Prenatal Diagnosis of Polycystic Kidney Disease with Hydroureter: A Comparison of Magnetic Resonance Imaging with Two-and Three-Dimensional Ultrasound

產前診斷多囊性腎臟合併輸尿管水腫：核磁共振造影與傳統超音波及立體超音波之比較

沈中章(Chung-Chang Shen) ； 呂鎮中(Chun-Chung Lui) ； 許德耀(Te-Yao Hsu) ； 張旭陽(Shiuh-Young Chang)

《Taiwanese Journal of Obstetrics & Gynecology》 42卷2期 (2003/06) Pp. 127-132

https://doi.org/10.29787/TJOG.200306.0007

摘要

目的：由於解剖位置相近的關係要鑑別診斷胎兒腸阻塞或輸尿管水腫有時是有困難的。我們在此報告以傳統超音波，立體超音波及核磁共振造影於產前診斷胎兒多囊性腎臟合併輸尿管水腫。
病例報告：本文報導一位30歲初產婦於懷孕30週時因懷疑胎兒腸阻塞轉診至本院門診。本院的高層次超音波顯示胎兒多囊性腎臟，立體超音波亦顯示胎兒多囊性腎臟，然而輸尿管水腫或腸阻塞卻不易區別。我們接著安排核磁共振造影，經由三個平面的影像顯示胎兒多囊性腎臟合併輸尿管水腫。出生後胎兒腎臟超音波檢查證實產前診斷。Tc-99m DTPA顯示左側腎臟功能缺損。由於此嬰兒重覆性泌尿道感染，因此在三個月大時接受左側腎臟輸尿管切除術，手術報告證實輸尿管於U-P junction處阻塞。病理報告為多囊性腎臟合併巨大輸尿管積水。病理診斷與核磁共振造影之診斷相符。結論：我們發現胎兒的冠狀面以核磁共振造影較超音波容易取得，因此核磁共振造影也比超音波容易鑑別。

關鍵字

胎兒多囊性腎臟 ； 輸尿管水腫 ； 產前診斷 ； 立體超音波 ； 核磁共振造影

並列摘要

Objective: To compare magnetic resonance imaging (MRI) with 2-dimensional (2D) and 3-dimensional (3D) ultrasound for the prenatal diagnosis of a polycystic kidney with hydroureter. Case Report(s): A 30-year-old Taiwanese women, gravida 2, para 0, was referred to our antenatal clinic under the impression of fetal bowel obstruction at 30-weeks¡¦ gestational age. Two- dimensional (level II) ultrasound was performed at our institutions and a polycystic kidney was impressed. Hydroureter was suspected, but dilatation of the bowel could not be ruled out. 3-D ultrasound confirmed the diagnosis of polycystic kidney but hydroureter or bowel obstruction remained undetermined. A T2-weighted MR image which was obtained in 3 orthogonal planes confirmed the fetal polycystic kidney combined with hydroureter. Postnatal pediatric renal sonography demonstrated left cystic kidney disease with hydroureter. Tc-99m DTPA radionuclide study revealed marked impaired left renal function. Recurrent urinary tract infection and fever in the infant were noted, and the infant received a left nephroureterectomy at the age of 3 months old. Surgical findings included polycystic kidney and obstruction of the urinary tract at the junction of the renal pelvis and the ureter. The pathology report demonstrated multicystic kidney disease, megaloureter, and hydroureter. The postnatal diagnosis proved the antenatal diagnosis by MRI.
Conclusion(s): We found that coronal scanning of the fetus could be performed more easily by magnetic resonance imaging. The MRI scan can provide better demonstration of hydroureter than is possible with ultrasound antenatally.

並列關鍵字

polycystic kidney ； hydroureter ； prenatal diagnosis ； 3D ultrasound ； MRI