Quillin S P, Brink J A, Heiken J P, Siegel C L, McClennan B L, Clayman R V
Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA.
AJR Am J Roentgenol. 1996 May;166(5):1125-30. doi: 10.2214/ajr.166.5.8615256.
The purpose of this study was to determine the feasibility of imaging crossing vessels at the ureteropelvic junction (UPJ) with helical (spiral) CT angiography for planning surgical repair of symptomatic UPJ obstruction.
Twenty-four consecutive patients with symptomatic UPJ obstruction were imaged with dual-phase, contrast-enhanced helical CT (collimation, 3 mm; pitch, 1.3-1.7; reconstruction interval, 2 mm; early phase, 20-42 sec; and delayed phase, 90-112 sec after initiation of IV contract material injection [125 ml of ioversol containing 320 mg of iodine per ml, delivered at 4-5 ml/sec]). All imaging data were viewed interactively on an imaging workstation. Prospective on-line interpretations were correlated with subsequent surgical and clinical findings at laparoscopy (n=3), open surgical repair (n=2), or ureteronephroscopic endopyelotomy (n=11). Vessels at the UPJ that were 2 mm or more in diameter were believed to be significant. Review of the transaxial images was performed to determine qualitatively the relative usefulness of the early versus the delayed phases for distinguishing arteries from veins. Multiplanar reformations also were retrospectively reviewed and compared with direct pyelograms to determine the accuracy with which the location of the UPJ and the proximal ureteral course were depicted with helical CT.
Eleven of 24 (46%) patients collectively had 11 anterior and three posterior vessels (> or = 2 mm in diameter) crossing the UPJ on helical CT. Distinction between arteries and veins was significantly better on early-phase than on delayed-phase images (p=.01). Visualization of the UPJ and the proximal ureteral course was good or excellent for 18 (78%) of 23 patients for whom pyelograms were available, regardless of the presence of a ureteral stent (p>.05). Laparoscopy and open surgery findings were in agreement with helical CT angiograms for five of five patients. Uncomplicated endopyelotomy was performed for 11 patients in whom no significant vessels were seen posterior or posterolateral to the UPJ.
Helical CT angiography can depict vessels crossing the UPJ and is valuable in planning surgical management.
本研究的目的是确定采用螺旋CT血管造影对输尿管肾盂连接部（UPJ）交叉血管进行成像以规划有症状的UPJ梗阻手术修复的可行性。
对24例有症状的UPJ梗阻患者进行双期对比增强螺旋CT成像（准直，3mm；螺距，1.3 - 1.7；重建间隔，2mm；早期，20 - 42秒；延迟期，静脉注射造影剂（125ml每毫升含320mg碘的碘海醇，以4 - 5ml/秒的速度注射）后90 - 112秒）。所有成像数据在成像工作站上进行交互式查看。前瞻性在线解读与随后腹腔镜检查（n = 3）、开放手术修复（n = 2）或输尿管肾镜内肾盂切开术（n = 11）的手术及临床结果进行对照。直径2mm或更大的UPJ处血管被认为具有重要意义。回顾轴位图像以定性确定早期与延迟期在区分动脉与静脉方面的相对有用性。还对多平面重建图像进行回顾性分析并与直接肾盂造影进行比较，以确定螺旋CT描绘UPJ位置和近端输尿管走行的准确性。
24例患者中有11例（46%）在螺旋CT上共有11条前侧血管和3条后侧血管（直径≥2mm）穿过UPJ。早期图像上动脉与静脉的区分明显优于延迟期图像（p = 0.01）。对于23例有肾盂造影的患者，无论是否存在输尿管支架，18例（78%）患者的UPJ和近端输尿管走行的可视化效果良好或极佳（p>0.05）。5例患者中有5例的腹腔镜检查和开放手术结果与螺旋CT血管造影结果一致。11例在UPJ后侧或后外侧未发现重要血管的患者接受了无并发症的内肾盂切开术。
螺旋CT血管造影能够描绘穿过UPJ的血管，对手术治疗规划具有重要价值。
