摘要
目的评价单次团注对比剂双源双能量CT泌尿系成像(CTU)上泌尿系显影情况,以及对无痛性血尿的诊断能力。方法对205例无痛性血尿患者行双源双能量CTU检查,包括常规平扫、肾实质期双能量扫描和大螺距排泄期扫描。两名医师独立评价排泄期上泌尿系各节段(双侧肾内集合系统、肾盂、近段输尿管和远段输尿管)的对比剂充盈情况。分别采用平扫、肾实质期和排泄期前瞻性诊断,以及虚拟平扫、肾实质期和排泄期回顾性诊断血尿的病因,参考标准包括病理、实验室检查、其他影像学资料和截至36个月的临床随访资料。分别计算前瞻性和回顾性诊断无痛性血尿的敏感性、特异性、阳性预测值、阴性预测值和准确性。采用受试者工作特征(ROC)分析并分别计算以上两种方法的曲线下面积(AUC),比较两种方法的诊断效能和放射剂量。结果两名医师认为充盈程度大于50%的上泌尿系节段分别占87.8%和86.8%。采用3期扫描图像前瞻性诊断血尿的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为95.2%、91.9%、98.2%、81.0%和94.6%,AUC为0.931±0.027。采用虚拟平扫和2期扫描图像回顾性诊断血尿的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为98.8%、91.9%、98.2%、94.4%和97.6%,AUC为0.940±0.026。两种方法诊断效能无明显差异(z=1.425,Bonferroni校正P>0.05)。回顾性诊断CTU方案的放射剂量为(12.732±3.485)mSv,明显低于前瞻性诊断CTU方案的(17.002±4.013)mSv(P=0.017),前者放射剂量减低为(32.74±8.92)%。结论单次团注对比剂肾实质期双能量扫描和大螺距排泄期扫描双期CTU检查中上泌尿系充盈较好,结合虚拟平扫图像对无痛性血尿诊断能力高,且放射剂量减低。
Objective To assess the upper urinary tract opacification and the diagnostic performance of one-bolus dual-source dual-energy CT urography （CTU） for painless hematuria.Methods Totally 205 patients who underwent dual-source dual-energy CTU for painless hematuria were enrolled in this study.CTU included true non-enhanced phase,dual-energy mode nephrographic phase,and FLASH mode excretory phase imaging of the urinary tract.Two radiologists independently evaluated the degree of upper urinary tract opacification.Prospective interpretations using true non-enhanced,nephrographic and excretory phase imaging for hematuria were recoMed,as well as retrospective diagnosis using virtual non-enhanced,nephrographic and excretory phase imaging.The standard of reference included all available clinical,imaging,laboratory and follow-up data for up to 36 months after CTU exam.Sensitivity,specificity,positive （PPV） and negative （NPV） predictive values,and accuracy were calculated.Receiver-operating characteristic （ROC） analysis was undertaken and the area under the curve （AUC） calculated.The prospective and retrospective diagnostic performance for hematuria and the radiation dose of two CTU protocols were compared.Results It was found that 87.8％ and 86.8％ of segments were at least 50％ opacified,respectively.The sensitivity,specificity,PPV,NPV and accuracy for hematuria for prospective interpretation were 95.2％,91.9％,98.2％,81.0％ and 94.6％,respectively.Comparable figures for retrospective diagnosis were 98.8％,91.9％,98.2％,94.4％ and 97.6％.The AUC for prospective and retrospective diagnosis were 0.931 ±0.027 and 0.940 ±0.026,respectively （z =1.425,Bonferroni-corrected P ＞ 0.05）.The radiation dose of the CTU protocol using in retrospective diagnosis[（12.732 ± 3.485） mSv] was significantly lower than that of prospective diagnosis [（17.002 ± 4.013） mSv] （P ＜0.05）,with dose reduction of （32.74 ± 8.92）％.Conclusion One-bolus two-phase dual-source dual-energy CT urograp
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2014年第3期283-290,共8页
Acta Academiae Medicinae Sinicae
关键词
CT泌尿系成像
双源双能量
虚拟平扫
放射剂量
无痛性血尿
CT urography
dual-source dual-energy
virtual non-enhanced
radiation dose
painless hematuria
