近年来泌尿系统结核发病率呈上升趋势，其中以肾结核最为多见，那这期我们就简单看看肾结核在影像中的表现是怎么样的。
Incidence of urinary tract tuberculosis is on the rise in recent years, of which the most renal tuberculosis, that that's the simple we look at what's the renal tuberculosis's performance in the image.
大多数无钙化的肾结核无异常X线表现，少数可见肾脏轮廓增大或缩小。初期的肾结核病变，有时可出现肾实质内小斑点、片状钙化；后期可 互相融合呈云絮状、环状钙化；终期肾脏可完全钙化，此时肾功能已经完全失代偿，称为肾自截；有时可见输尿管钙化及对侧肾区钙化灶。
Most abnormal X-ray findings without calcification of renal tuberculosis, a few visible kidney outline increased or reduced. The early renal tuberculosis, may sometimes small spots, patchy calcification in the renal parenchyma; Late to merging YunXuZhuang, annular calcification; End stage renal completely calcification, kidney function has been completely decompensation, called renal since section; Sometimes visible ureteral calcification and the contralateral renal calcifications.
↑ 右肾结核（肾自截）
腹部X线平片，可见右侧肾实质区域完全钙化，其密度不均，形态不整；右侧输尿管中段亦可见条形钙化影，左侧肾脏区域可见结节状钙化影
Abdominal X-ray plain film, visible on the right side of renal parenchyma area completely calcification, its density, form whole; Middle ureter are visible on the right side bar calcification shadow, nodular calcification area visible within the left kidney
↑左肾结核
静脉肾盂X线造影，可见左侧肾的上组肾盏边缘不规则，似虫蚀样破坏
Intravenous urography X-ray imaging and visible on the left side of the edge of renal calyces on group is irregular, like a worm corrosion damage
↑ 右肾结核
逆行性肾盂X线造影，显示右侧肾的肾盂、肾盏明显扩张，肾盏边缘不规则，肾实质内多发空洞形成
Retrograde urography X-ray imaging, display the right renal pelvis and calyces obvious expansion, calyx margin irregular, renal parenchyma in multiple hole formation
当结核病变位于肾实质内未与肾盏、肾盂相通时，可以表现为正常。当肾实质病变与肾盏相通时，可表现为肾盏边缘模糊，呈不规则或虫蚀状破坏，有时可见邻近肾实质内与肾小盏相连的对比剂团。病变进一步进展时，一组或多组肾盏变形、狭窄或扩张积水；可出现肾盂、肾盏形态不规则、不对称扩大，边缘模糊、毛糙。肾实质内有干酪样坏死物排出后遗留的脓腔等改变。当病变进展造成肾盏、肾盂广泛破坏或形成肾盂积脓时，排泄性尿路造影可见肾盂、肾盏显影浅淡或不显影，逆行尿路造影显示为肾盂狭窄，肾盏扩张，以及边缘不规则的空洞等改变。
When TB lesion in the renal parenchyma and calyces and renal pelvis are interlinked, can behave as normal. When renal parenchyma lesions and calyces are interlinked, can show the calyces edge blur, irregular or insect damage, sometimes visible within the renal parenchyma and renal adjacent small lamp of contrast medium. Lesions in the further progress, one or more sets calyces deformation, narrow or expansion of the water; Can appear renal pelvis and calyces form irregular, asymmetrical, edge blur, coarse. Renal parenchyma with caseous necrosis after discharge of the legacy of the pus cavity change, etc. When the lesion progress calyces and renal pelvis pyonephrosis, extensive damage or drain sex urinary tract imaging visible renal pelvis and calyces development shallow or not development, retrograde urinary tract imaging showed for stenosis of the renal pelvis, calyces expansion, and hole at the edge of the irregular change.
↑ 右肾结核（肾自截）
CT平扫可见右肾区域完全发生钙化，呈明显高密度影，体积缩小
CT scan shows calcified area completely, right kidney was significantly high density shadow, volume reduction
↑ 右肾结核
CT平扫可见右侧肾盏扩张，呈低密度影，边缘较光滑，囊壁可见钙化
CT scan is visible on the right side of calyces expansion, a low density shadow, the edge is smooth, the capsule wall calcification
早期肾结核CT诊断有一定的困难，在显示肾小盏的早期边缘改变方面，CT检查不如尿路造影敏感。在CT平扫图像上，肾脏阴影可增大、缩小或正常。肾结核早期的钙化表现为肾皮质内粟粒样结核结节钙化，晚期可见肾实质内结节状、斑块状或大片状钙化。肾自截时可见患侧全肾高密度钙化，钙化的肾脏可以增大或缩小。当肾结核破坏肾实质和肾盂、肾盏后，在肾实质内产生的异常空洞性病变，CT上表现为类圆形低密度阴影，有时边缘可见钙化。肾盏扩张是修复期肾结核的征象，表现为边缘不规则、张力较大，呈楔形或圆形的水样密度影，CT值略高于尿液，如多发者可围绕肾盂排列呈‘花瓣状’；CT增强后囊状阴影边缘及肾盂边缘可以出现线样强化。晚期由于纤维化改变可以使肾盂变小、变形、肾盂壁增厚，与扩张的肾盏不成比例。
Early renal tuberculosis CT has the certain difficulty, marginal changes in the early stages of the show renal small lamp, urinary tract imaging sensitive than CT examination. On CT scan images, can be increased, reduced or normal kidney shadow. Calcification manifestation of renal tuberculosis early for millet sample tuberculous nodules in the renal cortex calcification, late shows nodular, plaques in the renal parenchyma or big shape calcification. Kidney is visible when the cutting of the high density calcified kidney, calcified kidney can be increased or reduced. When renal tuberculosis damage after renal parenchyma and renal pelvis and calyces, to produce the abnormal hole in the renal parenchyma lesions, the CT performance for class a circular low density shadow, sometimes edge of calcification. Calyx expansion is a sign of repair period of renal tuberculosis, characterized by irregular edge, tension is bigger, watery density shadow show cuneate or rounded, CT value slightly higher than that of urine, such as multiple can around the pelvis arranged in 'petals shape; CT enhanced cystic shadow edges and renal pelvis can appear line sample reinforcement. Late due to fibrosis change can make the renal pelvis size, deformation, wall thickening of the renal pelvis, calyces disproportionate with the expansion.
↑ 右肾结核
CT平扫可见右侧肾脏肿大，肾实质内多个囊性低密度影，其内密度高低不等CTscan can be seen right kidney enlargement, renal parenchyma in multiple cystic low density shadow, its density is high and low
CT增强扫描可见囊腔壁呈弧形线样强化，多个囊腔排列呈‘花瓣状’
CT enhanced scan the lumen of the visible wall reinforcement with arc line samples, multiple cystic space arranged in 'the petal shape'
当尿路造影肾脏不显影或不适于进行CT增强检查时，使用MRI检查有助于显示结核病变与其他炎性病变及肿瘤进行鉴别，但MRI对肾结核的小钙化灶显示不如CT敏感。早期肾结核在MRI上显示为肾脏局限性肿胀，皮质变厚，T1WI与T2WI上皮髓质的界限显示不清，肾包膜模糊，增强后肾脏实质的强化弱于健侧。上述早期肾结核的MRI表现缺乏特异性且无临床症状，诊断困难。中晚期肾结核时，依肾脏受累的情况，可以表现为局限性或普遍性肾皮质变薄；肾实质内可见不规则或类圆形脓腔或空洞形成，洞壁不光滑，T1WI为低信号，T2WI为高信号，增强后脓肿壁呈线样或环状强化，腔内无强化，多分布于肾髓质内，呈散在分布或聚拢；可见肾盂、肾盏破坏变形，囊壁增厚，肾盂亦狭窄变形，肾盂与肾盏的扩张不成比例。当肾盂积脓时，T1WI上其信号常高于尿液。虽然MRI显示钙化不如CT敏感，但全肾钙化形成的肾自截改变，在T1WI上呈低信号或等信号，在T2WI上可呈混杂信号，可能与其内的钙化和干酪样坏死物质等多种混合成分有关。磁共振尿路水成像（MRU）可以清楚的显示肾盂积水的全貌，表现为肾盂狭窄，肾盏排列紊乱，不同程度的肾盏扩张及肾盏漏斗部的纠集、狭窄、挛缩等改变，有时可呈‘花瓣状’。
When urinary tract imaging kidney development or not suitable for CT enhancement examination, using MRI helps show tuberculous and other inflammatory lesions and tumors were identified, but MRI of renal tuberculosis small calcifications according to sensitive than CT. Early renal tuberculosis displayed on the MRI is a localized swelling of the kidney, cortical thickening, T1WI and T2WI medullary epithelial line display is not clear, fuzzy, renal capsule of renal parenchyma enhancement weak Yu Jian side. The early MRI manifestation of renal tuberculosis lack of specificity and no clinical symptoms, diagnosis difficult. Middle-late renal tuberculosis, in accordance with kidney involvement, can show the limitations or universality of renal cortical thinning; Can be seen in the renal parenchyma of irregular or circular pus cavity or empty form, the width is not smooth, T1WI low signal, for high T2WI signal, abscess wall show sample line or annular enhancement, cavity without reinforcement, throughout in the renal medulla, scattered in or together; Visible renal pelvis and calyces damage deformation, cystic wall thickening, also narrow the deformation of the renal pelvis, the expansion of the renal pelvis and calyces disproportionate. When pyonephrosis, its signal on T1WI often higher than urine. MRI showed calcification, though less sensitive CT, but the whole renal calcification formed since the sectional change, has low signal or signal on T1WI, can show mixed signal on T2WI, may with caseous necrosis and calcification within the material and so on the many kinds of mixture composition. Magnetic resonance imaging urinary water (MRU) can clearly show the whole picture of hydronephrosis, show the stenosis of the renal pelvis and calyces disordered arrangement, different degrees of calyces expansion and calyces infundibulum goons, narrow, contracture, such as change, sometimes can show 'petal shape.
↑双肾结核
左图为T1WI抑脂图像，可见右侧肾盏高度扩张，边缘不规则，呈不均匀低或等信号；左肾实质内见类圆形脓腔影，边缘光滑，呈均匀低信号Left for T1WI fatsuppression images, visible on the right side of calyces highly expansion, margin irregular, uneven is low or equal signal; See inside the left kidney essence class circular vomica shadow, the edge is smooth, homogeneously low signal
右图为T2WI，可见右肾扩张的肾盏呈花瓣状排列，呈不均匀高信号影，左肾脓腔病灶呈明显高信号影
Right as the T2WI, visible light petal shaped expansion of the right kidney kidney, heterogeneous high signal in the shadow, left kidney pus cavity lesions was significantly high signal
