对比随访中用于诊断尿路结石的超低剂量 CT 与 X 射线肾脏、输尿管和膀胱成像的诊断准确性。
Comparison of diagnostic accuracy of ultra low-dose computed tomography and X-ray of the kidneys, ureters and bladder for urolithiasis in the follow-up setting.
机构信息
Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
University of Sydney, Sydney, New South Wales, Australia.
出版信息
J Med Imaging Radiat Oncol. 2024 Mar;68(2):132-140. doi: 10.1111/1754-9485.13605. Epub 2023 Nov 24.
INTRODUCTION
Urolithiasis is frequently followed up with a low-dose computed tomography of the kidneys ureters and bladder (LD-CTKUB) with doses typically less than 3 millisieverts. Although X-ray is a lower dose (0.5-1.1 mSv) alternative for follow up, it has lower diagnostic accuracy and is limited to radiopaque calculi. This study aims to compare the diagnostic accuracy of sub-millisievert ultra-low dose CT (ULD-CTKUB) against X-ray KUB for the follow up of urolithiasis when both are compared against the standard of care of a low-dose CT KUB (LD-CTKUB).
METHODS
This prospective study included patients with a known diagnosis of urolithiasis on prior CTKUB presenting for follow up. Each patient underwent a repeat reference LD-CTKUB, ULD-CTKUB and X-ray KUB. All imaging studies were interpreted by three readers. The radiation dose and quantitative noise was calculated for each CT. Both CT and X-ray were assessed for the presence, number and size of all calculi ≥2 mm.
RESULTS
A total of 58 patients were included in this study. LD-CTKUB identified 197 calculi. ULD-CTKUB in our study had a mean effective dose of 0.5 mSv compared to X-ray KUB where doses range in the literature from 0.5 to 1.1 mSv. Per-patient pooled analysis for intrarenal calculi when comparing ULD-CTKUB versus X-ray KUB against a reference LD-CTKUB found a sensitivity of 90% versus 67% (P < 0.01) and specificity of 93% versus 98% (P = 0.18) respectively. For ureteric calculi, the sensitivity was 67% versus 33% (P < 0.01) and specificity 94% versus 94% (P = 1.00) respectively. Per-stone pooled analysis detection rate was 79% for ULD-CTKUB versus 48% for X-ray (P < 0.01) when each was compared to the reference LD-CTKUB. Interobserver agreement was high for intrarenal calculi and moderate for ureteric calculi.
CONCLUSION
Sub-millisievert ULD-CTKUB had lower doses and higher sensitivity than X-ray in patients requiring follow up of known urolithiasis.
简介
肾结石患者通常会接受低剂量肾脏输尿管膀胱计算机断层扫描（LD-CTKUB）进行随访，剂量通常低于 3 毫西弗。尽管 X 射线是一种剂量较低（0.5-1.1 mSv）的替代随访方法，但它的诊断准确性较低，且仅限于不透射线的结石。本研究旨在比较亚毫西弗超低剂量 CT（ULD-CTKUB）与 X 射线 KUB 在随访肾结石时的诊断准确性，当与 LD-CTKUB 的标准治疗相比时。
方法
本前瞻性研究纳入了先前 CTKUB 检查诊断为肾结石且需要随访的患者。每位患者均接受重复的参考 LD-CTKUB、ULD-CTKUB 和 X 射线 KUB 检查。三位阅片者对所有影像学检查结果进行解读。计算每位患者 CT 的辐射剂量和定量噪声。评估 CT 和 X 射线是否存在所有≥2mm 的结石及其数量和大小。
结果
本研究共纳入 58 例患者。LD-CTKUB 共检出 197 个结石。本研究中 ULD-CTKUB 的有效剂量均值为 0.5 mSv，而 X 射线 KUB 的剂量范围在文献中为 0.5 至 1.1 mSv。与参考 LD-CTKUB 相比，当将 ULD-CTKUB 与 X 射线 KUB 用于每位患者的肾内结石分析时，发现灵敏度分别为 90%和 67%（P<0.01），特异性分别为 93%和 98%（P=0.18）。对于输尿管结石，灵敏度分别为 67%和 33%（P<0.01），特异性分别为 94%和 94%（P=1.00）。当与参考 LD-CTKUB 相比，每个 ULD-CTKUB 的结石检出率为 79%，X 射线 KUB 的结石检出率为 48%（P<0.01）。观察者间一致性对肾内结石较高，对输尿管结石中等。
结论
在需要随访已知肾结石的患者中，亚毫西弗 ULD-CTKUB 的剂量低于 X 射线，且灵敏度更高。
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