CT仿真输尿管膀胱镜成像的初步临床应用

CT Virtual Ureterocystoscopy: Preliminary Clinical Applications

目的 探讨CT仿真输尿管膀胱镜成像技术和价值。方法 应用螺旋CT采集排泄期尿路断面影像 47例 ,层厚 5mm ,螺距 2 .0或 1.0 ,重建层厚 2 .5mm ;将源影像送至工作站作内窥镜成像等后处理。 6例同时作了膀胱镜或输尿管镜检查。结果 CT IVU和VE技术成功率达 10 0 % ,无并发症。VE内镜样显示了肾盏、肾盂、输尿管和膀胱内壁、内腔及其病变的三维结构 ,对 5mm以上膀胱癌检出率达 10 0 % ,较好地显示了肿瘤特征 ,增加了诊断信息。但VE无法显示尿路结石和区分输尿管真性狭窄与正常蠕动波 ,在显示尿路内腔解剖和病变细节也无输尿管膀胱镜佳 (P <0 .0 5 )。CT IVU图像质量比常规静脉尿路造影 (X IVU)的佳 (P <0 .0 5 )。结论 CT IVU内镜重建三维内镜样显示了尿路内腔与病变 ,对肿瘤病变准确性高 ,但无法检出尿路结石。CT IVU优于X IVU。

Objective To detect the techniques and clinical value of CT virtual endoscopy of urinary tracts. Methods Virtual endoscopy(VE) of urinary tracts was performed in 47 cases, using navigator software based on the source imaging data of excretory helical CT urography(CT IVU) with the following scanning parameters:slice 5mm,pitch 2.0 or 1.0. Images were reconstructed at 2.5mm interval. Excretory scout was done in 41 cases.Six cases were underwent meanwhile ureterorenoscopy or cystoscopy. Results The technical success rate of CT IVU and VE was 100% without any complication. The 3D display of Virtual ureterocystoscopy depicted endoscopelike the innerlumen anatomy and disorders of urinary tracts at any angle. The sensitivity of VE to bladder tumors more than 5 mm in diameter was 100%,with some tumor character. It added the diagnostic information to CT. It was difficult,however,for VE to detect the stones and to distinguish the normal uretal peristalses from stricture. Compared with ureterocystoscopy, the major limitation of CT virtual endoscopy was its inability to demonstrate the detail of lesions and mucosal surface of urinary tracts.The imaging quality of CT IVU was better than that of X IVU( P <0.05). Conclusion CT ureterocystoscopy provides endoscope like display of urinary tracts and lesions.The diagnostic accuracy of tumors,but stones, is higher. CT IVU is superior to X IVU. [