第六节
泌尿系统先天异常的比较影像学
泌尿系统先天异常性疾病的比较影像学有许多共同之处,有些在前几节中已分别提到,在这一节再集中讨论如下。
对于泌尿系统先天异常性疾病,目前CT及MRI已经逐步取代肾盂造影成为常规首选检查手段。泌尿系统先天异常性疾病以肾的先天畸形多见,如异位肾、融合肾、肾缺损等。平片有时可有些帮助,但不能定性及准确定位,只能发现合并的结石及海绵肾中的小结石。CT及MRI,尤其是前者为目前诊断肾先天畸形的最好方法,因可以完全显示病变的全貌,使之成为目前的常规检查,价格与静脉肾盂造影相差无几。但是对肾先天性旋转不良、肾盏憩室等必须应用肾盂造影方能很好显示其畸形。MRI多方位成像及MR水成像技术的发展,对确诊肾先天畸形有很大意义,其缺点是扫描时间长、不能发现合并的小结石等。B超对于诊断先天畸形有一定的帮助,但有时由于肠气等声影的干扰,完全定性则有困难,但其价格便宜,可用于床旁观察,初步发现异常,然后选择其他方法(如CT、MRI)定性,此点是B超的优势。肾血管的畸形只有选择性血管造影方能确诊。核素检查可发现个别异位肾,但作用不大,故一般很少应用。
输尿管的各种先天异常中,静脉法肾盂造影显示输尿管全貌为其主要检查方法,但有时由于肾功能不好,肾盂未见显影,必须应用逆行尿路造影以显示输尿管的情况,如输尿管狭窄、巨输尿管等。CT在某些部位可以观察到扩张的输尿管及确定阻塞部位,而对于其内部结构及有些发育异常,如输尿管开口异位、输尿管瓣膜等不能发现。MR水成像技术对于输尿管及肾盂显示有帮助,如巨输尿管、输尿管口囊肿等,可以作为辅助诊断手段,且对于有些细节显示不好。超声对于输尿管病变帮助不大。
膀胱的先天异常以尿路造影为主,如静脉法尿路造影可以充盈膀胱,多种位置投照可以显示重复膀胱、隔壁膀胱及膀胱憩室等,必要时可应用逆行膀胱造影,但对于先天性输尿管口囊肿,应用B超、CT及MRI均可显示。尿道先天异常主要应用排尿性尿道造影或逆行尿道造影,有时为了同时观察肾盂膀胱情况,可应用静脉法尿路造影,其他方法价值不大。
(陈丽华 季倩 沈文)
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