摘要
目的:探讨低辐射CT仿真膀胱镜(低辐射CTVC)作为膀胱肿瘤的诊断和术后随访手段的临床应用价值。方法:2007年1月～2008年3月对68例血尿或膀胱肿瘤术后复发患者应用常规16排螺旋CT与管电流减半(120 mA)的螺旋CT进行膀胱容积扫描,并利用"F1y Through"软件进行仿真膀胱镜检查。所有患者均进行膀胱B超和膀胱镜检查。以膀胱镜检查和病理检查作为诊断黄金标准,分别计算低辐射CTVC、B超两种无创诊断方法对膀胱肿瘤诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值、假阳性率、假阴性率,比较常规CT与低辐射CT的辐射剂量差异。结果:61例膀胱镜检查发现肿瘤的患者,低辐射CTVC检查均发现肿瘤,而B超发现其中的58例有肿瘤;低辐射CTVC检查的灵敏度为100%,特异度为71.43%,阳性预测值为96.83%,阴性预测值为100%,假阳性率为28.57%,假阴性率为0,准确度为97.06%,Kappa值=0.817。B超检查的灵敏度为95.08%,特异度为85.71%,阳性预测值为98.31%,阴性预测值为66.67%,假阳性率为14.29%,假阴性率为4.29%,准确度为94.12%,Kappa值=0.717。常规CT平均辐射吸收当量为17.4 mSv,低辐射CT的平均辐射吸收当量为6.9 mSv,差异有统计学意义(P<0.05)。结论:低辐射CTVC对大于0.5 cm膀胱肿瘤灵敏度达100%。对小于0.5 cm膀胱肿瘤也能达到很高的灵敏度;低辐射CTVC适合于膀胱肿瘤患者早期诊断和长期随访检查。
Objective.. To evaluate low radiation dose CT virtual cystoscopy（CTVC） in the diagnosis and postsurgical follow-up of the bladder tumors. Methods： From January 2007 to March 2008, 68 cases with hematuria or postoperative recurrence of bladder cancer were studied. Volume scanning was estimated by spiral CT, 240 mA in tube current of normal dose CT and 120 mA in tube current of low dose CT. Virtual cystoseopy images were generated from volumetric data of low CT using ＂Fly Through＂ software. All patients were examined by B-ultrasound and cystoscopy. Cystoscopy and biopsy was treated as a diagnostic gold-standard. The diagnostic data of two noninvasive diagnostic methods ： low radiation dose CTCV and B-ultrasound were calculated, such as the sensitivity, specificity, accuracy, positive predictive rate, negative predictive rate, false positive rate, and false negative rate. The differences between normal CT and low radiation dose CT were compared. Results： Bladder tumors were found by low radiation dose CTVC and cystoscopy in 61 cases, but by B-ultrasound only in 58 cases. The sensitivity of low radiation dose CTVC was 100%, specificity was 71.43%, positive predictive rate was 96.83%, negative predictive rate was 100%, false positive rate was 28.57%, none false negativity and accuracy rating was 97. 06%, Kappa=0. 817. The sensitivity of B-ultrasound was 95.08% specificity was 85.71%, positive predictive rate was 98.31 %, negative predictive rate was 66.67 %, false positive rate was 14.29 % and false negativity was 4.29%, accuracy rating was 94.12%, Kappa=0. 717. The average radiation dose of normal CT was 17.4 mSv, and that of low dose CTVC was 6.9 mSv （P〈0.05）. Conclusions： The sensitivity of low radiation dose CTVC to the bladder tumor bigger than 0 . 5 cm was 100%, and the sensitivity of that also high to the bladder tumor smaller than 0 . 5 cm. Low radiation dose CTVC has been proved to be a noninvasive and valuable methods in the early diagnosis and long-term follow-up of bladder tumors.
出处
《临床泌尿外科杂志》
北大核心
2009年第6期433-438,447,共7页
Journal of Clinical Urology
