Wu Guang-Yu, Lu Qing, Wu Lian-Ming, Zhang Jin, Chen Xiao-Xi, Xu Jian-Rong
Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200120, PR China.
Department of Urinary Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200120, PR China.
Eur J Radiol. 2014 Jun;83(6):893-899. doi: 10.1016/j.ejrad.2014.02.019. Epub 2014 Mar 3.
To evaluate the performance of computed tomographic urography (CTU), static-fluid magnetic resonance urography (static-fluid MRU) and combinations of CTU, static-fluid MRU and diffusion weighted imaging (DWI) in the diagnosis of upper urinary tract cancer.
Between January 2010 and June 2011, patients with suspected UUT cancer underwent CTU, static-fluid MRU and DWI (b=1000s/mm(2)) within a 1-week period. The diagnostic performances of CTU, static-fluid MRU and combinations of CTU, static-fluid MRU and DWI for upper urinary tract cancer were prospectively evaluated. The ureteroscopic and histopathologic findings were compared with the imaging findings.
Compared to static-fluid MRU alone (sensitivity: 76/75%, reader 1/reader 2), combining DWI with MRI can increase the sensitivity (sensitivity: 84/84%, p=0.031/p=0.016) of upper urinary tract cancer diagnosis. CTU had greater sensitivity (95/94%) and accuracy (92/91%) than both static-fluid MRU (sensitivity: p<0.001/p<0.001 and accuracy: 83/81%, p=0.001/p<0.001) and static-fluid MRU with DWI (sensitivity: p=0.023/p=0.039 and accuracy: 87/85%, p=0.042/p=0.049) for the diagnosis of upper urinary tract cancers. Compared with CTU alone, CTU with DWI did not significantly increase sensitivity, specificity or accuracy. However, the diagnostic confidence was improved when the combined technique was used (p=0.031/p=0.024). Moreover, there was no significant change in sensitivity, specificity, accuracy or diagnostic confidence when static-fluid MRU was used in combination with CTU and DWI.
Although there is a potential role for static-fluid MRU and static-fluid MRU with DWI in urinary tract imaging, CTU is still the better choice for the diagnosis of upper urinary tract cancer. Combining DWI with CTU can help improve confidence in upper urinary tract cancer diagnoses.
评估计算机断层扫描尿路造影（CTU）、静态液体磁共振尿路造影（静态液体MRU）以及CTU、静态液体MRU与扩散加权成像（DWI）联合应用在上尿路癌诊断中的性能。
2010年1月至2011年6月期间，疑似上尿路癌的患者在1周内接受了CTU、静态液体MRU和DWI（b = 1000s/mm(2)）检查。前瞻性评估CTU、静态液体MRU以及CTU、静态液体MRU与DWI联合应用对上尿路癌的诊断性能。将输尿管镜检查和组织病理学结果与影像学结果进行比较。
与单独使用静态液体MRU相比（敏感性：76/75%，阅片者1/阅片者2），DWI与MRI联合应用可提高上尿路癌诊断的敏感性（敏感性：84/84%，p = 0.031/p = 0.016）。CTU在上尿路癌诊断中的敏感性（95/94%）和准确性（92/91%）均高于静态液体MRU（敏感性：p < 0.001/p < 0.001，准确性：83/81%，p = 0.001/p < 0.001）以及静态液体MRU与DWI联合应用（敏感性：p = 0.023/p = 0.039，准确性：87/85%，p = 0.042/p = 0.049）。与单独使用CTU相比，CTU与DWI联合应用并未显著提高敏感性、特异性或准确性。然而，联合技术应用时诊断信心得到改善（p = 0.031/p = 0.024）。此外，静态液体MRU与CTU和DWI联合应用时，敏感性、特异性、准确性或诊断信心均无显著变化。
尽管静态液体MRU以及静态液体MRU与DWI联合应用在尿路成像中具有潜在作用，但CTU仍是上尿路癌诊断的更佳选择。DWI与CTU联合应用有助于提高上尿路癌诊断的信心。
