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| 双重超声造影诊断上尿路梗阻性疾病的方法与价值 |
| 樊静1△,章建全2△*,李颖如1,蒋晓春1,朱再生3,陈捷游4,王戏丹1 |
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(1. 金华市中心医院超声科, 金华 321000;
2. 第二军医大学长征医院超声诊疗科, 上海 200003;
3. 金华市中心医院泌尿外科, 金华 321000;
4. 永康市人民医院泌尿外科, 金华 321300
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 建立上尿路梗阻性疾病的双重超声造影新方法，探讨其诊断标准及诊断价值。方法 对147例上尿路梗阻患者进行超声引导下经皮肾盂穿刺引流术，经引流管直接向肾盂内注射造影剂微泡SonoVue溶液，连续观察造影剂强回声从肾盂向输尿管、膀胱运动的过程；同时进行经静脉超声造影检查，观察尿路以及周边结构的微血管灌注状态，即双重超声造影（DCEUS）。并且所有患者在1周内完成磁共振尿路水成像（MRU）、尿路增强CT（CTU）检查。以手术所见和（或）术后病理为金标准，比较DCEUS与MRU诊断上尿路梗阻平面和梗阻程度的准确性，比较DCEUS与CTU诊断上尿路梗阻病因的准确性。结果 （1）DCEUS诊断上尿路梗阻平面的准确率为100%，与MRU（98.0%）对比差异无统计学意义（P>0.05）；（2）DCEUS诊断上尿路梗阻程度的准确率为98.6%，优于MRU（89.8%），两者差异有统计学意义（P<0.01）；（3）DCEUS诊断上尿路梗阻病因的准确率为93.2%，与CTU（93.9%）对比差异无统计学意义（P>0.05）；（4）全部患者穿刺及造影过程中均无并发症，除4例失访外，其余病例经1~6个月彩色多普勒超声随访未见迟发不良反应。结论 双重超声造影是一种安全、高效的超声造影检查过程，对上尿路梗阻性疾病可作出精确的定位和准确的定性诊断，尤其与经皮穿刺肾盂造瘘术结合在一起后更具临床诊治价值。 |
| 关键词: 尿道梗阻 经皮肾盂穿刺造瘘术 尿路造影术 双重超声造影 磁共振尿路成像 CT尿路成像 |
| DOI：10.3724/SP.J.1008.2014.00141 |
| 投稿时间：2013-07-12修订日期：2013-08-20 |
| 基金项目:金华市科技局重点项目（2008-3-005）. |
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| Dual contrast-enhanced ultrasound for diagnosis of obstructive diseases in upper urinary tracts |
| FAN Jing1△,ZHANG Jian-quan2△*,LI Ying-ru1,,JIANG Xiao-chun1,ZHU Zai-sheng3,CHEN Jie-you4,WANG Xi-dan1 |
(1. Department of Ultrasound, Jinhua Central Hospital, Jinhua 321000, Zhejiang, China;
2. Department of Ultrasound, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
3. Department of Urology, Jinhua Central Hospital, Jinhua 321000, Zhejiang, China;
4. Department of Urology, People's Hospital of Yongkang, Jinhua 321300, Zhejiang, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To establish a dual contrast-enhanced ultrasonography (DCEUS) method for diagnosing the upper urinary tract obstructive diseases, and to discuss the diagnosis criterion and value. Methods A total of 147 patients with upper urinary tract obstructive diseases underwent dual contrast-enhanced ultrasound examination. A dose of SonoVue solution was directly injected into the renal pelvis via the puncture tube, and the antegrade contrast agent movement within the upper urinary tract was continuously monitored under CPS mode. Meanwhile, intravenous contrast-enhanced ultrasound was performed to observe the capillary filling of the urinary tract and surrounding structures, that is what we called DCEUS. And all the patient received magnetic resonance urography (MRU) and urinary contrast-enhanced CT within one week. With the operative findings and/or postoperative pathology taken as the golden standard, the accuracies of DCEUS and MRU in diagnosing the obstructive levels and severity of upper urinary tract obstruction were compared, and the accuracies of DCEUS and contrast-enhanced CT in diagnosing causes of the obstruction were compared. Results (1)The accuracy of DCEUS in revealing the obstructive levels were 100%, showing no significant difference with MRU(98.6%)(P>0.05). (2)The accuracy of DCEUS in evaluating the severity of upper urinary tract obstruction was 98.6%, which was significantly better than that of MRU(89.8%, P<0.01). (3) The accuracy of DCEUS in diagnosing the obstructive causes was 93.2%, showing no significant difference with contrast-enhanced CT (93.9%, P>0.05). (4) No complications were found during renal pelvis puncture or administration of SonoVue in the 147 patients,and no late complications were noticed during 1-6 months ultrasound follow-up in the 143 patients who were followed up. Conclusion DCEUS is a safe, effective method; it can accurately locate the upper urinary tract obstruction and help to make qualitative diagnosis, and combination with percutaneous nephrostomy can yield even better clinical values. |
| Key words: urinary obstruction percutaneous nephrostomy urography dual contrast-enhanced ultrasound magnetic resonance urography CT urography |
