Han Na Y, Sung Deuk J, Kim Min J, Park Beom J, Sim Ki C, Cho Sung B
Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Br J Radiol. 2016 Jul;89(1063):20160195. doi: 10.1259/bjr.20160195. Epub 2016 Apr 28.
To determine the association between perirenal fat stranding (PFS) on CT and bladder outlet obstruction (BOO).
CT scans from 122 patients who had undergone urodynamic study for lower urinary tract symptoms (LUTS) were registered after exclusion of patients with renal or retroperitoneal disease. Images were independently reviewed by two radiologists and compared with those of 244 age- and sex-matched control patients without LUTS. The PFS severity was scored on a four-point scale, and the interobserver agreement was assessed with kappa statistics. The severity score and incidence was compared between the groups, and the association with baseline characteristics was analyzed. For the LUTS group, an association between PFS severity and urodynamic and laboratory data was evaluated.
PFS was more frequent and more severe in the LUTS group than in the control group (p-value < 0.001); its presence was significantly associated with male gender and older age (p-value < 0.001). PFS was predominantly bilateral in both groups (80.1-93.2%). In the LUTS group, PFS severity scores were significantly correlated with the maximum flow rate, maximum detrusor pressure and estimated glomerular filtration rate (p-value < 0.001). Interobserver agreements were excellent for PFS presence (κ = 0.883) and severity (κ = 0.816).
Severe PFS was observed in older, male patients with LUTS. PFS severity was associated with the degree of BOO and impaired renal function.
Recognition of PFS on the CT scan may warrant further evaluation of BOO and appropriate management to prevent renal impairment.
确定CT上肾周脂肪条索状影（PFS）与膀胱出口梗阻（BOO）之间的关联。
对122例因下尿路症状（LUTS）接受尿动力学检查的患者进行CT扫描，排除患有肾脏或腹膜后疾病的患者。图像由两名放射科医生独立阅片，并与244例年龄和性别匹配的无LUTS的对照患者的图像进行比较。PFS严重程度采用四分制评分，观察者间一致性用kappa统计量评估。比较两组间的严重程度评分和发生率，并分析与基线特征的关联。对于LUTS组，评估PFS严重程度与尿动力学和实验室数据之间的关联。
LUTS组中PFS比对照组更常见且更严重（p值<0.001）；其出现与男性性别和年龄较大显著相关（p值<0.001）。两组中PFS主要为双侧（80.1-93.2%）。在LUTS组中，PFS严重程度评分与最大尿流率、最大逼尿肌压力和估计肾小球滤过率显著相关（p值<0.001）。观察者间对PFS的存在（κ=0.883）和严重程度（κ=0.816）的一致性良好。
在患有LUTS的老年男性患者中观察到严重PFS。PFS严重程度与BOO程度和肾功能受损有关。
CT扫描上识别PFS可能需要对BOO进行进一步评估并采取适当管理措施以预防肾功能损害。
