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Hyperechoic Medulla of the Kidney on Ultrasonography: Correlation with CT Scan
超音波之高回音腎髓質診斷與電腦斷層影像之比較
摘要
分析49位高回音腎髓質超音波影像的患者，其中41位有痛風性關節炎病史，3位為無症狀之高血尿酸症，另5位為腎髓質腎石灰沈著病(nephrocalcinosis)。所謂高回音腎髓質(hyperechoic medulla)，是指在超音波影像上腎髓質呈現花環狀高回音。19位痛風腎(gouty kidney)患者及3位腎髓質腎石灰沈著病患者，其高回音腎髓質影像之後方有音影出現；而痛瘋腎病人比腎髓質腎石灰沈著病患者具有更多異常腎臟超音波表徵：如腎臟變小，腎邊綠不規則，腎皮質變薄，腎皮質回音強度增加及具有腎水囊。 在12位接受無造影劑注射電腦斷層攝影之痛風腎患者，有10位患者其腎髓質呈現從輕微高密度班塊至高密度顆粒；而另2位電腦斷層影像則正常，故在痛風腎病人，其電腦斷層攝影腎臟所見與高回音腎髓質超音波影像並不相配合；然而5位腎髓質腎石灰沈著病的病人，呈現粗而高密度的顆粒，和超音波上影像類似；故我們認為在評估痛風腎，超音波比電腦斷層具有更顯著的影像表徵。
並列摘要
The sonographic patterns of 49 patients with hyperechoic renal medulla were reviewed. Forty-one presented gouty arthritis, 3 asymptomatic hyperuricemia and 5 medullary nephrocalcinosis. A hyperechoic wreath-like pattern of the renal medulla was referred to as the hyperechoic medulla (HM). Acoustic shadowing behind the hyperechoic medullae were noted in 19 of 44 patients with gouty kidneys and 3 of 5 nephrocalcinosis. There was a higher incidence of renal abnormalities in the gouty kidney than in medullary nephrocalcinosis, including small renal size, irregular margin, cortical thinning, increased cortical echogenicity and real cysts. In 12 patients with gouty kidneys who underwent non-contrast enhanced CT study, 10 patients showed changes in the renal medulla ranging from faint plaques of increased density to high diensity spots. No specific finding was present in the other 2 patients. No correlation could be observed between the aforementioned CT findings and sonographic appearances of the hyperechoic renal medulla. Five patients with medullary nephrocalcinosis showed coarse or dense granules, which is compatible with sonographic findings. We conclude that ultrasonography can better demonstrate the specific findings of gouty kidney than CT scan.
延伸閱讀
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