门静脉期对比增强CT上的肾结石：静脉内对比剂会干扰检测吗？
Renal stones on portal venous phase contrast-enhanced CT: does intravenous contrast interfere with detection?
作者信息
Dym R Joshua, Duncan Dameon R, Spektor Michael, Cohen Hillel W, Scheinfeld Meir H
机构信息
Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA,
出版信息
Abdom Imaging. 2014 Jun;39(3):526-32. doi: 10.1007/s00261-014-0082-4.
PURPOSE
To determine the sensitivity of portal venous phase contrast-enhanced CT for the detection of renal stones.
METHODS
This retrospective study included 97 CT examinations of the abdomen without and with intravenous contrast, including 85 (87.6%) examinations with at least one renal stone on the "gold standard" noncontrast images, as scored by a single radiologist. Three other radiologists each independently reviewed only the contrast-enhanced images from all 97 examinations and recorded all renal stones. Reviewer sensitivity for stones was categorized by stone diameter. Reviewer sensitivity and specificity for stone disease were also calculated on a per-kidney basis.
RESULTS
The 97 cases included a total of 238 stones ≥1 mm, with a mean (±SD) of 1.2 ± 1.9 stones per kidney and a stone diameter of 3.5 ± 3.0 mm. Pooling data for the three reviewers, sensitivity for all stones was 81%; sensitivity for stones ≥2, ≥3, ≥4, and ≥5 mm was 88%, 95%, 99%, and 98%, respectively. Sensitivity for stone disease on a per-kidney basis was 94% when considering all stones; when considering only stones ≥2, ≥3, and ≥4 mm, sensitivity was 96%, 99%, and 100%, respectively. Specificity for stone disease on a per-kidney basis was 98% overall, 99% when considering only stones ≥2 mm, and 100% when considering only stones ≥3 mm.
CONCLUSION
Contrast-enhanced CT is highly sensitive for the detection of renal stones ≥3 mm in diameter and less sensitive for smaller stones. In cases where the clinical diagnosis is uncertain and performance of a CT examination is being contemplated, intravenous contrast utilization would allow assessment for stone disease while also optimizing evaluation for other conditions.
目的
确定门静脉期对比增强CT检测肾结石的敏感性。
方法
这项回顾性研究包括97例腹部CT检查，有无静脉造影剂，其中85例（87.6%）在“金标准”非增强图像上有至少一颗肾结石，由一名放射科医生评分。另外三名放射科医生各自独立审查所有97例检查的对比增强图像并记录所有肾结石。根据结石直径对审查者对结石的敏感性进行分类。审查者对结石疾病的敏感性和特异性也按每侧肾脏计算。
结果
97例病例中共有238颗直径≥1mm的结石，每侧肾脏平均（±标准差）有1.2±1.9颗结石，结石直径为3.5±3.0mm。汇总三名审查者的数据，所有结石的敏感性为81%；直径≥2mm、≥3mm、≥4mm和≥5mm结石的敏感性分别为88%、95%、99%和98%。考虑所有结石时，每侧肾脏结石疾病的敏感性为94%；仅考虑直径≥2mm、≥3mm和≥4mm的结石时，敏感性分别为96%、99%和100%。每侧肾脏结石疾病的特异性总体为98%，仅考虑直径≥2mm的结石时为99%仅考虑直径≥3mm的结石时为100%。
结论
对比增强CT对直径≥3mm的肾结石检测高度敏感，对较小结石敏感性较低。在临床诊断不确定且考虑进行CT检查的情况下，使用静脉造影剂可评估结石疾病，同时优化对其他情况的评估。
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