【摘要】 目的 对照输尿管肾镜检查,探讨不同源影像技术MR仿真内镜诊断肾、输尿管结石的价值与限度。方法 9个5mm以内直径大小的尿路结石,经输尿管离断端置入因配型问题放弃移植的离体肾之输尿管肾盂内,以生理盐水、3％马根微显溶液充分充盈输尿管肾盂后,分别采用多层薄层快速自旋回波单激发(SS-FSE)、重T2(HT2-FSE)序列行磁共振水成像和采用3D、2D快速扰流梯度重聚(FSPGR)行磁共振尿路造影(MRU)。磁共振扫描源影像数据在工作站用导航软件作内镜成像重建(VE)。影像检查完成后摄X片和输尿管肾镜检查,然后正中冠状切开肾与榆尿管,再次观察结石数目、大小和位置。结果 5个结石为输尿管镜准确检出,其后方肾小盏内另4个结石未显示;VE检出的结石源于不同扫描序列不同,源于HT2-FSE序列者5个(5／9)、多层薄层SS-FSE序列者4个(4／9)、3D及2D FSPGR序列者均为4个(4／9)。VE检出的最小结石直径为2mm。几种方法对结石检出率无显著差异(P>0.5)。VE图像质量尤其管道内腔及结石表面细节显示度比输尿管镜的差(P<0.005),其基于长T2加权像MRH技术优于基于钆增强短T1加权像MRU技术(P<0.05),但其所示结石均稍有变形。 结论 尿路磁共振仿真内镜成像能够检出直径2mm以上结石.以HT2-FSE技术为佳,但其对结石的检出率和图像质量仍不及输尿?更多还原

【Abstract】 Objective To assess the value and limits of MR virtual endoscopy from various sources imaging techniques in diagnosis of renal and ureteral calculi by comparison with ureterorenoscopy. Methods Nine calculi diameter from 1mm to 5mm obtained from ureterolitho-tomy were pushed retrogradely into the ureter and pelvis of one kidney in vitro which was given up for transplation because of further tissue match failure. MR hydrography of this kidney was performed with heavily T2-weighted fast spin-echo (HT2-FSE) and thin-slice single-shot fast spin-echo(SS-FSE) after insufflation of the inner tract by 0.9% sodium chloride, and MR urography was performed with 3D/2D FSPGR sequences and by 3% gadopentate dimeglumine. Virtual endoscopic images were reconstructed by navigator software based on MR scanning data sets. Results Five of the 9 calculi were detected accurately by ureterorenoscopy,and the other four back calculi in one minor calyx were not shown. MR virtual endoscopic images based on scanning of HT2-FSE,SS-FSE, 3D and 2D FSPGR sequences revealed five,four,four,and four of the 9 calculi respectively,with the smallest ones being 2mm in diameter. There was no significant difference between these methods with respect to the number of depicted stones(P>0.5). The quality of virtual endoscopy, especially the visibility of the surface details of the intraluminal tract and stones, was inferior to that of ureterorenoscopy (P<0.005),and that of longer T2-weighted MRH was better than that of gadolinium-enhanced shorter T1-weighted MRU(P<0.05). The shape of all stones shown on virtual endoscopy was slightly deformed. Conclusion The best techniques of MR virtual endoscopy of the urinary tract is MRH with HT2-FSE sequences. MR ureterorenoscopy can depict the urinary calculi over 2mm in diameter,but its image quality and detectability of stones are poorer than those of ureterorenoscopy.更多还原