Bolduc S, Upadhyay J, Restrepo R, Sherman C, Farhat W, Bägli D J, McLorie G A, Khoury A E, El Ghoneimi A
Division of Urology, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
BJU Int. 2003 May;91(7):678-82. doi: 10.1046/j.1464-410x.2003.04247.x.
To compare the diagnostic imaging findings with the histological lesions in upper pole nephrectomy (UPN) specimens of duplex system ureteroceles, using renal ultrasonography (US) and nuclear renal scintigraphy.
Between 1992 and 2000, 86 patients with a ureterocele in a duplex system underwent surgery. The results from US were reviewed in 84 patients by a radiologist, for echogenicity, parenchymal thinning and hydronephrosis; 77 nuclear renal scans describing the differential function of the upper poles were also reviewed. Fifty-five patients underwent UPN (25 antenatal, 30 postnatal; 18 intravesical, 37 extravesical) and the specimens were available for independent review by a pathologist, describing five histological categories, i.e. chronic interstitial inflammation, fibrosis, tubular atrophy, glomerulosclerosis and dysplasia. Histological lesions were categorized as severe (> 25%) or minimal (<or= 25%). Radiological features and the histology of UPN were then analysed, and correlated using Fisher's exact test and multivariate analysis.
Severe histological lesions were reported in 38 specimens (69%) and minimal lesions in 17 UPN specimens (31%). Severe parenchymal thinning was associated with a severe pathological lesion (P < 0.02). There was no correlation with the echogenicity or degree of hydronephrosis. Dysplasia, found in 64% of specimens, did not correlate with increased echogenicity. Minimally functioning upper poles on nuclear renal scan (<or= 4% overall function) were significantly associated with severe histological lesions (P = 0.01). There was no correlation between diagnostic imaging features and the mode of presentation or type of ureterocele.
Multivariate analysis, severe parenchymal thinning on renal US and minimal function on nuclear renal scan can be used to predict the severity of histological lesions of the upper pole. These results may be helpful in the making therapeutic decisions for patients with ureteroceles in duplex systems.
利用肾脏超声（US）和核素肾显像，比较重复肾系统输尿管囊肿上极肾切除术（UPN）标本的诊断性影像学表现与组织学病变。
1992年至2000年间，86例重复肾系统输尿管囊肿患者接受了手术。一名放射科医生回顾了84例患者的超声检查结果，观察回声性、实质变薄和肾积水情况；还回顾了77例描述上极差异功能的核素肾扫描结果。55例患者接受了上极肾切除术（25例产前，30例产后；18例膀胱内型，37例膀胱外型），标本可供病理学家独立评估，病理学家描述了五种组织学类别，即慢性间质性炎症、纤维化、肾小管萎缩、肾小球硬化和发育异常。组织学病变分为严重（>25%）或轻微（≤25%）。然后分析上极肾切除术的放射学特征和组织学情况，并使用Fisher精确检验和多变量分析进行相关性分析。
38例标本（69%）报告有严重组织学病变，17例上极肾切除术标本（31%）有轻微病变。严重的实质变薄与严重的病理病变相关（P<0.02）。与回声性或肾积水程度无关。64%的标本中发现发育异常，与回声增强无关。核素肾扫描显示功能低下的上极（总功能≤4%）与严重组织学病变显著相关（P=0.01）。诊断性影像学特征与输尿管囊肿的表现方式或类型之间无相关性。
多变量分析显示，肾脏超声检查发现的严重实质变薄和核素肾扫描显示的功能低下可用于预测上极组织学病变的严重程度。这些结果可能有助于为重复肾系统输尿管囊肿患者做出治疗决策。
