低剂量非增强计算机断层扫描联合迭代重建技术在尿路结石评估中的应用：诊断性能及泌尿外科医生与放射科医生之间的一致性

Usefulness of low-dose nonenhanced computed tomography with iterative reconstruction for evaluation of urolithiasis: diagnostic performance and agreement between the urologist and the radiologist.

作者信息

Kwon Jong Kyou, Chang In Ho, Moon Young Tae, Lee Jong Beum, Park Hyun Jeong, Park Sung Bin

机构信息

Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.

Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.

出版信息

Urology. 2015 Mar;85(3):531-8. doi: 10.1016/j.urology.2014.11.021.

DOI:10.1016/j.urology.2014.11.021

PMID:25733262

Abstract

OBJECTIVE

To evaluate the efficacy of low-dose nonenhanced computed tomography (LDCT) with iterative reconstruction (IR) technique for urologists to detect urolithiasis by comparing diagnostic performance and interobserver agreement between the urologist and the uroradiologist.

PATIENTS AND METHODS

We evaluated the 116 patients with urinary stones (n = 197) using both conventional-dose nonenhanced computed tomography (CT) using filtered back projection (CDCT-FBP) and LDCT-IR. Scans were interpreted for stone characteristics, objective image noise, and subjective image assessment. Diagnostic performance and interobserver agreement of LDCT-IR were assessed between 1 urologist and 1 radiologist.

RESULTS

There were no significant differences in all stones. The average effective dose (mSV) in the all size groups was 5.92 (CDCT-FBP) and 1.39 (LDCT-IR), respectively (P <.001). The average effective dose reduction rate was 76.6%, allowing minimal additional radiation exposure from simultaneous CT. Objective image noise was higher in LDCT-IR (20.0-26.2; P <.01), but there was no significant difference in the Hounsfield unit between both CT protocols (52.3 and 56.7; P = .103). There were no cases of any unacceptable images in subjective image assessment. The sensitivity and specificity of LDCT-IR were 99.1%-100.0% with a diagnostic accuracy of 99.1%-100% for stones ≥3 mm. Diagnostic performance was similar between the urologist and the radiologist. Interobserver agreement of LDCT-IR between the 2 reviewers was high with kappa values (0.901-1.000).

CONCLUSION

LDCT-IR provided an excellent diagnostic performance and interobserver agreement between the urologist and the uroradiologist, reducing radiation exposure significantly; in real settings, the urologist should consider replacing LDCT-IR as the standard examination for detecting urolithiasis.

摘要

目的

通过比较泌尿外科医生和泌尿放射科医生的诊断性能及观察者间一致性，评估低剂量非增强计算机断层扫描（LDCT）联合迭代重建（IR）技术对泌尿外科医生检测尿路结石的有效性。

患者与方法

我们使用传统剂量非增强计算机断层扫描（CT）联合滤波反投影（CDCT-FBP）以及LDCT-IR对116例尿路结石患者（共197枚结石）进行了评估。对扫描结果进行结石特征、客观图像噪声及主观图像评估的解读。评估了1名泌尿外科医生和1名放射科医生之间LDCT-IR的诊断性能及观察者间一致性。

结果

所有结石情况均无显著差异。所有结石大小组的平均有效剂量（mSV）分别为5.92（CDCT-FBP）和1.39（LDCT-IR）（P <.001）。平均有效剂量降低率为76.6%，可使CT同步扫描时的额外辐射暴露降至最低。LDCT-IR的客观图像噪声更高（20.0 - 26.2；P <.01），但两种CT方案之间的亨氏单位无显著差异（52.3和56.7；P =.103）。主观图像评估中未出现任何不可接受图像的情况。对于≥3 mm的结石，LDCT-IR的敏感性和特异性为99.1% - 100.0%，诊断准确性为99.1% - 100%。泌尿外科医生和放射科医生之间的诊断性能相似。两位阅片者之间LDCT-IR的观察者间一致性较高，kappa值为（0.901 - 1.000）。