低辐射剂量和低造影剂用量的MSCTU泌尿系统一站式检查法在临床上的应用

Clinical application of low radiation dose and low contrast agent dose of MSCTU urinary system one-stop examination

目的探讨低辐射剂量和低造影剂用量的多层螺旋CT尿路成像(MSCTU)泌尿系统一站式检查法在泌尿系统评估中的应用价值。方法收集2015年10月至2017年9月重庆市合川区人民医院临床或B超确诊为泌尿系统疾病的患者160例,随机分为8组(管电流100mA组、80mA组、60mA组、160~360mA组,以及碘海醇注射液80mL组、60mL组、40mL组、20mL组),每组20例。患者分别在100、80、60、160~360mA管电压下,注射碘海醇注射液(350mgI/mL)80mL进行MSCTU,根据患者肾盏,肾盂,上、中、下段输尿管以及膀胱横断面多平面重组(MPR)、三维容积再现(VR)、最大密度投影(MIP)及曲面重建(CPR)图像评分筛选最佳辐射剂量。最佳辐射剂量下,患者分别注射80、60、40、20mL碘海醇注射液进行MSCTU,根据上述评定标准筛选最佳造影剂用量。结果管电流160~360mA组与100mA组、80mA组,以及碘海醇注射液80mL组与60mL组、40mL组的图像质量评分比较,差异均无统计学意义(P>0.05),且图像质量都能满足临床诊断。管电流60mA与100mA组、80mA组,以及碘海醇注射液20mL组与80mL组、60mL组、40mL组的图像质量评分差异均有统计学意义(P<0.05)。结论 80mA管电流和40mL的碘海醇注射液双低法的MSCTU能够充分满足尿路病变成像的需要,对尿路病变有较高的诊疗价值。

Objective To explore the application value of low dose and low contrast agent dose of multislice spiral CT urography （MSCTU） urological one-stop examination in the urinary system evaluation. Methods One hundred and sixty patients with urinary system disease diagnosed in clinic or B-mode ultrasonography in the Hechuan District People′s Hospital from December 2015 to September 2017 were randomly divided into 8 groups （tube current 100 mA,80 mA,60 mA,160-360 mA,and iohexol injection 80 mL,60 mL,40 mL,20 mL）,20 cases in each group.The patients were injected by iohexol injection （350 mgI/mL） 80 mL under the tube voltages of 100,80,60,160-360 mA and conducted MSCTU.The optimal radiation dose was screened according to the cross-sectional multiplanar recombination （MPR） of kidney calices,renal pelvis,upper,middle and lower ureter,and bladder cross section,three dimensional volumetric representation （VR）maximal intensity projection （MIP） and curved planar reformation （CPR） image scores.Under the optimal radiation dose,the patients were injected by 80,60,40,20 mL of iohexol injection respectively,MSCTU was conducted.Then the optimal contrast agent dose was screened by using the above evaluation standard. Results The image quality scores had no statistically significant difference between the tube current 160- 360 mA group with 100 mA group and 80 mA group and between the iohexol 80 mL group with 60 mL and 40 mL groups （ P 〉0.05）,moreover the image quality all met the clinical diagnosis.The image quality scores had statistically significant differences between the tube current 60 mA group with 100 mA group and 80 mA group and between the iohexol injection 20 mL group with 80 mL,60 mL and 40 mL group （ P 〈0.05）. Conclusion The dual low method of MSCTU with 80 mA tube current and 40 mL iohexol injection can fully meet the needs of urinary tract lesion imaging,and has a high diagnostic value for urinary tract lesions.