Sun Hao, Xue Hua-dan, Liu Wei, Wang Xuan, Chen Yu, Su Bai-yan, He Yong-lan, Zhang Da-ming, Zhu Liang, Jin Zheng-yu
Department of Radiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2014 Jun;36(3):283-90. doi: 10.3881/j.issn.1000-503X.2014.03.010.
To assess the upper urinary tract opacification and the diagnostic performance of one-bolus dual-source dual-energy CT urography (CTU) for painless hematuria.
Totally 205 patients who underwent dual-source dual-energy CTU for painless hematuria were enrolled in this study. CTU included true non-enhanced phase, dual-energy mode nephrographic phase, and FLASH mode excretory phase imaging of the urinary tract. Two radiologists independently evaluated the degree of upper urinary tract opacification. Prospective interpretations using true non-enhanced, nephrographic and excretory phase imaging for hematuria were recorded, as well as retrospective diagnosis using virtual non-enhanced, nephrographic and excretory phase imaging. The standard of reference included all available clinical, imaging, laboratory and follow-up data for up to 36 months after CTU exam. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were calculated. Receiver-operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated. The prospective and retrospective diagnostic performance for hematuria and the radiation dose of two CTU protocols were compared.
It was found that 87.8% and 86.8% of segments were at least 50% opacified, respectively. The sensitivity, specificity, PPV, NPV and accuracy for hematuria for prospective interpretation were 95.2%, 91.9%, 98.2%, 81.0% and 94.6%, respectively. Comparable figures for retrospective diagnosis were 98.8%, 91.9%,98.2%, 94.4% and 97.6%. The AUC for prospective and retrospective diagnosis were 0.931±0.027 and 0.940±0.026, respectively (z=1.425, Bonferroni-corrected P>0.05). The radiation dose of the CTU protocol using in retrospective diagnosis[(12.732±3.485)mSv] was significantly lower than that of prospective diagnosis [(17.002±4.013)mSv] (P<0.05), with dose reduction of (32.74±8.92)%.
One-bolus two-phase dual-source dual-energy CT urography provides at least 50% opacification of upper urinary tract segments and has high diagnostic performance for painless hematuria with relatively low radiation dose.
评估单剂量双源双能量CT尿路造影（CTU）对无痛性血尿患者上尿路的显影情况及其诊断效能。
本研究纳入了205例行双源双能量CTU检查的无痛性血尿患者。CTU检查包括真正的非增强期、双能量模式肾实质期以及FLASH模式排泄期尿路成像。两名放射科医生独立评估上尿路的显影程度。记录使用真正的非增强期、肾实质期和排泄期成像对血尿进行的前瞻性解读，以及使用虚拟非增强期、肾实质期和排泄期成像进行的回顾性诊断。参考标准包括CTU检查后长达36个月的所有可用临床、影像、实验室及随访数据。计算敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）及准确度。进行受试者操作特征（ROC）分析并计算曲线下面积（AUC）。比较两种CTU方案对血尿的前瞻性和回顾性诊断效能以及辐射剂量。
发现分别有87.8%和86.8%的节段至少50%显影。前瞻性解读对血尿的敏感度、特异度、PPV、NPV及准确度分别为95.2%、91.9%、98.2%、81.0%和94.6%。回顾性诊断的相应数值分别为98.8%、91.9%、98.2%、94.4%和97.6%。前瞻性和回顾性诊断的AUC分别为0.931±0.027和0.940±0.026（z = 1.425，经Bonferroni校正P>0.05）。回顾性诊断所使用的CTU方案的辐射剂量[（12.732±3.485）mSv]显著低于前瞻性诊断的辐射剂量[（17.002±4.013）mSv]（P<0.05），剂量降低了（32.74±8.92）%。
单剂量双期双源双能量CT尿路造影可使上尿路节段至少50%显影，对无痛性血尿具有较高的诊断效能，且辐射剂量相对较低。
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