多排计算机断层尿路造影术比排泄性尿路造影术更准确，可用于诊断血尿成人上尿路移行细胞癌。
Multidetector computerized tomography urography is more accurate than excretory urography for diagnosing transitional cell carcinoma of the upper urinary tract in adults with hematuria.
机构信息
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
J Urol. 2010 Jan;183(1):48-55. doi: 10.1016/j.juro.2009.08.144.
PURPOSE
It is debatable whether traditionally used excretory urography or the recently introduced multidetector computerized tomography urography is more accurate for diagnosing upper urinary tract transitional cell carcinoma. We compared accuracy measures of both methods for diagnosing upper urinary tract transitional cell carcinoma in adult patients with hematuria.
MATERIALS AND METHODS
We retrospectively analyzed consecutive adult patients with hematuria undergoing excretory urography and multidetector computerized tomography urography before any surgery, intervention or treatment from April 2004 to December 2006 in our hospital. The presence of upper urinary tract transitional cell carcinoma on excretory urography and multidetector computerized tomography urography was reviewed independently by 2 uroradiologists who were blinded to clinical information and other imaging results. Final diagnosis of upper urinary tract transitional cell carcinoma was confirmed by histological results. Measures of the diagnostic accuracy of excretory urography and multidetector computerized tomography urography for upper urinary tract transitional cell carcinoma were calculated and compared with reference to the final diagnosis.
RESULTS
Of 34 men and 26 women with hematuria (mean age 60.73 +/- 12.95 years) 19 (31.7%) had a final diagnosis of 24 upper urinary tract transitional cell carcinomas. The sensitivity, specificity and accuracy of excretory urography were 0.750, 0.860 and 0.849, respectively. In contrast, the sensitivity, specificity and accuracy of multidetector computerized tomography urography were 0.958, 1.000 and 0.996, respectively. Overall the area under the receiver operating characteristic curve for multidetector computerized tomography urography was significantly larger than that for excretory urography (0.978 vs 0.815, p = 0.005).
CONCLUSIONS
Multidetector computerized tomography urography is more sensitive, specific and accurate than excretory urography in the diagnosis of upper urinary tract transitional cell carcinoma in adult patients with hematuria. Therefore, multidetector computerized tomography urography rather than excretory urography should be the first choice noninvasive imaging modality for diagnosing upper urinary tract transitional cell carcinoma.
目的
传统使用的排泄性尿路造影术与最近引入的多排计算机断层尿路造影术，哪一种方法对诊断上尿路移行细胞癌更准确，这一点存在争议。我们比较了这两种方法在诊断成人血尿患者上尿路移行细胞癌方面的准确性。
材料与方法
我们回顾性分析了 2004 年 4 月至 2006 年 12 月在我院因血尿接受排泄性尿路造影术和多排计算机断层尿路造影术的连续成年患者。2 位泌尿科放射科医生对排泄性尿路造影术和多排计算机断层尿路造影术的上尿路移行细胞癌存在情况进行独立评估，他们对临床信息和其他影像学结果均不知情。上尿路移行细胞癌的最终诊断通过组织学结果证实。计算并比较了排泄性尿路造影术和多排计算机断层尿路造影术对上尿路移行细胞癌的诊断准确性指标，并与最终诊断进行了比较。
结果
34 名男性和 26 名女性患者（平均年龄 60.73±12.95 岁）出现血尿，其中 19 名（31.7%）最终诊断为 24 例上尿路移行细胞癌。排泄性尿路造影术的敏感性、特异性和准确性分别为 0.750、0.860 和 0.849。相比之下，多排计算机断层尿路造影术的敏感性、特异性和准确性分别为 0.958、1.000 和 0.996。总的来说，多排计算机断层尿路造影术的受试者工作特征曲线下面积明显大于排泄性尿路造影术（0.978 比 0.815，p=0.005）。
结论
多排计算机断层尿路造影术在诊断成人血尿患者上尿路移行细胞癌方面比排泄性尿路造影术更敏感、更特异、更准确。因此，多排计算机断层尿路造影术而非排泄性尿路造影术，应该成为诊断上尿路移行细胞癌的首选非侵入性影像学方法。
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