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目的:了解动态增强磁共振成像(MRI)在评估静脉肾盂造影(IVU)不显影梗阻性积水肾脏功能中的应用价值。方法:依据21例同1周内IVU检查积水侧肾脏显影情况将病例分为显影组(14例)和不显影组(7例),对21例单侧肾积水患者进行动态增强MRI检查,观察并记录注射造影剂前及注射后1min,3min,5min,10min,15min,30min,45min和60min肾实质和集合系统感兴趣区的相对信号强度(RSI)。结果:7例积水侧肾脏不显影者,动态增强MRI检查均可见造影剂进入肾实质,并可确定尿路梗阻部位。显影组积水侧和对侧集合系统60 min内RSI差异有统计学意义;不显影组积水侧肾实质与对侧以及2组间肾实质和集合系统在60min内RSI差异有统计学意义。显影组肾实质与对侧肾脏不同时间点RSI差异无统计学意义,集合系统在3min,5min和30min及以后时间点RSI差异有统计学意义;不显影组肾实质与对侧肾脏在10min及以后的各时间点RSI差异有统计学意义,集合系统在3min及以后各时间点差异有统计学意义。2组间积水肾脏肾实质10min及以后时间点RSI差异有统计学意义,集合系统在5min及以后各时间点差异有统计学意义。结论:动态增强MRI可以为IVU不显影梗阻性积水肾脏提供形态和功能信息。
Objective: To investigate the value of dynamic contrast-enhanced magnetic resonance imaging (MRI) in assessing hydronephrosis of the obstructive hydronephrosis without intravenous pyelography (IVU). Methods: The cases were divided into developing group (14 cases) and non-developing group (7 cases) according to the development of IVU in 21 cases with IVU within one week. Dynamic contrast-enhanced MRI was performed in 21 cases of unilateral hydronephrosis The relative signal intensity (RSI) of renal parenchyma and collection system before and 1, 3, 5, 10, 15, 30, 45, and 60 minutes after injection of contrast medium were observed and recorded. Results: 7 cases of hydronephrosis were not visualized, dynamic contrast-enhanced MRI examination showed the contrast agent into the renal parenchyma, and can determine the location of urinary tract obstruction. There was a significant difference in RSI within 60 min between the hydrologic side and the contralateral hydroponics system in the developing group. There was a significant difference in RSI within 60 min between the parenchyma and contralateral group and the two groups in the non-developing group. There was no significant difference in RSI between the renal parenchyma and the contralateral kidneys at different time points in the developing group. The RSI of the collecting system at 3, 5, 30, and later time points was significantly different. In the non-developing group, the renal parenchyma and the contralateral kidney at 10 min and later The differences of RSI at each time point were statistically significant. The differences of the collection system at 3min and later time were statistically significant. There was a significant difference in RSI between the two groups after 10min and after parenchymal kidney and renal parenchyma, and there was a significant difference in the collection system between 5min and later time points. Conclusions: Dynamic contrast-enhanced MRI can provide morphological and functional information for IVU non-visualized obstructive hydronephrosis.