Hwang Eu Chang, Kim Jun Seok, Kim Sun-Ouck, Jung Seung Il, Kang Taek Won, Kwon Dong Deuk, Park Kwangsung, Ryu Soo Bang, Kim Jin Woong, Wan Lu Ji
Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
Korean J Urol. 2011 Jan;52(1):13-8. doi: 10.4111/kju.2011.52.1.13. Epub 2011 Jan 24.
The objective of this study was to investigate the diagnostic accuracy of multi-detector computerized tomography urography (MDCTU) for the detection of bladder tumors.
We retrospectively reviewed the medical records of 143 patients who were scanned by use of 64-channel MDCTU and who underwent cystoscopy due to painless hematuria or a clinical suspicion of bladder tumor. We examined the accuracy of MDCTU for the detection of bladder tumors by comparing the results obtained by MDCTU with those obtained by cystoscopy. The associations between tumor characteristics, frequency of transurethral resection (TUR), and bladder volume and detectability of bladder tumors on MDCTU were also analyzed.
Of 143 patients, 50 patients had a history of urothelial carcinomas. In these patients, the sensitivity and specificity of MDCTU were 60.0% and 80.0%, respectively. In 93 patients without previous urothelial carcinomas, the sensitivity and specificity of MDCTU were 86.7% and 96.8%, respectively. Falsely diagnosed cases had a smaller distended bladder volume (p=0.014) and a smaller tumor size (p=0.022) than did true diagnosed cases. The false-negative rate increased when the bladder tumor was located at the bladder neck. In the univariate analysis, the tumor location, size, frequency of TUR, bladder volume, and initial hematuria were associated with detectability by MDCTU (p<0.05).
To improve the accuracy of MDCTU for diagnosing bladder tumors, bladder filling is recommended. Thus, cystoscopy should be considered as a standard diagnostic tool for bladder tumors even in patients with normal MDCTU results, especially in the evaluation of recurrent, bladder neck-located, small, or sessile bladder tumors.
本研究的目的是探讨多排螺旋计算机断层扫描尿路造影（MDCTU）检测膀胱肿瘤的诊断准确性。
我们回顾性分析了143例因无痛性血尿或临床怀疑膀胱肿瘤而接受64排MDCTU扫描并进行膀胱镜检查的患者的病历。通过比较MDCTU与膀胱镜检查的结果，我们检验了MDCTU检测膀胱肿瘤的准确性。还分析了肿瘤特征、经尿道切除术（TUR）频率、膀胱容量与MDCTU上膀胱肿瘤可检测性之间的关联。
143例患者中，50例有尿路上皮癌病史。在这些患者中，MDCTU的敏感性和特异性分别为60.0%和80.0%。在93例无既往尿路上皮癌的患者中，MDCTU的敏感性和特异性分别为86.7%和96.8%。与真正确诊的病例相比，误诊病例的膀胱扩张体积较小（p = 0.014），肿瘤大小较小（p = 0.022）。当膀胱肿瘤位于膀胱颈部时，假阴性率增加。在单因素分析中，肿瘤位置、大小、TUR频率、膀胱容量和初始血尿与MDCTU的可检测性相关（p < 0.05）。
为提高MDCTU诊断膀胱肿瘤的准确性，建议膀胱充盈。因此，即使MDCTU结果正常的患者，尤其是在评估复发性、膀胱颈部定位、小的或无蒂膀胱肿瘤时，也应将膀胱镜检查视为膀胱肿瘤的标准诊断工具。
