Department of Radiology, University of California, San Diego Health, San Diego, USA.
Department of Radiology, Veterans Affairs San Diego Healthcare, San Diego, CA, USA.
Abdom Radiol (NY). 2019 Dec;44(12):3919-3934. doi: 10.1007/s00261-019-02086-0.
The aim of this pictorial essay is to demonstrate several cases where the diagnosis would have been difficult or impossible without the excretory phase image of CT urography.
A brief discussion of CT urography technique and dose reduction is followed by several cases illustrating the utility of CT urography.
CT urography has become the primary imaging modality for evaluation of hematuria, as well as in the staging and surveillance of urinary tract malignancies. CT urography includes a non-contrast phase and contrast-enhanced nephrographic and excretory (delayed) phases. While the three phases add to the diagnostic ability of CT urography, it also adds potential patient radiation dose. Several techniques including automatic exposure control, iterative reconstruction algorithms, higher noise tolerance, and split-bolus have been successfully used to mitigate dose. The excretory phase is timed such that the excreted contrast opacifies the urinary collecting system and allows for greater detection of filling defects or other abnormalities. Sixteen cases illustrating the utility of excretory phase imaging are reviewed.
Excretory phase imaging of CT urography can be an essential tool for detecting and appropriately characterizing urinary tract malignancies, renal papillary and medullary abnormalities, CT radiolucent stones, congenital abnormalities, certain chronic inflammatory conditions, and perinephric collections.
本影像学论文旨在展示几例如果没有 CT 尿路造影的排泄期图像，诊断将变得困难或不可能的病例。
简要讨论 CT 尿路造影技术和剂量减少，然后介绍几个说明 CT 尿路造影实用性的病例。
CT 尿路造影已成为评估血尿以及尿路恶性肿瘤分期和监测的主要成像方式。CT 尿路造影包括非对比期、对比增强的肾实质期和排泄期（延迟期）。虽然这三个阶段增加了 CT 尿路造影的诊断能力，但也增加了患者潜在的辐射剂量。已经成功使用了几种技术，包括自动曝光控制、迭代重建算法、更高的噪声容限和分段推注，以减轻剂量。排泄期的时间安排使得排出的对比剂使尿路集合系统显影，从而更能检测到充盈缺损或其他异常。回顾了 16 个说明排泄期成像实用性的病例。
CT 尿路造影的排泄期成像可以成为检测和适当描述尿路恶性肿瘤、肾乳头和髓质异常、CT 透光结石、先天性异常、某些慢性炎症性疾病和肾周积液的重要工具。
