Department of Radiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
Radiology. 2010 May;255(2):508-16. doi: 10.1148/radiol.09082074. Epub 2010 Feb 16.
To retrospectively evaluate renal, vascular, and urinary tract visualization following a single postcontrast multidetector computed tomographic (CT) urographic sequence performed with three limited-volume bolus injections.
The institutional review board approved this retrospective study. Patient informed consent was waived. Triple-bolus multidetector CT urography was performed in 110 patients. Triple-bolus protocol consisted of 30 mL of contrast material at 2 mL/sec at 0 seconds, 50 mL at 1.5 mL/sec at 435 seconds, 65 mL at 3 mL/sec at 488 seconds, with total abdominal scanning time of 510 seconds. Two independent readers rated urinary tract opacification and qualitatively and quantitatively assessed renal parenchymal and vascular contrast enhancement. Upper urinary tract (UUT) distention was measured by one reader. Interobserver agreement was assessed by using kappa statistics.
Complete opacification of the intrarenal collecting system and proximal ureter was achieved in 91% (184 of 202) (kappa = 0.62) and 82% (166 of 202) (kappa = 0.94) of segments, respectively. The distal ureter was not opacified in 21% of the cases (kappa = 0.92), and the bladder was not opacified in 20% of the cases. Mean distention was higher for proximal (3.9 mm) than for distal (3.7 mm) segments. Image quality of renal parenchymal enhancement was excellent in 76% of cases. Arteries showed better contrast enhancement than veins (excellent rating in 89% vs 59% of the cases). Radiation dose calculated for triple-bolus acquisition was 9.8 mSv.
Triple-bolus multidetector CT urography is a dose-efficient protocol acquiring corticomedullary-nephrographic-excretory and vascular enhancement phases in a single acquisition and provides sufficient opacification and distention of the UUT. Simultaneously, adequate image quality of renal parenchyma and vascular anatomy is achieved.
回顾性评估单次对比增强多层螺旋 CT 尿路造影后肾脏、血管和尿路的可视化效果，该检查采用三次小容量团注对比剂完成。
本研究经机构审查委员会批准，患者知情同意豁免。110 例患者行三脉冲式多层螺旋 CT 尿路造影。三脉冲式对比剂注射方案为：0 秒时注射 30ml 对比剂（2ml/sec），435 秒时注射 50ml 对比剂（1.5ml/sec），488 秒时注射 65ml 对比剂（3ml/sec），全腹部扫描时间 510 秒。两位独立观察者评估尿路显影情况，并定性和定量评估肾实质和血管增强情况。一位观察者测量上尿路（UUT）扩张程度。采用κ 统计评估观察者间一致性。
184/202（91%）（κ=0.62）和 166/202（82%）（κ=0.94）的段可实现肾内集合系统和近端输尿管完全显影。21%的病例远端输尿管不显影（κ=0.92），20%的病例膀胱不显影。近端（3.9mm）比远端（3.7mm）段扩张程度更高。76%的病例肾实质增强的图像质量为优秀。动脉的增强效果优于静脉（89%的病例为优秀，59%的病例为优秀）。三脉冲式采集的辐射剂量为 9.8mSv。
三脉冲式多层螺旋 CT 尿路造影是一种高效的方案，可在单次采集时获得皮质-髓质-肾图-排泄期和血管增强期，充分显影 UUT 并扩张其管腔。同时，可获得良好的肾实质和血管解剖图像质量。
