Kemper J, Regier M, Stork A, Adam G, Nolte-Ernsting C
Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf.
Rofo. 2006 May;178(5):531-7. doi: 10.1055/s-2006-926630. Epub 2006 Apr 13.
To retrospectively quantify opacification of the urinary tract using a MSCTU protocol based on furosemide and individual adaptation of urographic acquisition delay.
MSCTU examinations obtained from 4-row and 16-row CT scanners in 53 patients (35 men, 18 women, average age 59) were independently reviewed by two radiologists. MSCTUs were performed using a low-dose injection of furosemide. No fixed scan delay for urographic image acquisition was applied. The urographic timing was individually adapted by performing low-dose test images of the distal ureters to display their current opacification. Image analysis included grading of the opacification of the segmented collecting system. The average urographic delay was calculated. Stratified comparisons of mean scores were assessed using the Friedman and Wilcoxon tests. The inter-observer kappa value was calculated.
The calculated median scan delay for patients with normal serum-creatinine levels (n = 51) was 418 sec (mean 447 sec; SD, 118 sec). The median number of acquired test images was 2 (range 1 - 6 images). The opacification analysis demonstrated that 98 % of the ICS, 90 % of the proximal, 86 % of the middle, and 83 % of the distal ureteral segments showed opacification greater than 90 %. 9.5 % of the distal ureteral segments could not be visualized. Statistics did not show significant opacification differences between proximal, middle, and distal ureteral segments (p > 0.05). The two observers were largely in agreement (kappa coefficient r = 0.81).
The analyzed MSCTU technique based on furosemide and scan delay timing by means of test images reliably lead to a homogenous opacification of the entire upper urinary tract. It features the individual adaptation of MSCTU to the excretory rate of the kidneys.
采用基于速尿和尿路造影采集延迟个体化调整的多层螺旋CT尿路造影（MSCTU）方案，对尿路的显影情况进行回顾性定量分析。
两名放射科医生独立回顾了53例患者（35例男性，18例女性，平均年龄59岁）使用4排和16排CT扫描仪进行的MSCTU检查。MSCTU检查采用低剂量速尿注射。尿路造影图像采集未采用固定的扫描延迟。通过对输尿管远端进行低剂量测试图像来显示其当前显影情况，从而对尿路造影的时间进行个体化调整。图像分析包括对分割后的集合系统显影情况进行分级。计算平均尿路造影延迟时间。采用Friedman检验和Wilcoxon检验对平均评分进行分层比较。计算观察者间的kappa值。
血清肌酐水平正常的患者（n = 51）计算出的中位扫描延迟时间为418秒（平均447秒；标准差，118秒）。采集的测试图像中位数为2张（范围1 - 6张）。显影分析表明，98%的肾盂集合系统、90%的近端输尿管、86%的中段输尿管和83%的远端输尿管段显影大于90%。9.5%的远端输尿管段无法显影。统计学分析未显示近端、中段和远端输尿管段之间存在显著的显影差异（p > 0.05）。两名观察者的意见基本一致（kappa系数r = 0.81）。
基于速尿和通过测试图像进行扫描延迟时间调整的分析性MSCTU技术能够可靠地使整个上尿路均匀显影。其特点是MSCTU能根据肾脏的排泄率进行个体化调整。
