N Engl J Med,2007,357(22):2277-2284.
14 汪玲,李强,仲伟,等.CT检查中碘对比剂对DNA损伤的初步分析[J].中华医学杂志,2017,97(21):1643-1646.