计算机断层扫描可见血尿 - 单肾相位足以检测肾细胞癌。

Computed tomography for visible haematuria - a single nephrographic phase is sufficient for detecting renal cell carcinoma.

机构信息

Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.

Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway.

出版信息

Scand J Urol. 2024 Jan 16;59:10-18. doi: 10.2340/sju.v59.18467.

DOI:10.2340/sju.v59.18467

PMID:38226799

Abstract

OBJECTIVES

No previous studies have compared two computed tomography (CT) protocols in patients presenting with visible haematuria, and most patients undergo a multiphase CT in order to detect upper tract malignancies. We aimed to prospectively compare the diagnostic performance of single- and four-phase CT for detecting renal cell carcinoma (RCC) in patients with visible haematuria.

MATERIALS & METHODS: 'A Prospective Trial for Examining Hematuria using Computed Tomography' (PROTEHCT) was a single-centre prospective paired diagnostic study in patients referred for CT due to painless visible haematuria between September 2019 and June 2021. All patients underwent four-phase CT (control) from which a single nephrographic phase dual energy CT (experimental) was extracted. Both were independently assessed for RCC by randomised radiologists. Histologically verified RCC defined a positive reference standard. Follow-up ascertainment of RCC diagnosis was completed in May 2022. Descriptive statistics were used to calculate the accuracies. Inter-reader agreement was assessed by kappa statistics.

RESULTS

A total of 308 patients (median age, 68 years [interquartile range 53-77, range 18-96], 250 males) were included for analysis. RCC was diagnosed in seven (2.3%) patients during a median follow-up time of 19 months (interquartile range: 15-25). For the control and experimental CT, sensitivity was 100% versus 100%, specificity was 97% versus 98% and accuracy 97% versus 97%. The positive predictive value was 44% versus 50%, and the negative predictive value was 100% versus 100%. The agreement between the control and experimental CT was 98% (k = 0.79).

CONCLUSION

A single nephrographic phase dual energy CT is sufficient for detecting RCC in patients with visible haematuria.

摘要

目的

以前没有研究比较过在出现肉眼血尿的患者中使用两种计算机断层扫描 (CT) 方案，大多数患者进行多期 CT 以检测上尿路恶性肿瘤。我们旨在前瞻性比较单期和四期 CT 在检测肉眼血尿患者肾细胞癌 (RCC) 中的诊断性能。

材料和方法

“使用计算机断层扫描检查血尿的前瞻性试验”（PROTEHCT）是 2019 年 9 月至 2021 年 6 月期间因无痛肉眼血尿而接受 CT 检查的患者的单中心前瞻性配对诊断研究。所有患者均接受四期 CT（对照组）检查，并从该组中提取单期肾期双能 CT（实验组）。两组均由随机放射科医生独立评估 RCC。组织学证实的 RCC 定义为阳性参考标准。2022 年 5 月完成 RCC 诊断的随访确认。使用描述性统计计算准确性。使用 Kappa 统计评估读者间的一致性。

结果

共纳入 308 例患者（中位年龄 68 岁[四分位距 53-77，范围 18-96]，250 例男性）进行分析。在中位随访时间为 19 个月（四分位距 15-25）期间，有 7 例（2.3%）患者诊断为 RCC。对照组和实验组 CT 的敏感性均为 100%，特异性分别为 97%和 98%，准确性分别为 97%和 97%。阳性预测值分别为 44%和 50%，阴性预测值分别为 100%和 100%。对照组和实验组 CT 的一致性为 98%（k=0.79）。