Helenius Malin, Brekkan Einar, Dahlman Pär, Lönnemark Maria, Magnusson Anders
a 1 Department of Radiology, Oncology and Radiation Science, Section of Radiology, Uppsala University Hospital , Uppsala, Sweden.
b 2 Department of Surgical Sciences, Section of Urology, Uppsala University Hospital , Uppsala, Sweden.
Scand J Urol. 2015;49(5):377-81. doi: 10.3109/21681805.2015.1026937. Epub 2015 Mar 20.
Computed tomography urography (CTU) can be used to direct further investigation of patients if the bladder tumour detection rate is high. The aim of this study was to compare a CTU protocol including an enhancement-triggered scan and flexible cystoscopy for detecting bladder tumours.
Patients with gross haematuria undergoing CTU during 2005-2008 were included. For patients younger than 50 years the CTU protocol included unenhanced, enhancement-triggered corticomedullary, and excretory phases. Patients older than 50 years followed the same protocol plus a nephrographic phase. The entire urinary tract was examined in all phases.
Of 435 patients, 55 patients were diagnosed with bladder tumour. CTU detected bladder tumour in 48 patients (87%). Five CTU examination reports were false positive. With CTU, sensitivity for finding bladder tumour was 0.87, specificity 0.99, positive predictive value (PPV) 0.91 and negative predictive value (NPV) 0.98. Cystoscopy detected bladder tumour in 48 patients (87%) and had one false-positive finding, resulting in sensitivity of 0.87, specificity 1.0, PPV 0.98 and NPV 0.98.
The detection rate of bladder tumours for the CTU protocol including an enhancement-triggered scan was high and comparable to flexible cystoscopy. Hence, this protocol could be used to assess the bladder as the primary investigation and direct further investigation of the patient.
如果膀胱肿瘤检出率较高，计算机断层扫描尿路造影（CTU）可用于指导对患者进行进一步检查。本研究的目的是比较一种包括增强触发扫描的CTU方案与软性膀胱镜检查在检测膀胱肿瘤方面的效果。
纳入2005年至2008年期间接受CTU检查的肉眼血尿患者。对于年龄小于50岁的患者，CTU方案包括平扫、增强触发的肾皮质髓质期和排泄期。年龄大于50岁的患者遵循相同方案并增加一个肾实质期。所有阶段均对整个尿路进行检查。
435例患者中，55例被诊断为膀胱肿瘤。CTU检测出48例膀胱肿瘤患者（87%）。5份CTU检查报告为假阳性。使用CTU，发现膀胱肿瘤的敏感性为0.87，特异性为0.99，阳性预测值（PPV）为0.91，阴性预测值（NPV）为0.98。膀胱镜检查检测出48例膀胱肿瘤患者（87%），有1例假阳性结果，敏感性为0.87，特异性为1.0，PPV为0.98，NPV为0.98。
包括增强触发扫描的CTU方案对膀胱肿瘤的检出率较高，与软性膀胱镜检查相当。因此，该方案可作为对患者进行初步检查以评估膀胱并指导进一步检查的方法。
