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題名 | Can Intravenous Urography be Replaced by CT Urography? Our Experience in the Evaluation for Hematuria=血尿病患之影像評估--電腦斷層可以取代靜脈尿路攝影嗎? |
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作者 | 沈書慧; 黃家槐; 黃姍姒; 張政彥; | 書刊名 | 中華放射線醫學雜誌 |
卷期 | 31:2 民95.04 |
頁次 | 頁63-70 |
分類號 | 415.802 |
關鍵詞 | 電腦斷層攝影; 血尿; 靜脈尿路攝影; 輸尿管結石; 尿路上皮細胞癌; Computed tomography; CT; Hematuria; Intravenous urography; IVU; Ureteral stone; Urothelial cell carcinoma; |
語文 | 英文(English) |
中文摘要 | 本前瞻性研究之目的為比較電腦斷層與靜脈尿路攝影對於血尿病因之診斷率,並建立適當的診斷流程。 一年期間,共有32 名血尿病患接受電腦斷層與靜脈尿路攝影檢查。電腦斷層攝影包括三相軸狀切面影像:不施打顯影劑phase Ⅰ,延遲90 秒 (phase Ⅱ)與延遲180 秒 (phase Ⅲ),並以二維影像重組phase I 與III 之冠狀切面。兩種影像學檢查之結果分別與最終診斷對照,並依據不同疾病比較二者之診斷率。 最常造成血尿之原因為結石;但在超過五十歲之病患中,惡性腫瘤為最常見之原因,特別是尿路上皮細胞癌。電腦斷層影像對血尿病患的確定診斷率為84.3%,靜脈尿路攝影則為31.3% 。靜脈尿路攝影雖然在絕大部分的病例都有可疑之影像學表現 (25/28, 89.3%),但經常無法得到確定診斷率而需要進ㄧ步之檢查。電腦斷層對於結石,腎實質病灶與其他的腹腔內病灶診斷率皆高於靜脈尿路攝影。對於尿路上皮細胞癌,雖然靜脈尿路攝影之影像解析度較佳,但因電腦斷層可清楚顯示壁厚,周圍脂肪浸潤與顯影增強,整體診斷率仍高於靜脈尿路攝影。在電腦斷層攝影的流程方面,phase I 與II 影像在大部分病例即可得到確定診斷,延遲相影像包括軸狀切面與冠狀重組所得的電腦斷層尿路攝影不一定能提供更多資訊,尤其是在有尿路阻塞的狀況。 電腦斷層攝影對於血尿的診斷率,整體而言高於靜脈尿路攝影,經常ㄧ次檢查便足夠得到確定診斷。我們認為,以電腦斷層攝影取代靜脈尿路攝影作為血尿病患之第一線評估工具可能是合理的,不過這仍需要更細緻的投資報酬率 (cost-effectiveness) 分析才能定論。 |
英文摘要 | This study was conducted for comparing the diagnostic rate of CT and IVU for hematuria and establishing a proper diagnostic protocol During the year of 2004, total 32 patients pre-sented with hematuria received both IVU and CT examination. The CT examination included three phase axial scan: noncontrast (phase I) , 90 seconds (phase II) and 180 seconds (phase III) after con-trast administration and coronal reconstruction for phase I and III images. The diagnosis of both imaging studies were compared with the final diag-nosis. The two examinations were compared by the results of diagnostic accuracy for different diseases. The most common cause of hematuria is stone, while malignancy is the most common cause in patients more than 50 years old, especially urothe-lial cell carcinoma (UCC) . The diagnostic accuracy for hematuria is 84.3% in CT and 31.3% in IVU. Although suspicious abnormal findings in IVU were recognized in most patients (25/28, 89.3%) , they were usually inadequate for making accu-rate diagnosis and further examinations were thus acquired. The diagnostic rate of CT for stone, renal parenchymal lesion and other intraabdominal pathology is higher than IVU. For the diagnosis of UCC, CT could yield better diagnostic rate as com-pared with IVU because of its ability to detect wall thickness, adjacent fat infiltration, and contrast enhancement, although IVU yielded better imaging resolution. In the protocol for CT, we found that diagnosis could be obtained in phase I and phase II imaging in most cases. CT has higher diagnostic rate for hematuria as compared with IVU and could be the one-stop examination for patient with hematuria. CTU should be under consideration to have CTU as the first line diagnostic tool, although more delicate cost-effectiveness evaluation is needed for the con-clusion. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。