Chevalier R L, Campbell F, Brenbridge A N
Urology. 1984 Jul;24(1):96-103. doi: 10.1016/0090-4295(84)90401-1.
Prompt diagnosis of renomegaly in the newborn is necessary for appropriate medical or surgical management to insure maximal recovery of renal function. To investigate both renal structure and function without iodinated contrast infusion, combined ultrasonography and nuclear scintigraphy were evaluated in 17 newborns with renomegaly and 6 infants with cystic renal abnormalities detected in utero. In 18 patients, intravenous pyelography (IVP) and/or voiding cystourethrography (VCUG) were performed subsequently. While ultrasonography or scintigraphy alone provided the major diagnosis in 48 per cent and 30 per cent of cases, respectively, the combination of both studies yielded the major diagnosis in 87 per cent. Subsequent IVP was less informative than combined sonography and scintigraphy in 5 of 15 patients, and VCUG confirmed the final diagnosis in 4 of 13 patients. We conclude that initial evaluation of the newborn with renomegaly should comprise ultrasonography followed by nuclear scintigraphy. This combination of studies provides adequate information to determine subsequent management in nearly 90 per cent of cases without subjecting infants to the risks of contrast infusion or higher doses of diagnostic levels of radiation.
新生儿肾肿大的及时诊断对于采取恰当的内科或外科治疗以确保肾功能最大程度恢复是必要的。为了在不注入碘化造影剂的情况下研究肾脏结构和功能，对17例肾肿大新生儿和6例产前检测出肾囊性异常的婴儿进行了超声检查和核素闪烁显像联合评估。随后对18例患者进行了静脉肾盂造影（IVP）和/或排尿性膀胱尿道造影（VCUG）。单独超声检查或闪烁显像分别在48%和30%的病例中做出主要诊断，而两种检查联合则在87%的病例中做出主要诊断。在15例患者中的5例中，后续IVP提供的信息不如超声检查和闪烁显像联合提供的信息多，在13例患者中的4例中，VCUG证实了最终诊断。我们得出结论，对肾肿大新生儿的初始评估应包括超声检查，随后进行核素闪烁显像。这种联合检查能提供足够的信息，以确定近90%病例的后续治疗方案，而无需让婴儿承受造影剂注入风险或更高剂量的诊断性辐射。
