泌尿道螺旋CT仿真内窥镜的临床应用价值

Helical CT virtual endoscopy of urinary tract:clinical applications and limitations

目的 探讨泌尿道螺旋 CT仿真内窥镜的临床应用价值。 方法 5 3例临床怀疑泌尿道病变的患者 ,都经纤维膀胱镜或 /和手术证实。应用螺旋 CT采集排泄期的图像作 CTVE成像 ,双盲法与轴位、多平面重组 (MPR)、三维重建 (3D)图像及纤维膀胱镜所见对照分析。 结果 CTVE能清楚地显示泌尿道腔内的各种正常解剖结构 ;CTVE对膀胱腔内病变的部位、大小、数目、形态及侵犯范围的显示均与纤维膀胱镜基本一致 ;膀胱癌的检出率为 94 .7% ,2个 <5 mm的肿瘤 CTVE显示清楚 ,而轴位图像未显示 ;CTVE检测膀胱壁增厚和膀胱外侵犯的状况、显示肾盂、输尿管病变的效果明显不如轴位、MPR及3D图像。 结论 CTVE对膀胱病变的显示和诊断是一种较可靠的、非侵袭性的方法 ,但对肾盂、输尿管病变的诊断价值不大 ,必须结合轴位和 MPR图像才能作出全面。

Objective To evaluate the clinical applications and limitations of helical CT virtual endoscopy (CTVE) in urinary tract diseases. Methods CTVE was performed in 53 patients suspected urinary tract diseases, all cases were confirmed by conventional cystoscopy and/ or surgery. CTVE images were generated from the volumetric data of the excretory phase using helical CT. The results were then compared with the findings of axial, MPR and 3D images and conventional cystoscopy in a double blinded manner. Results CTVE could clearly display the normal anatomic structures of the urinary tract. The location, size, numbers, configuration and extension of lesions showed on CTVE were corresponded well with that of conventional cystoscopy. The sensitivity to vesical carcinoma was 94.7%,2 tumors smaller than 5mm depicted on CTVE images were not seen on the axial images. Whereas areas of wall thickening and extravesical invasions were more readily appreciated on axial and MPR images. CTVE image was not as good as the axial, MPR and 3D images in demonstrating the lesion of the pelvis and ureter. Conclusion CTVE has proved to be a noninvasive and reliable technique in the detection and diagnosis of bladder lesions, but it was less useful in evaluating the diseases of the pelvis and ureter. The optimal evaluation of urinary tract diseases of CTVE should combine with the interpretation of axial and MPR images.