Uppsala University Section of Radiology, Department of Surgical Sciences, Uppsala, Sweden.
Uppsala University Section of Radiology, Department of Surgical Sciences, Uppsala, Sweden.
Radiography (Lond). 2021 Feb;27(1):136-141. doi: 10.1016/j.radi.2020.07.002. Epub 2020 Jul 26.
The protocol for preparation of computed tomography urography (CTU) examinations at our hospital was changed in 2013 to improve the quality of urinary bladder filling in the excretory phase. The aim of this study was to evaluate the quality of urinary bladder filling on CTU after different doses of furosemide were administered to patients with macroscopic hematuria.
The cohort was 215 patients who underwent elective CTU due to macroscopic hematuria between 2014 and 2018. 5 mg furosemide were administrated to 100 patients, 2.5 mg to 100 patients and 0 mg to 15 patients. Contrast medium layered bladders were excluded, leaving 193 patients: 92, 89 and 12 in each group. Urinary bladder volume was calculated in corticomedullary (CMP) and excretory phase (EP). Bladder distension was classified as satisfactory or not. Attenuation of bladder content in EP was noted.
Average volume in EP was 370 ± 224 ml (28-1052) after 5 mg furosemide, 274 ± 120 ml (43-628) after 2.5 mg and 180 ± 104 ml (53-351) after 0 mg. 85% of the bladders were satisfactory distended after 5 mg, 80% after 2.5 mg and 58% after 0 mg. Average attenuation was 266 ± 89 HU (103-524) after 5 mg, 362 ± 156 HU (118-948) after 2.5 mg and 761 ± 331 HU (347-1206) after 0 mg. The differences in volume and attenuation were significant.
5 mg furosemide is preferred rather than 2.5 mg in preparation for CTU examinations of patients with macroscopic hematuria. There was no difference between the doses concerning rate of satisfactory bladder distension, but the higher dose resulted in larger bladder volume and more suitable attenuation of bladder content.
Development of CTU-image quality could improve bladder cancer diagnostics.
我院的 CT 尿路造影（CTU）检查方案于 2013 年进行了修订，以改善排泄期膀胱充盈质量。本研究旨在评估不同剂量速尿给药后，大量血尿患者 CTU 检查的膀胱充盈质量。
该队列包括 2014 年至 2018 年期间因大量血尿接受择期 CTU 检查的 215 名患者。100 名患者给予 5mg 速尿，100 名患者给予 2.5mg 速尿，15 名患者给予 0mg 速尿。排除造影剂分层膀胱，共纳入 193 名患者：每组各 92、89 和 12 名。在皮质髓质期（CMP）和排泄期（EP）计算膀胱容量。分类评估膀胱扩张是否满意。记录 EP 时膀胱内容物的衰减。
5mg 速尿后 EP 平均容量为 370±224ml（28-1052），2.5mg 后为 274±120ml（43-628），0mg 后为 180±104ml（53-351）。5mg 后 85%的膀胱充盈满意，2.5mg 后 80%，0mg 后 58%。5mg 后平均衰减值为 266±89HU（103-524），2.5mg 后为 362±156HU（118-948），0mg 后为 761±331HU（347-1206）。容量和衰减的差异有统计学意义。
与 2.5mg 相比，5mg 速尿更适合准备大量血尿患者的 CTU 检查。两种剂量对膀胱充盈满意度无差异，但高剂量可使膀胱容量更大，膀胱内容物衰减更合适。
CTU 图像质量的提高可改善膀胱癌的诊断。
