首诊泌尿道感染患儿影像学检查评价与分析  

Evaluation and analysis of imaging modalities in children with first urinary tract infection

作　　者：赵瑞芳[1] 曾纪骅[1] 季志英[1] 吕孝妹[1] 吴哈[1] 李益卫[1] 顾凡磊[1] 赵晓斐[1] 

机构地区：[1]复旦大学医学院附属儿科医院核医学科,上海200032

出　　处：《中国医学影像技术》2006年第7期1083-1086,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的通过对首次就诊的UTI患儿核素肾皮质显像、肾脏B超等影像检查结果进行分析比较,从而探讨小儿UTI影像学检查的策略.方法研究对象为224例首次就诊的UTI患儿,在1周内进行^99Tc^m-DMSA肾皮质显像及肾脏超声检查评价是否有肾实质感染,一到两周内进行膀胱输尿管显像以评价VUR.结果经DMSA显像证实121例（54%）存在肾实质感染,其中8人伴肾瘢痕形成;103例（46%）DMSA显像正常.以DMSA肾显像为诊断标准,B超检查评价肾实质感染的灵敏度为53.72%.在肾实质感染患儿中,41%存在膀胱输尿管返流.100个发生损害的肾脏,48%存在膀胱输尿管返流;而92个未发生损害的肾脏,有1个存在中度VUR.在有肾瘢痕的UTI患儿中,75%存在膀胱输尿管返流.对VUR分度及肾损害分级进行等级相关分析,发现肾损害分级程度越重,VUR分度越高.结论对首诊的UTI患儿,临床上怀疑肾实质感染者,应行DMSA显像以准确评价肾损害程度,B超检查可作为筛查及补充手段;DMSA显像提示肾损害或有反复尿路感染者,尤其是有瘢痕形成的UTI患儿,行VUR检测十分必要,并建议3～6个月后随访DMSA显像,以检测是否发生肾瘢痕.Objective To study the strategy of imaging modalities in children with first urinary tract infection （UTI） by analyzing and evaluating the results of ^99Tc^m-DMSA renal cortical scintigraphy findings, renal ultrasound and radionuclide cystogram （RNC）. Methods We studied 224 children with first UTI. ^99Tc^m-DMSA renal cortical scintigraphy and renal ul- trasound were performed in 1 week, and RNC in 1 or 2 weeks. Results 121 cases （54%） were proved renal parenchyma inflammation, including 8 cases of renal scar, and 103 cases （46%） were normal kidneys by ^99Tc^m-DMSA renal cortical scintigraphy. Taking renal cortical scintigraphy findings as the standard of reference, the sensitivity for detecting renal parenchyma inflammation using renal ultrasound was 53.72%. Vesicoureteral reflux （VUR） was found in 41% patients with renal parenchyma infection. While in 92 normal kidneys, moderate VUR was detected in only 1 kidney. Among 100 damaged kidneys, 48% had VUR. And in children with renal scar, 75% were discovered to have VUR. Statistics analysis proved that grade of renal damage demonstrate a significant correlation with the presentation of a high grade of VUR. Conclusion For children with first UTI, who are suspected of renal parenchyma inflammation, ^99Tc^m-DMSA renal cortical scintigraphy should be performed to identify kidneys at risk for acute pyelonephritis and renal scarring accurately. And renal ultrasound is taken as screening and supplementary means. If ^99Tc^m- DMSA renal cortical scintigraphy showed renal damage, especially renal scar, it is wise to evaluate VUR for the moment. To detect possibilities of scar formation, it is suggested to follow up three to six months later.

关 键 词：泌尿道感染 小儿 肾实质损害 诊断显像 

分 类 号：R691.3[医药卫生—泌尿科学] R817.4[医药卫生—外科学]