Emphysematous Pyelonephritis: Imaging Diagnosis and Follow - up

為了評估個種影像診斷工具對氣腫性腎盂腎炎之診斷能力及角色並將影像學發現與癒後傷一對照比較，我們回溯性地分析28位氣腫性腎盂腎炎病人之各種影像學檢查及治療過程。這28位病人在診斷腎盂腎炎後全部接受電腦斷層引導下之經皮引流治療，影像學檢查包括腹部X光素片及腹部超音波對偵測氣腫性腎盂腎炎不正常氣體之敏感度分別為68％及88％。而以經皮引流術治療腎盂腎炎之死亡率為11％。各種不同影像學表現及受波及範圍之大小並不影響以經皮引流術治療氣腎盂腎炎之死亡率。在術後一個月內之電腦斷層攝影可發現86％之type I之氣腫性腎盂腎炎轉變為type II。而在大於3個月後所作之電腦斷層攝影發現廣泛型及局部型之氣腫性腎盂腎炎分別呈現腎萎縮及局部瘢痕化。而受波及之腎臟在經引流治療後仍提供30％之腎功能。因此我們認為雖然電腦斷層攝影為最敏感之診斷工具，但x光素片及腹部超音波仍具診斷價值。電腦斷層攝影引導之經皮引流術可提供簡便有效之治療並保存相當之腎功能，各種型式之氣腫性腎盂腎炎並不影響死亡率，但引流後之過程及變化則有所差異。

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並列摘要

We conducted the study to evaluate the efficacy and roles of different imaging modalities in the diagnosis and follow-up of emphysematous pyelonephritis (EPN) and to correlate imaging findings with clinical outcome. Retrospective analysis of the imaging studies and clinical outcome were performed in 28 consecutive patients with EPN. They were all initially treated with CT-guided percutaneous drainage (PCD). The imaging studies performed included plain abdominal radiography (KUB) (n=28), sonography (US)(n=24), intravenous urography (IVU)(n=5), retrograde pyelography(RP)(n=20) and computed tomography (CT)(n=28).Follow-up imaging studies included CT(n=23) and renal scintigraphy (n=15). The sensitivities of detecting abnormal gas in EPN on KUB and US were 66% and 88%. The mortality rate was 11%, not associated with different types, stages or renal involvement, On the follow-up CT performed within one month of PCD, type I EPN evolved into type II in 86% of the cases. On the long-term follow-up CT, renal atrophy and focal scarring were revealed in the diffuse and focal renal involvement of EPN. The mean split renal function shown on the follow-up scintigraphy was 30%. We concluded KUB and US were valuable for screening EPN, although CT was the most Specific and sensitive. Follow-up CT studies not only demonstrate the response of treatment but also depict the different courses and the results of different types and renal involvement of EPN, although not associated with mortality rate.

並列關鍵字

emphysematous pyelonephritis ； imaging diagnosis ； percutaneous drainage

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Emphysematous Pyelonephritis: Imaging Diagnosis and Follow - up

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