多排螺旋计算机断层摄影泌尿系成像临床应用的系列研究
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摘要
目的：回顾性研究生理盐水输注、腹部加压和两种排泄期延迟扫描时间对64排螺旋CTU图像质量的影响。
材料与方法：获得全部参加研究患者的病史和知情同意书。共122名患者参与此研究(男性50人,女性72人),行两期延迟期CTU检查,检查设备是西门子64排螺旋CT。CTU检查所用造影剂为300mgI/ml,共注射100ml,注射造影剂后行或不行团注100ml生理盐水,注射速度均为5ml/s。每名患者均进行延迟400s和550s的两期排泄期扫描,在进行排泄期扫描前患者接受或不接受腹部加压。研究者阅读轴位和后处理重建图像(包括VRT和MIP)以评价泌尿系的扩张及造影剂充盈情况。使用方差分析和卡方检验评价四种检查方法(生理盐水输注和腹部加压、仅生理盐水输注、仅腹部加压、既无生理盐水输注也无腹部加压)和两期排泄期扫描对于CTU图像质量的影响。
结果：生理盐水输注可以提高肾内集合系统和近段输尿管的充盈程度(P<0.05)并提高图像质量(P<0.01)。腹部加压(P<0.05)和550s排泄期扫描(P<0.01)可以提高肾内集合系统和近段输尿管的扩张程度,但是不影响其充盈情况。四种检查方法和两期排泄期扫描对远段输尿管扩张及造影剂充盈情况的影响无统计学显著性差异,但是550s排泄期扫描中有更多节段的远段输尿管显影。
结论：生理盐水输注、腹部加压和550s排泄期扫描对提高上泌尿系扩张、造影剂充盈情况和图像质量有一定影响。550s排泄期扫描有助于显示更多的远段输尿管。
目的：评价FLASH双源CT泌尿系成像双能量虚拟平扫临床应用的可行性。
材料与方法：对240例患者进行FLASH双源CT泌尿系成像,包括常规平扫、肾实质期双能量扫描(100kVp/230mAs和Sn140kVp/178mAs)和排泄期扫描。顺序注射造影剂100ml (370mgI/ml)和100ml生理盐水,注射速度均为5ml/s。利用'Liver VNC'软件处理得到虚拟平扫CT图像,与常规平扫CT图像比较在器官CT值、噪声、信号噪声比、图像质量和放射剂量等方面的差异。
结果：常规平扫和虚拟平扫所测器官CT值均无统计学显著性差异(P>0.05),虚拟平扫图像噪声明显低于常规平扫而信号噪声比明显高于常规平扫(P<0.05),虚拟平扫图像质量低于常规平扫但无统计学显著性差异(P>0.05),肾实质期双能量扫描放射剂量高于常规平扫和排泄期扫描(P<0.05)。
结论：在FLASH双源CT泌尿系成像中,双能量虚拟平扫具有取代常规平扫的可能,减少1次平扫的放射剂量,具有临床应用价值。
目的：评价单次团注造影剂双源双能量CT泌尿系成像中上泌尿系显影情况,及对无痛性血尿的诊断能力。
材料与方法：2010年8月至2010年12月间,共205名患者因无痛性血尿行双源双能量CT泌尿系成像(CTU)检查,其中男性137人,女性68人,年龄18-89岁,平均年龄61.1±14.9岁)。双源双能量CTU检查包括常规平扫、肾实质期双能量扫描(100kVp/230mAs和Sn140kVp/178mAs)和大螺距(3.0)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)的造影剂充盈情况。分别评价使用平扫、肾实质期和排泄期前瞻性诊断、以及使用虚拟平扫、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15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。使用受试者工作特征(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有87.8%和86.8%。使用三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0.991±0.007。使用虚拟平扫和两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0.993±0.006。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方案的放射剂量是(12.732±3.485)mSv,明显低于前瞻性诊断CTU方案的放射剂量[(17.002±4.013)mSv](P<0.05),前者放射剂量减低为(32.74±8.92)%。
结论：单次团注造影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,放射剂量减低。
目的：评价多排螺旋CT泌尿系成像(MDCTU)在尿路上皮癌患者随访中的临床价值。
材料与方法：2006年1月至2010年7月间,我科共行2800例MDCTU检查,其中413名尿路上皮癌患者术后随访共行466例MDCTU检查,包括平扫、肾实质期和排泄期三期扫描。顺序注射造影剂100ml (370mgI/ml)和100ml生理盐水,注射速度均为5ml/s。对MDCTU轴位及三维后处理图像进行前瞻性诊断,以评价是否有肿瘤复发。分析诊断的敏感性、特异性、准确性、阳性和阴性预测值。参考标准为病理学结果和随访临床资料。
结果：对尿路上皮癌患者的术后随访中,MDCTU诊断肿瘤复发的敏感性、特异性、准确性、阳性和阴性预测值分别为92.0%、99.0%、97.1%、97.2%和97.1%。
结论：MDCTU对随访尿路上皮癌患者肿瘤复发具有重要的临床价值。
Purpose To retrospectively evaluate the effects of saline administration following contrast material injection, abdominal compression and two delay phase acquisition on image quality improvement of CT urography (CTU).
Materials and Methods Medical records and informed consents of patients were obtained. In totally122patients (50men,72women), two delay phase images with MDCT(Siemens Somatom Sensation64) were performed. Scans began simultaneously with a contrast bolus injection of100ml (300mgI/ml) and or not a saline bolus injection of100ml at a rate of5ml/s. Two delay phase images were undergone at400and550seconds for each patient. Examinations were taken by using abdominal compression or not. The distention and opacification of the urinary tract were evaluated by two interpreters together on transverse images and post-processing3D images (VRT and MIP). Effects of four techniques (saline administration and abdominal compression, saline administration only, compression only, and neither saline administration nor compression) and two delay phase acquisition on image quality improvement were analysed by using ANOVA and Chi-square test.
Results Saline administration improved opacification (P<0.05) and increased overall image quality (P<0.01) of the intrarenal collecting system and proximal ureter. Abdominal compression (P<0.05) and delayed phase image acquisition of550seconds (P<0.01) all improved distention of the intrarenal collecting system and proximal ureter but did not improve opacification. No statistically significant effects on the distal ureter were found. However, there were more visualized distal ureteral segments with the longer imaging delay.
Conclusion Saline administration, abdominal compression and longer imaging delays are all effective in improving image quality of64-detector row CTU.
Purpose To evaluate the clinical feasibility of dual-source CT urography using dual-energy virtual non-enhanced CT.
Materials and Methods Totally240patients received dual-source CT, which included true non-enhanced CT (TNCT), nephrographic phase scanning with dual-energy mode (100kVp/230mAs and Sn140kVp/178mAs) and excretory phase scanning. A contrast bolus injection of100ml (370mgI/ml) contrast material following100ml saline which were all at a rate of5ml/s. Virtual non-enhanced CT (VNCT) image sets were reformatted from 'LiverVNC' software. The mean CT number, noise, signal to noise ratio (SNR), image quality and radiation dose were compared between TNCT and VNCT image sets.
Results There was no significant difference in mean CT numbers of all organs (P>0.05). However, VNCT images had significantly lower noise and higher SNR than TNCT images (both P<0.05). Image quality of VNCT was lower than that of TNCT without significant difference (P>0.05). Radiation dose of nephrographic phase with dual-energy mode was significantly higher than that of TNCT and excretory phase scanning (both P<0.05).
Conclusions In dual-source CT urography, dual-energy VNCT has potential clinical values in replacing TNCT with consequent saving in radiation dose.
Purpose To assess upper urinary tract opacification and the performance of one-bolus dual-dource dual-energy CT urography for painless hematuria.
Materials and Methods Between August2010and December2010, we identified205patients (137men,68women; age range,18-89years; mean±SD,61.1±14.9years) who underwent dual-source dual-energy CT urography (CTU) for painless hematuria. CTU included true non-enhanced phase, dual-energy mode nephrographic phase (100kVp/230mAs and Sn140kVp/178mAs) and FLASH mode (pitch3.0) 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 recorded, as well as retrospective diagnosis using virtual non-enhanced, nephrographic and excretory phase imaging. The standard of reference included all available clinical, imaging, and laboratory data for up to15months after CT urography. 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 protocol were compared.
Results87.8%and86.8%of segments were at least50%opacified, respectively. Sensitivity, specificity, PPV, NPV and accuracy for hematuria for prospective interpretation were95.2%,91.9%,98.2%,81.0%and94.6%, respectively. Comparable figures for retrospective diagnosis were98.8%,91.9%,98.2%,94.4%and97.6%. The AUC for prospective and retrospective diagnosis were (0.991±0.007) and (0.993±0.006), respectively (z=1.425, Bonferroni-corrected P>0.05). The radiation dose of CTU protocol using in retrospective diagnosis[(12,732±3.485)mSv] was significantly lower than that of prospective diagnosis [(17.002±4.013)mSv], with dose reduction of (32.74±8.92)%.
Conclusion One-bolus two-phase dual-source dual-energy CT urography provided at least50%opacification of upper urinary tract segments and had high diagnostic performance for painless hematuria, as well as with relatively low radiation dose.
Purpose To assess the clinical value of multi-detector row CT urography(MDCTU) in follow-up of patients with a history of previous urothelial tumor.
Materials and Methods At our department, totally2800MDCTU examinations were performed from January2006through July2010. Of these,466CT urograms in413patients evaluated for a history of urothelial tumor, were included in the study. MDCTU was used for non-enhanced, nephrographic phase and excretory phase scanning that began with a contrast bolus injection of100ml (370mgI/ml) contrast material following100ml saline which were all at a rate of5ml/s. Axial and three-dimensional reformation images were prospectively evaluated for urothelial tumor recurrence. Sensitivity, specificity, accuracy, positive and negative predictive values were analyzed with the standard of reference, including all available pathological and clinical materials.
Results In the post-operative follow-up of patients with previous urothelial cancer, sensitivity, specificity, accuracy, positive and negative predictive values of MDCTU for tumor recurrence were92.0%、99.0%、97.1%、97.2%and97.1%, respectively.
Conclusions MDCTU plays an important role in the post-operative follow-up of patients with a history of urothelial cancer for recurrence.
材料与方法：获得全部参加研究患者的病史和知情同意书。共122名患者参与此研究(男性50人,女性72人),行两期延迟期CTU检查,检查设备是西门子64排螺旋CT。CTU检查所用造影剂为300mgI/ml,共注射100ml,注射造影剂后行或不行团注100ml生理盐水,注射速度均为5ml/s。每名患者均进行延迟400s和550s的两期排泄期扫描,在进行排泄期扫描前患者接受或不接受腹部加压。研究者阅读轴位和后处理重建图像(包括VRT和MIP)以评价泌尿系的扩张及造影剂充盈情况。使用方差分析和卡方检验评价四种检查方法(生理盐水输注和腹部加压、仅生理盐水输注、仅腹部加压、既无生理盐水输注也无腹部加压)和两期排泄期扫描对于CTU图像质量的影响。
结果：生理盐水输注可以提高肾内集合系统和近段输尿管的充盈程度(P<0.05)并提高图像质量(P<0.01)。腹部加压(P<0.05)和550s排泄期扫描(P<0.01)可以提高肾内集合系统和近段输尿管的扩张程度,但是不影响其充盈情况。四种检查方法和两期排泄期扫描对远段输尿管扩张及造影剂充盈情况的影响无统计学显著性差异,但是550s排泄期扫描中有更多节段的远段输尿管显影。
结论：生理盐水输注、腹部加压和550s排泄期扫描对提高上泌尿系扩张、造影剂充盈情况和图像质量有一定影响。550s排泄期扫描有助于显示更多的远段输尿管。
目的：评价FLASH双源CT泌尿系成像双能量虚拟平扫临床应用的可行性。
材料与方法：对240例患者进行FLASH双源CT泌尿系成像,包括常规平扫、肾实质期双能量扫描(100kVp/230mAs和Sn140kVp/178mAs)和排泄期扫描。顺序注射造影剂100ml (370mgI/ml)和100ml生理盐水,注射速度均为5ml/s。利用'Liver VNC'软件处理得到虚拟平扫CT图像,与常规平扫CT图像比较在器官CT值、噪声、信号噪声比、图像质量和放射剂量等方面的差异。
结果：常规平扫和虚拟平扫所测器官CT值均无统计学显著性差异(P>0.05),虚拟平扫图像噪声明显低于常规平扫而信号噪声比明显高于常规平扫(P<0.05),虚拟平扫图像质量低于常规平扫但无统计学显著性差异(P>0.05),肾实质期双能量扫描放射剂量高于常规平扫和排泄期扫描(P<0.05)。
结论：在FLASH双源CT泌尿系成像中,双能量虚拟平扫具有取代常规平扫的可能,减少1次平扫的放射剂量,具有临床应用价值。
目的：评价单次团注造影剂双源双能量CT泌尿系成像中上泌尿系显影情况,及对无痛性血尿的诊断能力。
材料与方法：2010年8月至2010年12月间,共205名患者因无痛性血尿行双源双能量CT泌尿系成像(CTU)检查,其中男性137人,女性68人,年龄18-89岁,平均年龄61.1±14.9岁)。双源双能量CTU检查包括常规平扫、肾实质期双能量扫描(100kVp/230mAs和Sn140kVp/178mAs)和大螺距(3.0)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)的造影剂充盈情况。分别评价使用平扫、肾实质期和排泄期前瞻性诊断、以及使用虚拟平扫、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15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。使用受试者工作特征(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有87.8%和86.8%。使用三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0.991±0.007。使用虚拟平扫和两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0.993±0.006。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方案的放射剂量是(12.732±3.485)mSv,明显低于前瞻性诊断CTU方案的放射剂量[(17.002±4.013)mSv](P<0.05),前者放射剂量减低为(32.74±8.92)%。
结论：单次团注造影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,放射剂量减低。
目的：评价多排螺旋CT泌尿系成像(MDCTU)在尿路上皮癌患者随访中的临床价值。
材料与方法：2006年1月至2010年7月间,我科共行2800例MDCTU检查,其中413名尿路上皮癌患者术后随访共行466例MDCTU检查,包括平扫、肾实质期和排泄期三期扫描。顺序注射造影剂100ml (370mgI/ml)和100ml生理盐水,注射速度均为5ml/s。对MDCTU轴位及三维后处理图像进行前瞻性诊断,以评价是否有肿瘤复发。分析诊断的敏感性、特异性、准确性、阳性和阴性预测值。参考标准为病理学结果和随访临床资料。
结果：对尿路上皮癌患者的术后随访中,MDCTU诊断肿瘤复发的敏感性、特异性、准确性、阳性和阴性预测值分别为92.0%、99.0%、97.1%、97.2%和97.1%。
结论：MDCTU对随访尿路上皮癌患者肿瘤复发具有重要的临床价值。
Purpose To retrospectively evaluate the effects of saline administration following contrast material injection, abdominal compression and two delay phase acquisition on image quality improvement of CT urography (CTU).
Materials and Methods Medical records and informed consents of patients were obtained. In totally122patients (50men,72women), two delay phase images with MDCT(Siemens Somatom Sensation64) were performed. Scans began simultaneously with a contrast bolus injection of100ml (300mgI/ml) and or not a saline bolus injection of100ml at a rate of5ml/s. Two delay phase images were undergone at400and550seconds for each patient. Examinations were taken by using abdominal compression or not. The distention and opacification of the urinary tract were evaluated by two interpreters together on transverse images and post-processing3D images (VRT and MIP). Effects of four techniques (saline administration and abdominal compression, saline administration only, compression only, and neither saline administration nor compression) and two delay phase acquisition on image quality improvement were analysed by using ANOVA and Chi-square test.
Results Saline administration improved opacification (P<0.05) and increased overall image quality (P<0.01) of the intrarenal collecting system and proximal ureter. Abdominal compression (P<0.05) and delayed phase image acquisition of550seconds (P<0.01) all improved distention of the intrarenal collecting system and proximal ureter but did not improve opacification. No statistically significant effects on the distal ureter were found. However, there were more visualized distal ureteral segments with the longer imaging delay.
Conclusion Saline administration, abdominal compression and longer imaging delays are all effective in improving image quality of64-detector row CTU.
Purpose To evaluate the clinical feasibility of dual-source CT urography using dual-energy virtual non-enhanced CT.
Materials and Methods Totally240patients received dual-source CT, which included true non-enhanced CT (TNCT), nephrographic phase scanning with dual-energy mode (100kVp/230mAs and Sn140kVp/178mAs) and excretory phase scanning. A contrast bolus injection of100ml (370mgI/ml) contrast material following100ml saline which were all at a rate of5ml/s. Virtual non-enhanced CT (VNCT) image sets were reformatted from 'LiverVNC' software. The mean CT number, noise, signal to noise ratio (SNR), image quality and radiation dose were compared between TNCT and VNCT image sets.
Results There was no significant difference in mean CT numbers of all organs (P>0.05). However, VNCT images had significantly lower noise and higher SNR than TNCT images (both P<0.05). Image quality of VNCT was lower than that of TNCT without significant difference (P>0.05). Radiation dose of nephrographic phase with dual-energy mode was significantly higher than that of TNCT and excretory phase scanning (both P<0.05).
Conclusions In dual-source CT urography, dual-energy VNCT has potential clinical values in replacing TNCT with consequent saving in radiation dose.
Purpose To assess upper urinary tract opacification and the performance of one-bolus dual-dource dual-energy CT urography for painless hematuria.
Materials and Methods Between August2010and December2010, we identified205patients (137men,68women; age range,18-89years; mean±SD,61.1±14.9years) who underwent dual-source dual-energy CT urography (CTU) for painless hematuria. CTU included true non-enhanced phase, dual-energy mode nephrographic phase (100kVp/230mAs and Sn140kVp/178mAs) and FLASH mode (pitch3.0) 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 recorded, as well as retrospective diagnosis using virtual non-enhanced, nephrographic and excretory phase imaging. The standard of reference included all available clinical, imaging, and laboratory data for up to15months after CT urography. 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 protocol were compared.
Results87.8%and86.8%of segments were at least50%opacified, respectively. Sensitivity, specificity, PPV, NPV and accuracy for hematuria for prospective interpretation were95.2%,91.9%,98.2%,81.0%and94.6%, respectively. Comparable figures for retrospective diagnosis were98.8%,91.9%,98.2%,94.4%and97.6%. The AUC for prospective and retrospective diagnosis were (0.991±0.007) and (0.993±0.006), respectively (z=1.425, Bonferroni-corrected P>0.05). The radiation dose of CTU protocol using in retrospective diagnosis[(12,732±3.485)mSv] was significantly lower than that of prospective diagnosis [(17.002±4.013)mSv], with dose reduction of (32.74±8.92)%.
Conclusion One-bolus two-phase dual-source dual-energy CT urography provided at least50%opacification of upper urinary tract segments and had high diagnostic performance for painless hematuria, as well as with relatively low radiation dose.
Purpose To assess the clinical value of multi-detector row CT urography(MDCTU) in follow-up of patients with a history of previous urothelial tumor.
Materials and Methods At our department, totally2800MDCTU examinations were performed from January2006through July2010. Of these,466CT urograms in413patients evaluated for a history of urothelial tumor, were included in the study. MDCTU was used for non-enhanced, nephrographic phase and excretory phase scanning that began with a contrast bolus injection of100ml (370mgI/ml) contrast material following100ml saline which were all at a rate of5ml/s. Axial and three-dimensional reformation images were prospectively evaluated for urothelial tumor recurrence. Sensitivity, specificity, accuracy, positive and negative predictive values were analyzed with the standard of reference, including all available pathological and clinical materials.
Results In the post-operative follow-up of patients with previous urothelial cancer, sensitivity, specificity, accuracy, positive and negative predictive values of MDCTU for tumor recurrence were92.0%、99.0%、97.1%、97.2%and97.1%, respectively.
Conclusions MDCTU plays an important role in the post-operative follow-up of patients with a history of urothelial cancer for recurrence.
引文
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