常染色体显性多囊肾病相关精道梗阻所致男性不育的MRI特征  

MRI diagnosis and clinical analysis for autosomal dominant polycystic kidney disease related male infertility

作　　者：王焕军[1] 彭洋 张繁 张皓钦 肖煦阳 郭燕[1] 关键[1] Wang Huanjun;Peng Yang;Zhang Fan;Zhang Haoqin;Xiao Xuyang;Guo Yan;Guan(Jian Department of Radiology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院医学影像科,广州510080

出　　处：《中华放射学杂志》2019年第2期115-120,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金青年基金(81701747);广东省自然科学基金(2017A030313902);广东省医学科研基金(A2017008).

摘　　要：目的探讨常染色体显性多囊肾病(ADPKD)相关精道梗阻所致男性不育的MRI特征。方法回顾性分析2015年1月至2018年6月中山大学附属第一医院临床确诊为ADPKD相关精道梗阻无精症的14例男性不育患者。均行盆腔MR平扫和增强扫描,分析MRI影像特征。结果双侧多囊肾并双侧精囊囊肿10例,双侧多囊肾并多囊肝及双侧精囊囊肿者2例,双侧多囊肾并多囊肝并双侧精囊缺如、射精管扩张1例,双侧多囊肾并双侧精囊囊肿及前列腺苗勒管囊肿1例。腹盆腔大范围冠状面T2WI可同时清楚显示肝、双肾的多囊状改变和盆腔精囊区的异常。所有患者的精道梗阻部位均位于射精管-精囊水平,双侧精囊囊肿表现为双侧精囊管明显扩张成囊状,其内可见絮状或结节状沉积物,增强扫描后囊内容物无强化,壁轻度强化。结论ADPKD相关精道梗阻所致男性不育是以双侧多囊肾和射精管-精囊水平梗阻为主要MRI表现,可同时合并其他异常。Objective To improve the recognition and knowledge of autosomal dominant polycystic kidney disease (ADPKD) related male infertility through investigation for MRI characteristics of this disease. Methods Fourteen patients confirmed with ADPKD related obstructive azoospermia were retrospectively analyzed. All patients referred to clinic with male infertility, and obstructive azoospermia were additionally confirmed by laboratory tests and clinical examination. Subsequent abdominopelvic MR examinations were performed to comfirm obstructive factors and obstructive location. All patients were performed an abdominopelvic MR examination including non-enhanced and enhanced MR. MR imaging characteristics were analyzed and summarized by two experienced radiologists. Results MRI results for all cases were classified into 4 groups: 10 cases with bilateral polycystic kidneys and bilateral seminal vesicle cysts, 2 cases with bilateral polycystic kidneys, polycystic liver and bilateral seminal vesicle cysts, 1 case with bilateral polycystic kidneys, polycystic liver and absence of bilateral seminal vesicles, 1 case with bilateral cystic kidneys, bilateral seminal vesicle cysts as well as Müllerian duct cyst. A wide range of coronal T2WI scan was necessary to observe cystic lesions in both liver and bilateral kidneys as well as abnormal changes in pelvis. The obstructive sites in all cases were located in level from ejaculatory duct to seminal vesicle. Bilateral seminal vesicle cysts presented as significantly dilated glandular ducts of seminal vesicles, in which flocculence or nodular sediment can be found. Conclusion Male infertility caused by ADPKD-related deferential duct obstrution is characterized by bilateral polycystic kidney disease and Seminal vesicle ejaculatory duct obstruction in MRI, which can be combined with other abnormalities.

关 键 词：常染色体显性多囊肾病 梗阻性无精子症 精囊囊肿 射精管囊肿 磁共振 成像 

分 类 号：R698.2[医药卫生—泌尿科学] R692[医药卫生—外科学] R445.2[医药卫生—临床医学]