高分辨率CT联合多平面重组在鉴别飞行员肾乳头钙化与肾结石中的应用价值

Application value of high-resolution CT with multiplanar reformation in differentiating renal papillary calcification and renal calculi of pilots

目的评价高分辨率CT(high-resolution computer tomography, HRCT)联合多平面重组(multiplanar reformation, MPR)在鉴别飞行员肾乳头钙化与肾结石中的作用。方法采用回顾性研究。收集2017年6月至2021年10月空军特色医学中心收治的行HRCT检查怀疑肾结石并经输尿管软镜检查确诊的飞行员病例资料, 利用MPR对获取的图像进行分析及测量;依据输尿管软镜检查结果将其分为肾乳头钙化组及肾结石组。对比分析两组飞行员病灶的大小(横径、纵径和纵横径差值)和CT值。结果纳入飞行员18例。共检测出33个病灶, 其中肾乳头钙化8个, 肾结石25个。①肾乳头钙化灶的横径为(2.93±0.42)mm, 纵径为(3.00±0.41)mm, 纵横径差值为(0.12±0.81)mm;肾结石横径为(4.47±2.18)mm, 纵径为(4.01±1.49)mm, 纵横径差值为(0.89±0.96)mm;组间差异均有统计学意义(t=3.78、2.93、3.77, P=0.001、0.007、0.001)。②肾乳头钙化与肾结石的CT值分别为(270.87±86.95)、(610.74±347.03)HU, 差异有统计学意义(t=4.32, P<0.001)。③肾乳头钙化与肾结石的横径、纵径和纵横径差值以及CT值的受试者工作特征曲线下面积分别为0.793、0.701、0.894、0.788;纵横径差值临界值为0.225 mm, 约登指数为0.745, 其敏感度及特异度分别为87.0%、87.5%。结论 HRCT联合MPR有助于鉴别肾乳头钙化及肾结石, 其中以病灶纵横径差值的诊断准确性最高。

Objective To evaluate the role of high-resolution computer tomography(HRCT)with multiplanar reformation(MPR)in the differential diagnosis of renal papillary calcification and renal calculi.Methods Retrospective study was used upon collecting the clinical data of pilots who were suspected of renal calculi by HRCT and diagnosed by ureteroscopy in the Air Force Medical Center from June of 2017 to October of 2021.MPR was used to analyze and measure the acquired images.According to the results of ureteroscopy,they were divided into renal papillary calcification group and renal calculi group.The sizes(transverse diameter,longitudinal diameter,and difference between transverse and longitudinal diameters)and CT values of the lesions were compared between 2 groups and analyzed.Results Eighteen pilots were included.A total of 33 lesions were detected,including 8 renal papillary calcification and 25 renal calculi.①The transverse diameter of renal papillary calcification lesions was(2.93±0.42)mm,the longitudinal diameter was(3.00±0.41)mm,and the difference between transverse and longitudinal diameters was(0.12±0.81)mm;the transverse diameter of renal calculi lesions was(4.47±2.18)mm,the longitudinal diameter was(4.01±1.49)mm,and difference between longitudinal and transverse diameters was(0.89±0.96)mm.The differences between 2 groups were statistically significant(t=3.78,2.93,3.77,P=0.001,0.007,0.001).②The CT values of renal papillary calcification and renal calculi was(270.87±86.95)HU and(610.74±347.03)HU,respectively,with a statistically significant difference(t=4.32,P<0.001).③The area under the receiver operating characteristic curve of the transverse diameter,longitudinal diameter and difference between longitudinal and transverse diameters,as well as CT values,was 0.793,0.701,0.894,0.788,respectively;the critical value of the difference between longitudinal and transverse diameters was 0.225 mm,and the Youden′s J statistic was 0.745.Its sensitivity and specificity was 87.0%and 87.5%respectively.Conclusions HRCT combined with MPR is helpful to differentiate renal papillary calcification from renal calculi.The diagnostic accuracy is the highest on differentiating the difference between the longitudinal and transverse diameter of the lesion.