Karavaş Erdal, Gürel Safiye, Kıyan Aysu, Halicioğlu Sıddıka, Dağistan Emine
Department of Radiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey.
Department of Radiology, İzzet Baysal Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey.
Urol Int. 2018;101(2):167-174. doi: 10.1159/000490735. Epub 2018 Jul 6.
The aim of this study is to evaluate the effects of performing computed tomography (CT) urogram in the prone position in terms of diagnosis.
CT urograms of 208 patients imaged randomly in the prone and supine positions were included in this study. A total of 199 patients and 370 collecting systems were examined in total. Axial raw data and reconstructed coronal thin and thick MIP images with a slice thickness of 5 mm were evaluated by 2 independent radiologists blinded to the initial diagnosis. Renal collecting system, ureters, and bladder were included in radiological evaluation. Anatomically, the renal collecting system was separated into 7 regions. Filling and dilatation of collecting systems were evaluated via images at urogram phase by scoring.
Filling in lower pole infundibulum (p = 0.006), distal ureter (p = 0.006); and highly dilated lower pole calyx (p = 0.020), pelvis (p = 0.006), and bladder (p < 0.001) were determined to be better in images in the prone position compared to the supine position. There were no statistical differences in other regions.
Better contrast material filling is achieved in dilated or non-dilated lower pole collecting system, dilated renal pelvis, non-dilated distal ureter of kidney, and in the bladder only by imaging the urogram phase in the prone position compared to the supine position. Additionally, presence of dilatation is a factor that could adversely affect filling. Studies in the future may investigate the contribution of prone positioning to CT urogram with larger series comparing it with other methods and modalities.
本研究旨在评估俯卧位计算机断层扫描（CT）尿路造影在诊断方面的效果。
本研究纳入了208例患者的CT尿路造影图像，这些患者随机以俯卧位和仰卧位成像。总共检查了199例患者和370个集合系统。由2名对初始诊断不知情的独立放射科医生评估轴向原始数据以及重建的冠状位薄层和厚层最大密度投影（MIP）图像，层厚为5毫米。放射学评估包括肾集合系统、输尿管和膀胱。在解剖学上，肾集合系统被分为7个区域。通过在尿路造影期图像上评分来评估集合系统的充盈和扩张情况。
与仰卧位相比，俯卧位图像显示下极漏斗部（p = 0.006）、输尿管远端（p = 0.006）的充盈；以及高度扩张的下极肾盏（p = 0.020）、肾盂（p = 0.006）和膀胱（p < 0.001）情况更好。其他区域无统计学差异。
与仰卧位相比，仅通过俯卧位成像尿路造影期，在扩张或未扩张的下极集合系统、扩张的肾盂、未扩张的肾远端输尿管以及膀胱中可实现更好的对比剂充盈。此外，扩张的存在是可能对充盈产生不利影响的一个因素。未来的研究可能会通过更大样本量并与其他方法和模式进行比较，来探究俯卧位对CT尿路造影的贡献。
