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目的:探讨螺旋CT增强延时及图像后处理技术在诊断小儿先天性尿路梗阻性疾病的临床应用价值。方法:108例经手术证实的小儿先天性泌尿系梗阻畸形患儿,术前1周行多层螺旋CT重建尿路成像(MSCTU)不同增强延时时间点低剂量扫描及图像后处理和超声检查,实质期及排泄期分别测量肾脏最大截面CT值;皮质期、实质期采用多平面重组(MPR),排泄期加做最大密度投影(MIP)、曲面重组(CPR)及表面重组(SSD)图像,并将MSCTU诊断结果与超声诊断结果进行比较。结果:重度肾盂输尿管连接部梗阻(UPJO)男孩左侧肾脏发病率为76.19%,明显高于其他泌尿系畸形;重复肾重复输尿管积水以女孩发病为多,发病率为84.00%。单纯肾输尿管远端梗阻患肾功能均较好;重度UPJO患肾分泌功能尚存在,排泄功能较差;重度肾发育不全和积水型重复肾,患肾功能最差,其次为反流性肾病的肾脏。MSCTU的术前诊断完全符合率为96.30%,超声的术前诊断完全符合率为60.04%。MPR方便快捷,适合于肾脏功能及结构观察;CPR,MIP,SSD适合集合系统形态轮廓整体观察、肾排泄功能评价、积水梗阻平面判定及疾病定性诊断。结论:掌握最佳的MSCTU增强延时时间,选择合理的低剂量扫描及图像后处理功能,能十分准确地诊断小儿先天性复杂泌尿系梗阻畸形疾病,MSCTU技术可作为泌尿系术前常规影像学一站式首选检查方法。
Objective: To investigate the clinical value of spiral CT enhanced delay and image postprocessing in the diagnosis of congenital urinary tract obstructive diseases in children. Methods: One hundred and eight children with congenital urinary tract obstruction deformity were confirmed by surgery. One month before operation, low-dose scanning, post-processing and ultrasonography were performed on MSCTU with different enhanced delay time points , And the maximal CT value of the kidney was measured during the period of excretion and the period of excretion. The cortical phase, MPR, MIP, CPR and SSD images , And MSCTU diagnostic results and ultrasound diagnostic results were compared. Results: The incidence of left kidney in male with UPJO was 76.19%, which was significantly higher than that of other urinary malformations. The recurrence rate was 84.00% in girls with repeated ureteral hydronephrosis. Renal ureteral obstruction with simple renal function are better; severe UPJO renal excretion function still exists, excretion dysfunction; severe renal dysplasia and hydronephrosis repeated kidney, the worst renal function, followed by reflux nephropathy Kidney. The complete coincidence rate of preoperative diagnosis of MSCTU was 96.30%. The preoperative diagnosis of ultrasound was 60.04%. MPR is convenient and quick, suitable for renal function and structure observation; CPR, MIP, SSD is suitable for the overall observation of morphological configuration of the collection system, evaluation of renal excretion function, water plane obstruction determination and disease diagnosis. Conclusion: Mastering the best MSCTU enhances the delay time, choosing reasonable low-dose scanning and image post-processing function, can diagnose the complicated congenital urinary tract obstructive deformity disease in children very accurately, MSCTU technique can be used as preoperative urography preoperative routine imaging One-stop preferred method of inspection.