CT尿路成像分泌期图像诊断泌尿系统病变的价值  

Diagnostic value of excretory phase in CT urography

作　　者：杨晓霞[1] 唐光健[2] 南喜文[1] 李东春[1] 樊森秀[1] 

机构地区：[1]山西省大同市第三人民医院放射科,037008 [2]北京大学第一医院放射科

出　　处：《中华放射学杂志》2015年第2期117-120,共4页Chinese Journal of Radiology

摘　　要：目的：探讨CT尿路成像（CTU）分泌期图像在泌尿系统病变诊断中的价值。方法回顾性分析行CTU检查的101例患者（197侧输尿管）资料，其中44例有X线剂量结果。由3名不同年资医师分2次于PACS上调取影像独立诊断。第1次诊断（诊断A）仅调取平扫、增强肾皮质期与肾实质期影像，第2次诊断（诊断B）调取平扫、增强肾皮质期、肾实质期与分泌期影像。2次诊断间隔3个月。以诊断B的结果为标准，计算诊断A的诊断符合率，并记录诊断符合率≤80%的病变类型。3名医师在诊断B图像上共同评价输尿管对比剂充盈评分，并将病变分为肾盂输尿管病变、膀胱病变、肾脏与尿路外病变和无病变4组，统计不同病变的输尿管充盈评分。分别采用χ2检验、Kruskal-Wallis检验和t检验比较3名医师间诊断A诊断符合率的差异、4组病变间输尿管充盈评分的差异和2种诊断方法有效剂量的差异。结果3名医师的诊断A总符合率分别为95.4%（188/197）、93.9%（185/197）和92.4%（182/197），差异无统计学意义（χ2=1.60，P〉0.05）。诊断A符合率≤80%的病变包括肾盂旁囊肿和肾盏憩室。肾盂输尿管病变、膀胱病变、肾脏尿路外病变及无病变组分泌期尿路充盈对比剂评分的中位数分别为2、3、3和4分，差异有统计学意义（HC=31.7，P〈0.05）。采用诊断A和诊断B图像的有效剂量分别为（32.36±11.04）、（41.47±14.27）mSv，差异有统计学意义（t=3.35，P〈0.01）。结论 CTU检查分泌期影像对多数泌尿系统疾病的诊断无影响，且失败率高、增加了扫描剂量，应谨慎选择应用。Objective To determine the diagnostic value and necessity of excretory phase of CT urogrphy （CTU）. Methods One hundred and one cases with 197 sides of cohort CTU studies were enrolled from PACS system retrospectively, and 44 cases had the records of radiation dosage. Three different seniority senior radiologists reviewed the images and diagnosed 2 times blindly with the clinical information. At the first time, plane scan, contrast enhanced renal cortical phase and renal parenchymal phase images （Diag. A） were reviewed. At the second time, with 3 kinds of images mentioned above plus excretive phase images （Diag. B） were reviewed, with interval of 3 months between the two reviews. With Diag. B as reference standard, accordance rate of diagnoses of Diag. A was calculated. The difference of the 3 rediologists＇s accordance rates were analyzed with Chi-square test, and the lesions with accordance rate ≤80% were recorded. The cases of 197 urinary tracts were divided into 4 groups： lesions of renal pelvic and ureter, lesions of bladder, lesions of kidney and extra-urinary tract, without lesion. The filling of contrast media in the urinary tract was recorded with 5-scale scoring system. The differences of the urinary tract filling among the 4 groups were analyzed with Kruskal-Wallis test. The effective radiation dosages of CTU with and without excretory phase scan were recorded and calculated, and the difference was analyzed with t test. Result The diagnostic accordance rate of CTU with and without excretory phase of the 3 radiologists was 95.4%（188/197）, 93.9%（185/197）, 92.4%（182/197）respectively（χ2=1.60, P〉0.05）. Lesions with diagnostic rate≤80%were parapelvic cyst and caliceal diverticulum. The median score of urinary tracts filling in the lesions of renal pelvic and ureter, lesions of bladder, lesions of kidney and extra-urinary tract, without lesion group were＆nbsp;2, 3, 3, 4, and the differences were significant （HC=31.7, P〈0.05）. The effective radiation dosages of CTU

关 键 词：输尿管 体层摄影术 X线计算机 辐射剂量 

分 类 号：R691[医药卫生—泌尿科学] R816.7[医药卫生—外科学]