Tannenbaum Alex P, Lubner Meghan G, Mithqal Ayman, Ziemlewicz Timothy J, Allen Glenn O, Brace Christopher L, Jason Abel E, Mankowski-Gettle Lori, Schenkman Noah S, Wells Shane A
University of Wisconsin School of Medicine and Public Heath, Madison, WI, USA.
Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 600 Highland Avenue, Madison, WI, 53792, USA.
Abdom Radiol (NY). 2022 Jun;47(6):2230-2237. doi: 10.1007/s00261-022-03448-x. Epub 2022 Mar 3.
To compare image quality and radiation dose between single-bolus 2-phase and split-bolus 1-phase CT Urography (CTU) performed immediately after microwave ablation (MWA) of clinically localized T1 (cT1) RCC.
Forty-two consecutive patients (30 M, mean age 67.5 ± 9.0) with cT1 RCC were treated with MWA from 7/2013 to 12/2013 at two academic quaternary-care institutions. Renal parenchymal enhancement, collecting system opacification and distention and size-specific dose estimate (SSDE) were quantified and image quality subjectively assessed on single-bolus 2-phase versus split-bolus 1-phase CTU. Kruskal-Wallis and Pearson's Chi-squared tests were performed to assess differences in continuous and categorical variables, respectively. Two-sample T test with equal variances was used to determine differences in quantitative and qualitative image data.
Median tumor diameter was larger [2.9 cm (IQR 1.7-5.3) vs 3.6 cm (IQR 1.7-5.7), p = 0.01] in the split-bolus cohort. Mean abdominal girth (p = 0.20) was similar. Number of antennas used and unenhanced CTs obtained before and during MWA were similar (p = 0.11-0.32). Renal pelvis opacification (2.5 vs 3.5, p < 0.001) and distention (4 mm vs 8 mm, p < 0.001) were improved and renal enhancement (Right: 127 HU vs 177 HU, p = 0.001; Left: 124 HU vs 185 HU, p < 0.001) was higher for the split-bolus CTU. Image quality was superior for split-bolus CTU (3.2 vs 4.0, p = 0.004). Mean SSDE for the split-bolus CTU was significantly lower [163.9 mGy (SD ± 73.9) vs 36.3 mGy (SD ± 7.7), p < 0.001].
Split-bolus CTU immediately after MWA of cT1 RCC offers higher image quality, improved opacification/distention of the collecting system and renal parenchymal enhancement at a lower radiation dose.
比较临床局限性T1（cT1）期肾细胞癌（RCC）微波消融（MWA）后立即进行的单剂量2期与分剂量1期CT尿路造影（CTU）的图像质量和辐射剂量。
2013年7月至2013年12月期间，在两家学术性四级医疗机构对42例连续的cT1期RCC患者（30例男性，平均年龄67.5±9.0岁）进行了MWA治疗。对单剂量2期与分剂量1期CTU的肾实质强化、集合系统显影和扩张以及特定尺寸剂量估计（SSDE）进行量化，并主观评估图像质量。分别进行Kruskal-Wallis检验和Pearson卡方检验，以评估连续变量和分类变量的差异。使用等方差双样本T检验来确定定量和定性图像数据的差异。
分剂量组的肿瘤中位直径更大[2.9 cm（IQR 1.7 - 5.3）对3.6 cm（IQR 1.7 - 5.7），p = 0.01]。平均腹围（p = 0.20）相似。MWA之前和期间使用的天线数量以及获得的平扫CT相似（p = 0.11 - 0.32）。分剂量CTU的肾盂显影（2.5对3.5，p < 0.001）和扩张（4 mm对8 mm，p < 0.001）得到改善，肾强化更高（右侧：127 HU对177 HU，p = 0.001；左侧：124 HU对185 HU，p < 0.001）。分剂量CTU的图像质量更好（3.2对4.0，p = 0.004）。分剂量CTU的平均SSDE显著更低[163.9 mGy（SD±73.9）对36.3 mGy（SD±7.7），p < 0.001]。
cT1期RCC MWA后立即进行分剂量CTU可提供更高的图像质量，改善集合系统的显影/扩张以及肾实质强化，同时降低辐射剂量。
