Department of Urology, University of Virginia Health System, Charlottesville, Virginia, USA.
J Endourol. 2012 Jul;26(7):814-8. doi: 10.1089/end.2011.0478. Epub 2012 Mar 26.
Cone beam CT (CBCT) is a novel imaging modality that combines the versatility of conventional C-arm imaging with the functionality of cross-sectional imaging. This is a pilot study to evaluate the capabilities of this new technology to obtain percutaneous access and for the immediate postoperative evaluation of residual fragments in percutaneous nephrolithotomy (PCNL).
A retrospective analysis of all PCNL cases performed between April 2007 and November 2007 was performed. One urologist (NSS) and one radiologist (JFA) reviewed the studies postoperatively. Preoperative films were evaluated to see if CBCT influenced or improved percutaneous access. Postoperative films were evaluated that compared CBCT with conventional noncontrast CT to determine efficacy in finding postoperative stone fragments. Parameters of stone size, location, and quantity of fragments were compared.
For preoperative access, CBCT was used in 52 cases of PCNL between April 2007 and November 2007. In eight of these cases, CBCT altered the percutaneous access. In postoperative evaluation, 26 cases had both CBCT and conventional CT for comparison. In 11 cases with residual stones, conventional CT identified a greater number of fragments, but these were less than 2 mm. The postoperative recommendation for a secondary procedure concurred in 22 of 26 studies.
CBCT may provide advantages of improved preoperative imaging, which may result in better percutaneous access, and improved postoperative imaging, which allows surgeons to have "real-time" access to CT quality images. The intraoperative availability of these high quality tomographic images may obviate the need for other postoperative imaging and subsequent adjunctive procedures for residual fragments.
锥形束 CT（CBCT）是一种新型成像方式，结合了传统 C 臂成像的多功能性和横截面成像的功能。这是一项评估该新技术在经皮肾镜取石术（PCNL）中获得经皮通道和对残留结石碎片进行即刻术后评估能力的初步研究。
回顾性分析了 2007 年 4 月至 2007 年 11 月期间进行的所有 PCNL 病例。一名泌尿科医生（NSS）和一名放射科医生（JFA）对术后的研究进行了审查。对术前影像进行评估，以了解 CBCT 是否影响或改善了经皮通道。对术后影像进行评估，将 CBCT 与常规非对比 CT 进行比较，以确定在发现术后结石碎片方面的有效性。比较了结石大小、位置和碎片数量的参数。
在 2007 年 4 月至 2007 年 11 月期间，52 例 PCNL 中使用了 CBCT 进行术前通道。在这 8 例中，CBCT 改变了经皮通道。在术后评估中，26 例病例同时进行了 CBCT 和常规 CT 比较。在 11 例有残留结石的病例中，常规 CT 识别出更多的碎片，但这些碎片小于 2 毫米。在 26 项研究中，有 22 项推荐进行二次手术。
CBCT 可能提供改进术前成像的优势，这可能导致更好的经皮通道，以及改进的术后成像，使外科医生能够实时访问 CT 质量图像。这些高质量断层图像的术中可用性可能免除了对其他术后成像和残留碎片的辅助治疗程序的需要。
