Bertolotto M, Perrone R, Rimondini A
Dipartimento di Scienze Cliniche, Morfologiche e Tecnologiche, UCO di Radiologia, Università di Trieste.
Arch Ital Urol Androl. 2000 Dec;72(4):127-34.
Ultrasonography is the first imaging approach in evaluation of patients with urinary obstruction. Presence of hydronephrosis, urinomas and inflammatory complications can be assessed. Moreover, the level and the cause of obstruction are often identified. The major limits of ultrasonography are poor visibility of the lumbar portion of the urinary tract and lack of specificity in detection of pyelocaliectasis. These limits are partially overcome with Doppler studies. Several factors can bias diagnostic accuracy of colour Doppler ultrasonography in evaluating renal obstruction; in particular, partial or intermittent obstruction cause minimum hemodynamic changes in patients with renal colic. Sensitivity of colour Doppler ultrasonography to detect obstruction decreases following medical treatment with NSAID and increases following hydration and diuretics administration. Diuretic ultrasound, colour Doppler evaluation of ureteral jets and evaluation of the twinkling artefact of stones are useful imaging techniques as well. Tissue harmonic imaging is a new imaging technique available in most latest generation US equipments. Evaluation of the kidney and of the urinary tract improves using this technique due to artefact reduction and increased contrast resolution.
超声检查是评估尿路梗阻患者的首选影像学方法。可评估肾积水、尿瘤和炎症并发症的存在情况。此外，梗阻的部位和原因也常常能够确定。超声检查的主要局限性在于尿路腰部区域的可视性较差，以及在检测肾盂扩张方面缺乏特异性。多普勒研究部分克服了这些局限性。在评估肾梗阻时，有几个因素会影响彩色多普勒超声检查的诊断准确性；特别是，部分或间歇性梗阻在肾绞痛患者中引起的血流动力学变化最小。彩色多普勒超声检查检测梗阻的敏感性在使用非甾体抗炎药进行药物治疗后会降低，而在补液和给予利尿剂后会增加。利尿超声、输尿管喷流的彩色多普勒评估以及结石闪烁伪像的评估也是有用的成像技术。组织谐波成像在大多数最新一代超声设备中是一种新的成像技术。由于伪像减少和对比分辨率提高，使用该技术可改善对肾脏和尿路的评估。
