Kowalchuk R M, Banner M P, Ramchandani P, Forman H P
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, USA.
Acad Radiol. 1998 Jun;5(6):415-22. doi: 10.1016/s1076-6332(98)80027-5.
The authors prospectively explored the efficacy of using prone positioning during intravenous urography to improve diagnostic visualization and eliminate the need for retrograde pyeloureterography in patients with no obstruction but with hematuria, history of urothelial tumor, or abnormal results of urine cytology.
Prone radiography was added to the usual intravenous urography protocol in 510 patients (347 men, 163 women) without urinary tract obstruction. Interpretations of intravenous urograms and recommendations for retrograde pyeloureterography were made before and after evaluation of the prone image.
Confidence in the urographic interpretation was improved with acquisition of the prone radiograph in 100 of 510 patients (19.6%) (95% confidence interval, 82.1, 118). Retrograde pyeloureterography was obviated in 46 of 510 patients (9.0%) (95% confidence interval, 33.1, 58.9). The prone image was most helpful in evaluating the distal ureters (sacral and pelvic segments).
Prone patient positioning during intravenous urography is useful when complete visualization of the upper urinary tract is desirable. Obtaining the additional image is cost-effective, even when only a few retrograde pyeloureterography studies are obviated.
作者前瞻性地探讨了在静脉肾盂造影期间采用俯卧位以改善诊断可视化效果，并消除对无梗阻但有血尿、尿路上皮肿瘤病史或尿液细胞学检查结果异常的患者进行逆行肾盂输尿管造影的必要性。
在510例无尿路梗阻的患者（347例男性，163例女性）的常规静脉肾盂造影检查方案中增加俯卧位X线摄影。在评估俯卧位图像前后，对静脉肾盂造影进行解读并给出逆行肾盂输尿管造影的建议。
510例患者中有100例（19.6%）（95%置信区间，82.1，118）在获取俯卧位X线片后，对肾盂造影解读的信心得到提高。510例患者中有46例（9.0%）（95%置信区间，33.1，58.9）无需进行逆行肾盂输尿管造影。俯卧位图像对评估输尿管远端（骶段和盆腔段）最有帮助。
当需要对上尿路进行完整可视化时，静脉肾盂造影期间患者采用俯卧位是有用的。即使仅避免了少数逆行肾盂输尿管造影检查，获取额外的图像也是具有成本效益的。
