儿童急性肾盂肾炎肾瘢痕化的影像学研究进展

Research Development of Imaging in Acute Pyelonephritis and Renal Scarring in Children

摘要: 儿童急性肾盂肾炎是常见的上尿路感染性疾病，若未及时干预，可导致肾瘢痕形成，进而引发高血压、蛋白尿及慢性肾功能衰竭等严重并发症。影像学检查在急性肾盂肾炎的诊断、肾损伤评估及瘢痕监测中具有核心作用。本文综述了肾瘢痕形成的病理机制及其影像学评估的最新进展。DMSA显像作为检测肾瘢痕的“金标准”，能够精准评估肾皮质功能与结构损伤；超声技术(如能量多普勒、微血管多普勒及对比增强超声)在早期诊断和随访中表现出较高的应用潜力；CT可清晰显示解剖细节及并发症，但需关注辐射暴露风险；MRI凭借多序列功能成像(如DWI、DTI)在无辐射条件下提供微循环及纤维化信息，适用于长期随访。此外，人工智能与影像组学技术的发展有望进一步提升诊断效率与预后预测准确性。未来需优化多模态影像协同策略，以实现儿童肾瘢痕的早期干预与个体化管理。

Abstract: Acute pyelonephritis (APN) is a common upper urinary tract infection in children. Without timely intervention, it may lead to renal scarring, which can progress to severe complications such as hypertension, proteinuria, and chronic renal failure. Imaging techniques play a central role in the diagnosis of APN, assessment of renal injury, and monitoring of scar formation. This review summarizes recent advances in the pathological mechanisms of renal scarring and its imaging evaluation. Dimercaptosuccinic acid (DMSA) scintigraphy remains the “gold standard” for detecting renal scars, providing a precise assessment of cortical function and structural damage. Ultrasonographic techniques, including power Doppler, microvascular Doppler, and contrast-enhanced ultrasound, show great potential in early diagnosis and follow-up. Computed tomography (CT) offers detailed anatomical visualization and complication detection, though radiation exposure remains a concern. Magnetic resonance imaging (MRI), with functional sequences such as diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI), enables non-radiation evaluation of microcirculation and fibrotic changes, making it suitable for long-term monitoring. Furthermore, artificial intelligence and radiomics are emerging tools that may enhance diagnostic accuracy and prognostic prediction. Future efforts should focus on optimizing multimodal imaging strategies to achieve early intervention and personalized management of renal scarring in children.