经腹壁超声与螺旋CT诊断微小输尿管结石价值分析

Analysis of the Value of Transabdominal Ultrasound and Spiral CT in the Diagnosis of Small Ureteral Calculi

目的评价经腹壁超声和螺旋CT平扫对输尿管微小结石检出的诊断价值。方法回顾分析我院近三年172例急性肾绞痛患者的经腹壁超声和螺旋CT影像资料,比较两种方法对输尿管微小结石检出率是否存在差异,并评价两种方法诊断一致性。结果172例急性肾绞痛患者平均年龄为42.3±14.2(岁)。61例(36.1%)位于上段,30例(17.7%)位于中段,78例(46.2%)位于下段。下段结石直径分别与上段和中段结石直径存在统计学差异(P<0.05)。5mm常规CT平扫诊断准确率、漏诊率和误诊率分别为93.0%、5.2%和1.8%,显著优于经腹壁超声的诊断准确率(45.9%)、漏诊率(45.3%)和误诊率(8.8%)。螺旋CT平扫和经腹壁超声检查诊断输尿管微小结石的一致性差。经腹壁超声的输尿管各段微小结石检出率显著低于CT平扫(P<0.05)。超声检出组输尿管微小结石直径显著大于和未检出组(P<0.05)。结论经腹壁超声的输尿管微小结石检出率低,当初筛发现输尿管扩张时,应用螺旋CT平扫诊断效果更好。

Objective To evaluate the diagnostic value of transabdominal ultrasound and spiral CT plain scan in detecting small ureteral calculi.Methods The imaging data of 172 patients with acute Renal colic diagnosed and treated in our hospital in the past three years were retrospectively analyzed by transabdominal ultrasound and spiral CT.The difference in the detection rate of ureteral microlithiasis between the two methods was compared,and the diagnostic consistency of the two methods was evaluated.Results The average age of 172 patients with acute Renal colic was 42.3±14.2 years old.61 cases(36.1%)were located in the upper segment,30 cases(17.7%)in the middle segment,and 78 cases(46.2%)in the lower segment.There was a statistical difference in the diameter of the lower segment stones compared to the upper and middle segments stones(P<0.05).The diagnostic accuracy,missed diagnosis rate,and misdiagnosis rate of 5mm conventional CT plain scan were 93.0%,5.2%,and 1.8%,respectively,significantly superior to the diagnostic accuracy(45.9%),missed diagnosis rate(45.3%),and misdiagnosis rate(8.8%)of transabdominal ultrasound.The consistency between spiral CT plain scan and transabdominal ultrasound examination in diagnosing small ureteral stones is poor(Kappa=0.35).The detection rate of small stones in various segments of the ureter by transabdominal ultrasound was significantly lower than that by CT plain scan(P<0.05).The diameter of small ureteral stones in the ultrasound detection group was significantly larger than that in the non detection group(P<0.05).Conclusion The detection rate of small ureteral stones by transabdominal ultrasound is low,and when ureteral dilation was first detected through screening,spiral CT plain scan has a better diagnostic effect.