【摘要】 目的 探讨多层螺旋CT输尿管造影(CT urography，CTU)不同后处理重建方法在辅助诊断输尿管疾病中的应用价值。方法 选择58例经过临床及手术病理确诊的输尿管疾病患者作为研究对象，参照肾功能受损程度不同进行15、30、60min的延迟扫描，并行薄层重建。后处理重建采用曲面重建(CPR)、多平面重建(MPR)、最大密度投影(MIP)方法，观察输尿管的解剖结构、毗邻关系及行走路径。分析不同的重建方法对最佳延迟时间段图像质量、疾病判断的准确度及毗邻关系的应用价值。结果 (1)CPR显示：图像质量评级为优良54例(93.1%)，评级为差4例(6.9%)。疾病判断的准确度为：输尿管结石100%(30/30)；输尿管肿瘤62.5%(5/8)；输尿管囊肿100%(5/5)；先天性输尿管狭窄100%(9/9)；输尿管炎症66.7%(4/6)。CPR能清晰显示输尿管行径、解剖与毗邻结构。(2)MPR显示：图像评级为优良48例(82.8%)，评级为差10例(17.2%)。疾病判断的准确度为：结石100%、肿瘤87.5%、囊肿100%、先天性狭窄100%、炎症50.0%。MPR部分显示输尿管部分行径、解剖与毗邻结构。(3)MIP显示：图像评级为优良39例(67.2%)，评级为差19例(32.8%)。疾病判断的准确度为：结石86.7%、肿瘤50.0%、囊肿80.0%、先天性狭窄77.8%、炎症50.0%。结论 根据输尿管显像程度，选择合适的重建方法完整显示输尿管与疾病的解剖关系,有助于疾病的诊断和指导临床治疗。

    【关键词】 X线计算机；输尿管造影；诊断；重建

    Evaluation of reconstruction methods of CT urography in the diagnosis of ureteral diseases

    CHANG Shi-xin，HAO Nan-xin，WANG Yi-bin,et al.

    Department of Radiology,East Hospital,Tongji University,Shanghai 200120，China

    【Abstract】 Objective To assess the value of CT urography in the diagnosis of urinary tract diseases with different reconstruction methods.Methods 58 cases of ureteral diseases who were diagnosed by clinic and pathology were retrospectively analyzed.The delay scan and thin slice reconstruction was progress in 15min,30min,60min refer to renal function.Reconstruction methods were made with CPR,MPR and MIP.By observing ureteral tract anatomy and adjacent tissue,the value of different reconstruction methods was analyzed in the image quality and disease diagnosis.Results (1)The reconstruction with CPR display that the percent of excellent was 93.1% and the worse was 6.9% in image quality.The accuracy of diagnosis respectively was 100%(ureteral stone),62.5%(ureteral neoplasm),100%( ureteral cyst),100%( urinary tract abnormality) and 66.7%(uretera inflammation).The CPR can clearly show ureteral tract anatomy and adjacent tissue.(2)The percent of excellent was 82.8% and the wores was 17.2% in image quality with MPR.The accuracy of diagnosis respectively were 100%,87.5%,100%,100% and 50.0%.(3)The reconstruction with MIP show that the percent of excellent was 67.2% and the worse was 32.8%.The accuracy of diagnosis respectively was 86.7%,50.0%,80.0%,77.8% and 50.0%.Conclusion According to ureteral tract brightness,high image quality and high success rate with correctly reconstruction can delineate ureter cubicity,which is helpful in diagnosing and instructing clinical treatment. ......