Taniguchi Lincoln S, Torres Ulysses S, Souza Saulo M, Torres Lucas R, D'Ippolito Giuseppe
1 Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil.
2 Grupo Fleury, São Paulo, Brazil.
Acta Radiol. 2017 May;58(5):634-640. doi: 10.1177/0284185116665424. Epub 2016 Sep 30.
Background The most widely accepted computed tomography (CT) protocol for diagnosis of acute pyelonephritis (APN) includes at least a pre- and post-contrast scan, which may expose patients to higher doses of ionizing radiation. Purpose To establish the accuracy, reproducibility, and degree of confidence in CT diagnosis of acute pyelonephritis (APN) and urolithiasis using only images obtained during the nephrographic phase. Material and Methods A retrospective study of 100 consecutive patients (88 women; age range, 19-70 years) with clinical and laboratory suspicion of APN and who underwent triphasic abdominal CT scans (non-contrast, nephrographic, and excretory phases) was performed. Two readers first evaluated independently only the nephrographic phase of scans, and, in a second session, the entire study. The diagnostic reference standard was settled by a third experienced radiologist who reviewed all triphasic scans and clinical data. Results The accuracy of only nephrographic phase for diagnosis of APN and urolithiasis was in the range of 90.3-91.78% and 96.27-99.25%, respectively. There was no significant difference in comparison with the triphasic reading (z: -0.4 - 0.2; P = 0.34-0.83). The average degree of confidence for APN also showed no significant variation for both readers ( P = 0.4 and 0.08). Almost perfect inter-observer agreements for the diagnosis of APN (k = 0.86, P < 0.001) and for urolithiasis (k = 0.84, P < 0.001) were observed when considering only the nephrographic phase. Conclusion CT assessment of APN and urolithiasis can be accurately performed using only the late nephrographic phase, with consequent dose reduction.
用于诊断急性肾盂肾炎（APN）的最广泛接受的计算机断层扫描（CT）方案至少包括一次增强扫描前和增强扫描后扫描，这可能会使患者暴露于更高剂量的电离辐射。目的：仅使用肾实质期获得的图像来确定CT诊断急性肾盂肾炎（APN）和尿路结石的准确性、可重复性和可信度。材料与方法：对100例连续患者（88例女性；年龄范围19 - 70岁）进行回顾性研究，这些患者临床和实验室检查怀疑患有APN且接受了腹部三期CT扫描（平扫、肾实质期和排泄期）。两名阅片者首先仅独立评估扫描的肾实质期，然后在第二个阶段评估整个研究。诊断参考标准由第三位经验丰富的放射科医生确定，其审查了所有三期扫描和临床数据。结果：仅肾实质期诊断APN和尿路结石的准确性分别在90.3 - 91.78%和96.27 - 99.25%范围内。与三期阅片相比无显著差异（z： - 0.4 - 0.2；P = 0.34 - 0.83）。两位阅片者对APN的平均置信度也无显著差异（P = 0.4和0.08）。仅考虑肾实质期时，观察到APN诊断（k = 0.86，P < 0.001）和尿路结石诊断（k = 0.84，P < 0.001）的观察者间一致性几乎完美。结论：仅使用肾实质晚期进行CT评估APN和尿路结石可以准确进行，从而减少辐射剂量。
