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目的探讨磁共振尿路成像(MRU)技术在诊断新生儿先天性肾盂输尿管连接部梗阻(CUJO)中的应用价值。方法回顾性分析2010—2011年在我院行MRU检查的新生儿影像资料及手术结局。MRU检查序列包括3D尿路成像、常规轴位快速恢复快速自旋回波T2WI和稳态采集快速成像。所有图像在AW4.2工作站经最大密度投影、容积再现和Reformat重建出3DMRU图像。结果共21例患儿行MRU检查,均为孕期B超发现胎儿肾积水、出生后复查B超肾积水加重或临床症状加重就诊。MRU诊断双肾积水1例,右肾积水伴肾盂输尿管移行部狭窄7例,左肾积水伴肾盂输尿管移行部狭窄13例。21例患儿均接受手术治疗,其中腹腔镜下左肾盂成形术加膀胱镜探查术13例,右肾盂成形术加膀胱镜探查术6例,经脐单孔腹腔镜右肾输尿管切除术1例,双肾盂成形术加膀胱镜探查术1例。术后诊断均与MRU诊断相符。结论 MRU技术因具有无射线损伤、多角度、多方位、多参数成像等特点,已成为新生儿CUJO诊断、鉴别诊断及外科手术方案制定中不可缺少的重要检查手段,具有良好的发展前景。
Objective To investigate the value of magnetic resonance urography (MRU) in diagnosis of congenital ureteropelvic junction obstruction (CUJO) in neonates. Methods Retrospective analysis of 2010-2011 in our hospital MRU examination of neonatal imaging data and surgical outcomes. The MRU sequence included 3D urography, rapid axial rotation with fast spin echo T2WI, and rapid acquisition of steady state acquisition. All images were reconstructed to 3DMRU images at maximum density projection, volume reproduction and Reformat at AW4.2 workstation. Results A total of 21 children underwent MRU examination. All of them were found to have fetal hydronephrosis during pregnancy. After birth, B patients with hydronephrosis or exacerbation of clinical symptoms were diagnosed. MRU diagnosis of hydronephrosis in 1 case, right hydronephrosis with ureteropelvic stenosis in 7 cases, left hydronephrosis with ureteropelvic stenosis in 13 cases. Twenty-one children underwent laparoscopic surgery, including 13 cases of laparoscopic left pyeloplasty plus cystoscopy, 6 cases of right pyeloplasty plus cystoscopy, 1 case of transrectal laparoscopic right renal ureteropexy , Double pyeloplasty plus cystoscopy in 1 case. Postoperative diagnosis is consistent with MRU diagnosis. Conclusion The MRU technique has become an indispensable and important tool in the diagnosis, differential diagnosis and surgical planning of neonatal CUJO because of its characteristics of no radiation injury, multi-angle, multi-orientation and multi-parameter imaging. It has good prospects for development.