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目的探讨静脉肾盂造影一侧或双侧尿路显示不良,2～8h后行CT平扫检查的诊断价值。方法23例静脉肾盂造影显示不良或无显示的患者,于造影后2～8h内接受CT平扫。尿路扩张明显者进行全尿路的曲面重建、多平面重组、容积再现、最大密度投影等成像处理。结果23例中,CT诊断14例为输尿管第二、三生理狭窄处细小结石,并伴有不同程度的尿路扩张;3例为肾结核自截和肾动脉狭窄所致单侧肾功能不良;2例为炎性输尿管狭窄;另有输尿管癌、神经源性膀胱、急性弥漫性肾盂肾炎、慢性肾盂肾炎并肾癌各1例。结论静脉肾盂造影失败时,CT的高密度分辨率可使含有低浓度对比剂的尿路成像,利用扩张积水的输尿管进行CT的多模式重建能够完整地显示尿路状况。静脉肾盂造影后数小时内进行CT平扫是静脉肾盂造影失败后最有效的补救的措施,是明确尿路梗阻和肾功能不良病因的最佳方法。
Objective To evaluate the diagnostic value of one or two-sided urinary perfusion of IVP in 2 ~ 8h after CT scan. Methods Twenty-three patients with poor or no IVP showed CT scan within 2-8h after angiography. Patients with significant urinary tract dilatation were treated with curved surface reconstruction, multiplanar reconstruction, volumetric reconstruction, and maximum density projection of the entire urinary tract. Results Of the 23 cases, CT diagnosis of 14 cases of small ureteral stones in the second and third physiological stenosis accompanied by varying degrees of dilatation of the urinary tract; 3 cases of renal tuberculous renal artery stenosis caused by unilateral renal dysfunction; 2 cases of inflammatory ureteral stricture; the other ureteral cancer, neurogenic bladder, acute diffuse pyelonephritis, chronic pyelonephritis and renal cell carcinoma in 1 case. Conclusions When intravenous pyelography fails, the high resolution of CT can make urinary tract imaging by using urinary catheter with dilated hydronephrosis and multimodal reconstruction of CT. Intravenous pyelography within a few hours after CT scan is the most effective relief after intravenous pyelography measures to clarify the urinary tract obstruction and renal failure is the best way to cause.