Kirsch Andrew J, McMann Leah P, Jones Richard A, Smith Edwin A, Scherz Hal C, Grattan-Smith J Damien
Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
J Urol. 2006 Oct;176(4 Pt 2):1755-61. doi: 10.1016/j.juro.2006.03.115.
We report the role of magnetic resonance urography in children with ureteropelvic junction obstruction. Differential renal function, the single kidney glomerular filtration rate index, renal transit time, renal length and renal pelvis anteroposterior diameter were compared before and after pyeloplasty.
Magnetic resonance urography was performed before and after pyeloplasty in 24 patients with a mean age of 1.9 years (range 3 months to 10 years). Renal length, renal transit time and renal pelvis anteroposterior diameter were determined by the radiologist. The volume of functioning renal tissue and descending aorta were segmented and the ratio of the volumes of functioning kidney tissue was used to calculate differential renal function. Rutland-Patlak plots were used to calculate single kidney glomerular filtration rate index, that is the Patlak score.
Mean renal pelvis renal pelvis anteroposterior diameter was 3.3 cm preoperatively and 2.5 cm postoperatively (p = 0.0003). There was no difference in average renal length (p = 0.22). Of the 24 cases 22 (92%) showed stable or improved differential renal function. Improvement in renal transit time was seen in 20 of 23 cases (87%). Of 15 patients with complete Patlak scores 14 (93%) showed postoperative improvement. Mean preoperative and postoperative differential renal function, renal transit time and Patlak score were 36% and 41% (p = 0.003), 16.2 and 8.6 minutes (p = 0.0005), and 6.6 and 11.9 ml per minute (p = 0.01), respectively.
Magnetic resonance urography provides superior anatomical and unprecedented functional information to fully define the preoperatively and postoperative status of corrected ureteropelvic junction obstruction. Magnetic resonance urography has the potential to become the imaging study of choice for evaluating pediatric hydronephrosis and obstructive uropathy.
我们报告磁共振尿路造影在肾盂输尿管连接部梗阻患儿中的作用。比较肾盂成形术前和术后的分肾功能、单肾肾小球滤过率指数、肾通过时间、肾长度和肾盂前后径。
对24例平均年龄1.9岁（范围3个月至10岁）的患者在肾盂成形术前和术后进行磁共振尿路造影。肾长度、肾通过时间和肾盂前后径由放射科医生测定。对有功能的肾组织和降主动脉的体积进行分割，并使用有功能的肾组织体积比来计算分肾功能。使用Rutland-Patlak图计算单肾肾小球滤过率指数，即Patlak评分。
术前肾盂前后径平均为3.3 cm，术后为2.5 cm（p = 0.0003）。平均肾长度无差异（p = 0.22）。24例中有22例（92%）分肾功能稳定或改善。23例中有20例（87%）肾通过时间改善。15例有完整Patlak评分的患者中，14例（93%）术后改善。术前和术后分肾功能、肾通过时间和Patlak评分的平均值分别为36%和41%（p = 0.003）、16.2分钟和8.6分钟（p = 0.0005）、以及每分钟6.6 ml和11.9 ml（p = 0.01）。
磁共振尿路造影提供了优越的解剖学信息和前所未有的功能信息，以充分界定矫正肾盂输尿管连接部梗阻术前和术后的状态。磁共振尿路造影有可能成为评估小儿肾积水和梗阻性尿路病的首选影像学检查。
