螺旋CT仿真内窥镜对早期诊断膀胱肿瘤价值的探讨

Computed tomography virtual cystoscopy in the detection of bladder cancer

目的:研究螺旋CT仿真内窥镜技术(CTVE)在早期诊断膀胱肿瘤中的价值。方法:通过导尿管抽出尿液后向膀胱内注入气体行螺旋CT扫描,图像传至工作站行三维仿真膀胱镜重建。盲法评价CTVE和横轴位图像显示膀胱内肿瘤结节病变检出数量的差异,以及两种方法提供的信息情况。结果:20例中CTVE发现膀胱肿瘤18例,而轴位像仅发现14例。横断面图像检出26个结节,CTVE检出31个结节,两者有差异(P<0.05)。CTVE的敏感性和阴性预测值均为100％;横断面图像的敏感性和阴性预测值仅为77.8％和33.3％。5个直径≤5mm的结节轴位像均漏诊。结论:CTVE为一种无创检查,无盲区,可准确显示直径≤5mm的膀胱肿瘤;膀胱充气状态螺旋CT横断面图像可准确显示膀胱壁的增厚等异常;两者结合可为膀胱肿瘤的早期发现和合理治疗提供准确信息。

Objective: To investigate the value of computed tomography virtual cystoscopy (CTVE) in the detection of bladder cancer . Methods: 20 patients with clinically suspected bladder tumor were examined with CTVE. The bladders insufflated with 250- 500 ml air through a catheter were scaned . The data were downloaded to a workstation for interacactive inrtaluminal navigation. The results of transverse images and CTVE were evaluated by five observers independently. Results: Thirty - one lesions were identified on the CTVE including five lesions of less than 5mm, but only 26 on the transverse images. Compared both two methods, the analysis of axial image yielded a sensitivity77.8% and negative predictive value33.3% . The analysis of CTVE yielded a sensitivity 100%, negative predictive value100%. Conclusion: CTVE could be a effective and useful tool in the detection of bladder tumor. Interpretation of both transverse and virtual images is necessary because both of them are complementary in the detection of bladder tumor.