磁共振成像和磁共振尿路造影对诊断输尿管病变的应用价值  

Utility of MRI and MRU for diagnosing the ureteral diseases

作　　者：王琦[1] 李俊林[1] 张雪峰[1] 郭雅茹[1] 欧阳雪晖[1] 肖来柱[1] 

机构地区：[1]内蒙古自治区医院介入放射科MRI室,内蒙古呼和浩特010017

出　　处：《实用医学影像杂志》2009年第5期310-313,共4页Journal of Practical Medical Imaging

基　　金：内蒙古自治区卫生厅医疗卫生科研基金资助项目;项目编号:2005063

摘　　要：目的探讨磁共振成像诊断对输尿管病变的临床应用价值。方法回顾性分析经手术病理学证实的58例输尿管病变的MR表现。结果原发性输尿管病变50例中,包括输尿管结石20例,肾盂输尿管连接部梗阻11例,输尿管炎性狭窄9例,输尿管癌7例,先天性输尿管囊肿2例和输尿管结核1例;继发性输尿管病变8例中,包括腹膜后纤维化2例,子宫体癌2例,胃癌腹膜后淋巴结转移1例,子宫内膜样癌术后腹膜后和盆腔淋巴结转移1例和医源性输尿管损伤2例。MRI和MRU证实,输尿管结石多表现为梗阻断端呈杯口状或鸟嘴状狭窄;肾盂输尿管连接部梗阻,断端多为盲端;输尿管炎性狭窄为渐进性节段性管腔变细;输尿管癌多为突然截断或偏心狭窄伴局部管壁增厚或软组织肿块;先天性输尿管囊肿的眼镜蛇和晕圈征具有特征性;输尿管结核典型者病变段输尿管管壁均匀增厚并呈环形强化,病肾见多发空洞;腹膜后纤维化在腹主动脉和下腔静脉前方及两侧由纤维团块包绕,将输尿管推向中线;腹膜后和盆腔淋巴结转移瘤多为异常信号肿块推移压迫病变段输尿管向两侧移位;此外,医源性输尿管损伤是依据确切的手术史诊断的。结论MRI和MRU相结合能直观、清晰地显示输尿管病变的部位、形态,具有较高的定性诊断准确性,并对制定手术方案有重要意义。Objective To evaluate the utility of magnetic resonance imaging（MRI） and magnetic resonance urography（MRU） for diagnosing ureteral diseases. Methods Fifty-eight patients with surgically and pathologically proved ureteral diseases underwent MRI and MRU. Imaging findings in all patients were analyzed retrospectively. Results Among 50 cases of primary ureteral diseases, ureteral calculi were found in 20, pelviureteric junction obstruction in 11, inflammatory ureteric stricture in 9, ureteral carcinoma in 7, congenital ureterocele in 2, and ureteral tuberculosis in 1; among 8 cases of secondary ureteral diseases, retroperitoneal fibrosis in 2, uterine body carcinoma in 1, gastric carcinoma associated with retroperitoneal lymphonodus metastasis in 1, endometrioid carcinoma associated with postoperatively retroperitoneal and pelvic lymphonodus metastasis in 1, and iatrogenic ureteral injuries in 2. MRI and MRU demonstrated that, ureteral calculi most appeared as cup mouth-like or bird＇s mouth-like stenosis of the obstructive segments, pelviureteric junction obstruction most appeared as blind end, inflammatory ureteric stricture appeared as progressive-segmentary lumen thinning, ureteral carcinoma appeared as sudden interruption or eccentric stenosis associated with local thickening of ureteral walls or soft tissue mass, congenital ureterocele was characterized by cobra and halo sign, typical ureteral tuberculosis appeared as homogeneous thickening with circular enhancement of the affected ureter walls and multiple cavities in the kidney, retroperitoneal fibrosis appeared as fibriform masses surrounding abdominal aorta and inferior vena cava and the ureter was pushed to midline, rctroperitoneal and pelvic lymphonodus metastases most were masses with abnormal signal, which impressed the affected ureter segments and resulted in bilateral displacement, except these, iatrogenic ureter injury was diagnosed based on the definite operation history. Conclusion The combination of MRI and MRU can directly and clearly s

关 键 词：输尿管病变 磁共振成像 磁共振尿路造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R693[医药卫生—诊断学]