Bischof T P, Thoeni R F, Melzer J S
Department of Radiology, University of California, San Francisco 94143-0628, USA.
AJR Am J Roentgenol. 1995 Aug;165(2):349-54. doi: 10.2214/ajr.165.2.7618555.
This study was undertaken to assess the value of CT cystography, using scans made with full bladder distention by a combination of iodinated contrast material and air and scans made after active voiding, for detecting duodenal segment leaks in patients with kidney transplants and pancreas transplants associated with small duodenal segments and duodenovesical anastomoses.
18 patients with such kidney-pancreas transplants underwent CT cystography for clinically suspected leaks from the duodenal segment. Six patients had two examinations, resulting in 24 CT cystograms. The CT protocol consisted of an initial series of pelvic scans (plain CT) without oral, IV, or bladder contrast material; CT cystogram with the bladder fully distended by iodinated contrast material and air; and, if the findings were negative, CT after voiding. If no leak was demonstrated, the remainder of the abdomen to the liver dome was examined. Diagnoses were proved by surgery or cystoscopy (n = 11) and clinical follow-up examinations (n = 13).
Overall, bladder-duodenal segment leaks were demonstrated in 11 of 12 studies: one by plain CT, seven by full CT cystography, and four by CT after voiding following negative findings on full CT cystography. One surgically proved leak was missed by CT cystography owing to a large amount of pelvic fluid. In 12 studies without a leak, CT cystography results correlated well with clinical follow-up studies. There were no false-positive results. Sensitivity was 92%, specificity was 100%, and accuracy was 96%.
CT cystography with a dedicated protocol is an accurate way to diagnose leaks of the duodenal segment in patients with bladder-drained kidney-pancreas transplants if administration of air combined with contrast material into the bladder and CT after voiding are used.
本研究旨在评估CT膀胱造影术在检测肾移植和胰腺移植患者十二指肠段漏液方面的价值，这些患者伴有小十二指肠段和十二指肠膀胱吻合术，采用碘化造影剂和空气联合使膀胱充分充盈后的扫描以及主动排尿后的扫描。
18例接受此类肾胰联合移植的患者因临床怀疑十二指肠段漏液而接受CT膀胱造影术。6例患者进行了两次检查，共获得24张CT膀胱造影图像。CT检查方案包括一系列初始盆腔扫描（平扫CT），不使用口服、静脉或膀胱造影剂；膀胱内注入碘化造影剂和空气使其充分充盈后的CT膀胱造影；如果结果为阴性，则在排尿后进行CT检查。如果未发现漏液，则检查至肝脏穹窿的腹部其余部分。诊断通过手术或膀胱镜检查（n = 11）以及临床随访检查（n = 13）得到证实。
总体而言，12项研究中有11项显示膀胱十二指肠段漏液：1项通过平扫CT发现，7项通过全CT膀胱造影发现，4项在全CT膀胱造影结果为阴性后通过排尿后CT发现。由于盆腔内大量液体，1例经手术证实的漏液被CT膀胱造影漏诊。在12项无漏液的研究中，CT膀胱造影结果与临床随访研究相关性良好。无假阳性结果。敏感性为92%，特异性为100%，准确性为96%。
如果在膀胱内注入空气和造影剂并在排尿后进行CT检查，采用专门的检查方案进行CT膀胱造影术是诊断膀胱引流的肾胰联合移植患者十二指肠段漏液的准确方法。
