Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C76F, New York, NY 10065, USA.
Radiology. 2012 Oct;265(1):143-50. doi: 10.1148/radiol.12110548. Epub 2012 Aug 1.
To determine whether ureteral segments not filled with contrast material at computed tomographic (CT) urography ever contain tumor detectable only by filling these segments with contrast material.
In this institutional review board-approved, HIPAA-compliant retrospective study, with waiver of informed consent, databases were searched for all patients who underwent heminephroureterectomy or ureteroscopy between January 1, 2001, and December 31, 2009, with available CT urography findings in the 12 months prior to surgery or biopsy and patients who had undergone at least two CT urography procedures with a minimum 5-year follow-up between studies. One of two radiologists blinded to results of pathologic examination recorded location of unfilled segments, time of scan, subsequent filling, and pathologic or 5-year follow-up CT urography results. Tumors were considered missed in an unfilled segment if tumor was found at pathologic examination or follow-up CT urography in the same one-third of the ureter and there were no secondary signs of a mass with other index CT urography sequences. Estimated radiation dose for additional delayed sequences was calculated with a 32-cm phantom.
In 59 male and 33 female patients (mean age, 66 years) undergoing heminephroureterectomy, 27 tumors were present in 41 partially nonopacified ureters in 20 patients. Six tumors were present in nonopacified segments (one multifocal, none bilateral); all were identifiable by means of secondary signs present with earlier sequences. Among 182 lesions biopsied at ureteroscopy in 124 male and 53 female patients (mean age, 69 years), 28 tumors were present in nonopacified segments in 25 patients (four multifocal, none bilateral), all with secondary imaging signs detectable without delayed scanning. In 64 male and 29 female patients (mean age, 69 years) who underwent 5-year follow-up CT urography, three new tumors were revealed in three patients; none occurred in the unfilled ureter at index CT urography. Estimated radiation dose from additional sequences was 4.3 mSv per patient.
Targeted delayed scanning at CT urography yielded no additional ureteral tumors and resulted in additional radiation exposure.
确定 CT 尿路造影术显示未充盈对比剂的输尿管段是否存在仅通过充盈这些段才能检测到的肿瘤。
本研究经机构审查委员会批准，符合 HIPAA 规定，为回顾性研究，豁免知情同意。研究检索了 2001 年 1 月 1 日至 2009 年 12 月 31 日期间行半肾输尿管切除术或输尿管镜检查的所有患者的数据库，这些患者在手术或活检前的 12 个月内有 CT 尿路造影检查结果，并且至少有两次 CT 尿路造影检查，两次检查之间有至少 5 年的随访。两位盲法阅片的放射科医生记录未充盈段的位置、扫描时间、后续充盈情况以及病理或 5 年随访 CT 尿路造影的结果。如果在同一段输尿管的同一三分之一处发现肿瘤且其他指数 CT 尿路造影序列没有肿块的继发征象，则认为未充盈段存在肿瘤。使用 32cm 体模计算额外延迟序列的估计辐射剂量。
在 59 名男性和 33 名女性患者（平均年龄 66 岁）中，20 名患者的 41 个部分非充盈输尿管中有 27 个肿瘤。6 个肿瘤位于未充盈段（1 个为多灶性，均为单侧）；所有肿瘤均通过较早序列的继发征象识别。在 124 名男性和 53 名女性患者（平均年龄 69 岁）的 182 例输尿管镜活检中，25 名患者的 28 个肿瘤位于非充盈段（4 个为多灶性，均为单侧），所有肿瘤均存在无需延迟扫描即可检测到的继发影像学征象。在 64 名男性和 29 名女性患者（平均年龄 69 岁）中，这些患者行 5 年随访 CT 尿路造影，3 名患者中有 3 名新发现肿瘤；指数 CT 尿路造影中未发现未充盈输尿管中的肿瘤。额外序列的估计辐射剂量为每位患者 4.3mSv。
在 CT 尿路造影术上进行靶向延迟扫描未发现额外的输尿管肿瘤，并导致额外的辐射暴露。
