CT 尿路造影与排泄性尿路造影在上尿路尿路上皮癌的检测和定位中的比较。

Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract.

机构信息

Department of Diagnostic Radiology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan.

出版信息

AJR Am J Roentgenol. 2011 May;196(5):1102-9. doi: 10.2214/AJR.10.5249.

DOI:10.2214/AJR.10.5249

PMID:21512076

Abstract

OBJECTIVE

The purpose of this study was to compare the accuracy of CT urography and excretory urography for the detection and localization of upper urinary tract urothelial carcinoma.

MATERIALS AND METHODS

Of 128 patients at high risk for upper tract urothelial carcinoma who were examined with both CT urography and excretory urography between 2002 and 2007, 24 were undiagnosed and excluded. CT urography and excretory urography results of the remaining 104 patients and 552 urinary tract segments were compared with histopathologic examination or follow-up imaging at 1 year. Two readers independently scored the confidence levels for the presence or absence of upper urinary tract urothelial carcinoma in each of six upper urinary tract segments on both CT urography and excretory urography; differences were resolved by consensus.

RESULTS

Upper urinary tract urothelial carcinoma was diagnosed in 77 (14%) segments of 46 (44%) patients. Per-patient sensitivity, specificity, overall accuracy, and area under the receiver operating characteristic curves for detecting carcinomas with CT urography (93.5% [43/46], 94.8% [55/58], 94.2% [98/104], and 0.963, respectively) were significantly greater than those for excretory urography (80.4% [37/46], 81.0% [47/58], 80.8% [84/104], and 0.831, respectively) (p = 0.041, p = 0.027, p = 0.001, and p < 0.001, respectively). Per-segment sensitivity and overall accuracy for the localization of upper urinary tract urothelial carcinoma were significantly greater with CT urography (87.0% [67/77] and 97.8% [540/552]) than with excretory urography (41.6% [32/77] and 91.5% [505/552]) (p < 0.0001).

CONCLUSION

CT urography was more accurate than excretory urography in the detection and localization of upper urinary tract urothelial carcinoma and should be considered as the initial examination for the evaluation of patients at high risk for upper urinary tract urothelial carcinoma.

摘要

目的

本研究旨在比较 CT 尿路造影和排泄性尿路造影对上尿路尿路上皮癌的检测和定位的准确性。

材料与方法

2002 年至 2007 年间，对 128 例有上尿路尿路上皮癌高危因素的患者同时行 CT 尿路造影和排泄性尿路造影检查，其中 24 例未诊断并排除。比较剩余的 104 例患者和 552 个尿路节段的 CT 尿路造影和排泄性尿路造影结果与组织病理学检查或 1 年后的随访影像学结果。两位读者分别对 CT 尿路造影和排泄性尿路造影中 6 个上尿路节段的每个节段存在或不存在上尿路尿路上皮癌的置信水平进行评分；差异通过共识解决。

结果

46 例（44%）患者的 77 个（14%）尿路节段诊断为尿路上皮癌。CT 尿路造影检测膀胱癌的患者检出率、特异度、总准确率和受试者工作特征曲线下面积分别为 93.5%（43/46）、94.8%（55/58）、94.2%（98/104）和 0.963，显著大于排泄性尿路造影的 80.4%（37/46）、81.0%（47/58）、80.8%（84/104）和 0.831（均为 p=0.041、p=0.027、p=0.001 和 p<0.001）。CT 尿路造影对膀胱癌的定位的检出率和总准确率也显著高于排泄性尿路造影（87.0%（67/77）和 97.8%（540/552）比 41.6%（32/77）和 91.5%（505/552））（均为 p<0.0001）。