低剂量非增强螺旋CT、超声和KUB平片检查在肾绞痛诊断中的前瞻性比较

目的探讨低剂量非增强螺旋CT在急诊肾绞痛中的诊断价值。方法对123例急性腰腹部绞痛而怀疑泌尿系结石患者,根据体质量指数行低剂量非增强螺旋CT检查,并同时行泌尿系超声和KUB平片检查作对照。结果103例确诊为泌尿系结石,其中25例自行排出,45例体外碎石后排出,33例行输尿管镜碎石。低剂量非增强螺旋CT诊断泌尿系结石100例;超声诊断泌尿系结石77例;KUB诊断泌尿系结石68例,5例假阳性。低剂量非增强螺旋CT、超声和KUB的敏感度分别为1Do％、74．8％、66．1％,特异度分别为100％、100％、75％,阳性预测值分别为100％、100％、93．1％,阴性预测值分别为86．9％、43．5％、30．0％,约登指数分别为0．97、0．75、0．41。CT与超声组对比X^2＝21．23,P＝0．000,两种方法差别具有显著性。CT与KUB组对比X^2＝33．04,P＝0．000,两种方法差别具有显著性。结论低剂量非增强螺旋CT诊断泌尿系结石比超声和KUB具有更高的敏感度和特异度,且降低了患者的辐射剂量,可作为临床怀疑泌尿系结石、尤其是急性肾绞痛患者的常规检查方法。     

28例泌尿系结石的B超检查与X线检查对照分析

本文总结了1986年6月至1991年10月治疗的28例泌尿系结石患者的 B 超检查和 X 线检查。其中2例手术病理证实结石。26例肉眼见到排出结石。并于排石后复查 B 超及拍摄 X 线腹部“平片”对照。本组结石症 B 超诊断符合率为89.8%(25/28)。X 线诊断符合率85.7%(24/28)。(X~2=0.16,p>0.05)。其中肾结石 B 超诊断符合率为94.4%(17/18)。X 线诊断符合率为83.3%(15/18)。(x~2=1.12,P>0.05)。其中输尿管结石的 B 超诊断符合率为75.0%(6/8)。X 线诊断符合率为87.5%(78)(x~2=0.84,P>0.05)。两组无显著差异。     

泌尿系结石螺旋CT低辐射量扫描的临床应用

目的:探讨螺旋CT低剂量扫描在泌尿系结石诊断中的临床应用价值。方法:对75例临床怀疑泌尿系结石患者根据就诊顺序分为3组:标准剂量组、低剂量组1和低剂量组2,标准剂量组采用120kV,180mA,螺距0.938进行扫描;低剂量组1和低剂量组2分别采用管电流120mA、80mA进行扫描,其它扫描条件与标准剂量组相同。记录每次扫描的放射容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)和有效剂量(ED)。由两位具有10年以上CT工作经验的医师进行影像诊断和图像质量评估,计算标准剂量和低剂量CT检查诊断泌尿系结石的敏感度、诊断符合率和阳性预测值。对所有图像进行主观质量评分,并测量其客观噪声值。结果:两个低剂量组与标准剂量组比较,CT剂量指数分别减少29.7%和55.5%,低剂量组1、2对泌尿系结石诊断的敏感度均为93.8%,诊断符合率分别为96.0%和95.5%,阳性预测值分别88.2%和100%,与标准剂量组比较差异均无统计学意义。图像质量方面,尽管剂量降低后图像噪声有所增加,但所有图像质量仍符合诊断要求。结论:低剂量螺旋CT扫描能满足泌尿系结石的诊断要求,大大降低了受检者的辐射剂量。     

CT与MRI对胰岛素瘤定位诊断的比较研究

目的:比较CT与MRI对于胰岛素瘤定位诊断的临床价值.资料和方法:2006-09～2009-12临床疑诊胰岛素瘤患者共28名,均接受CT和MRI检查.以手术病理及临床定性诊断为对照标准,对比分析两种检查方式对胰岛素瘤的定位诊断效能.结果:19名患者经手术病理证实胰岛素瘤19例,其中CT检出12例,MRI检出16例.9名临床定性诊断除外胰岛素瘤的患者CT和MRI检查均为阴性.CT对胰岛素瘤术前定位诊断的敏感度、特异度、阳性预测值及阴性预测值分别为63.2%(12/19)、100%(9/9)、100%(12/12)及56.3%(9/16),MRI上述数值分别为84.2%(16/19)、100%(9/9)、100%(16/16)及75%(9/12).两种检查方法对胰岛素瘤定位诊断敏感度、阴性预测值间的差异无统计学意义(P=0.1336,P=0.4343).结论:CT和MRI对胰岛素瘤定位诊断的价值无明显差异.     

胎儿唇腭裂的MRI表现

目的 探讨MRI诊断胎儿唇腭裂的征象及其优缺点.方法 对12例超声怀疑胎儿唇腭裂的孕妇进行胎儿MR检查,并将超声、MRI及随访结果进行对照.结果 12例孕妇,检出胎儿12例,随访结果显示1例为不完全型唇裂、11例为完全唇裂并合并腭裂.B超和MRI诊断唇裂的结果与随访一致.胎儿唇裂的MRI表现为胎儿唇部软组织连续性不完全或完全中断,内充填羊水,T2WI呈高信号.腭裂的MRI表现为胎儿腭部组织信号不连续、局部被长T_2高信号中断,口腔与鼻腔直接相通.MRI漏诊腭裂1例,正确诊断腭裂10例,正确排除腭裂1例,诊断正确率为91.7%(11/12),敏感度为90.9%(10/11),特异度为100%(1/1);B超诊断腭裂5例,正确排除腭裂1例,漏诊6例,诊断正确率为50.0%(6/12),敏感度为45.5%(5/11),特异度为100%(1/1).结论 MRI对于腭裂的诊断较B超有一定优势,在超声或其他检查怀疑胎儿有腭裂时,有必要进一步进行MR检查.     

符合线路SPECT在消化系统肿瘤术后复发转移中的应用研究

探讨18F-FDG符合线路SPECT在消化系统肿瘤术后复发转移中的临床应用价值.材料和方法:对35例临床怀疑复发转移的消化系统肿瘤术后患者行18F-FDG符合线路SPECT显像,对其显像结果进行分析,计算其诊断的准确率、灵敏度、特异性、阳性预测值、阴性预测值及其95%可信区间,并与B超、CT、MRI的诊断结果相比较.结果:在35例消化系统肿瘤术后患者中,其诊断的准确率、灵敏度、特异性、阳性预测值、阴性预测值分别为91.4%、88.9%、100%、100%、72.7%;其95%可信区间分别为77%～98%、71%～98%、63%～100%、86%～100%、39%～94%.符合线路SPECT的诊断准确率、灵敏度明显高于B超,与CT和MRI的比较尚无显著性差异;95%可信区间分析,结果显示符合线路SPECT高于B超、CT和MRI;18F-FDG符合线路SPECT和B超、CT、MRI联合应用在某些病例的诊断中具有互补性.结论:18F-FDG SPECT/PET显像在消化系统肿瘤术后复发转移的诊断中具有较高的临床应用价值.     

血管超声与经导管造影诊断颈动脉狭窄的对比研究

目的:评价血管超声技术诊断颈动脉狭窄的临床应用价值。方法:对41例怀疑有颈动脉狭窄的患者行超声(US)和血管造影(DSA)检查,颈动脉狭窄应用NASCET标准测量并计算狭窄率。结果:82支颈内动脉中DSA诊断为正常血管53支、轻度~中度狭窄(≤69%)11支、重度狭窄(≥70%)10支、闭塞(100%)8支;以阴性(正常)与阳性(狭窄或闭塞)为切分点时,超声诊断的敏感度、特异度、阳性预测值、阴性预测值分别为94.2%、90%、94.2%、90%;以血管狭窄率70%为切分点时,其敏感度、特异度、阳性预测值、阴性预测值分别为86.4%、72.7%、89%、66%。结论:血管超声诊断颈动脉狭窄的敏感度较高,但特异度偏低,血管超声可用于颈动脉狭窄的筛选。但对于血管重度狭窄(≥70%)拟行颈动脉内膜剥脱术或经皮颈动脉成形术的患者,术前应行DSA检查。     

低放射剂量CT诊断输尿管结石的价值

目的 :评价螺旋CT平扫在放射剂量与静脉尿路造影等同的条件下对输尿管结石的诊断价值。方法 :采用一种新的方案( 12 0kV ,70mA ,旋转时间 0 .75s ,准值 5mm ,螺距 2 )依次对 2 0 9例有肾绞痛临床症状的患者进行CT检查 ,得出的诊断结果通过逆行尿路造影 ,尿路内镜 ,手术取石等方法验证。CT检查的放射剂量用Nagel法计算。最终确诊输尿管结石患者占患者总数的 70 %。结果 :CT在低放射剂量条件下对输尿管结石的诊断价值 :敏感度达到 97.3 % ,特异度达到 96.8% ,阳性预测值99.3 % ,阴性预测值 92 .4%。平均放射剂量在男性身上达到0 .97msv ,…     

MRCP诊断术后胆管结石:2D、3D FASE序列对照

目的评价磁共振胰胆管成像(MRCP)二维高级快速自旋回波(2D FASE)序列和三维高级快速自旋回波(3D FASE)序列对胆道术后残余对胆道术后病变的诊断价值.方法对72例胆道术后出现不明原因发热、黄疸、肝功能异常、右上腹痛等症状患者同时进行MRCP 2种序列检查,结果分别与手术、直接胆道造影对照.结果MRCP 2D FASE序列、3D FASE序列诊断肝内胆管结石的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为43.5%、100%、100%、79%、81.9%以及69.6%、95.9%、88.9%、87%、87.5%.2种序列诊断有显著性差异(P＜0.05).MRCP 2D FASE序列和3D FASE序列诊断胆总管及吻合口结石的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为77.8%、96.3%、87.5%、92.9%、91.7%以及83.3%、98.1%、93.8%、94.6%、94.4%.2种序列相比无显著性差异(P＞0.05).结论MRCP 2种序列对胆系结石均有很高的检出率.3D FASE序列较2DFASE序列能检出更细小的结石.     

飞行员输尿管结石治愈后放飞两例

一、临床资料例1男性,28岁,歼7H飞行员,飞行时间900h。2004年5月4日起无明显诱因出现右侧腰部及右下腹阵发性绞痛,即到场站医院行B超检查示:右肾积水,右输尿管上段扩张,初步诊断“右输尿管结石”。5月10日送体系医院。入院专科检查:尿常规红细胞(++)/Hp,右肾区叩击痛(+);腹部B超示:右肾积水,右输尿管上段扩张,可见6mm×5mm结石影;诊断为“右输尿管结石”,给予“尿石通”口服,大量饮水并做跳跃运动。22日又出现右下腹绞痛,复查B超示:结石下移至右输尿管下段膀胱入口处。27日行体外超声碎石,排出少许沙粒状结石。6月5日行腹部B超及腹部平片…     

A prospective comparative study of non-contrast helical computed tomography and intravenous urogram for the assessment of renal colic

Objective: To compare noncontrast helical computed tomography (NCHCT) and intravenous urography (IVU) for diagnosis of urinary calculi in evaluation of renal colic. Materials and methods: A 4-month prospective paired study compared NCHCT and IVU in patients being evaluated for renal colic. Each patient was studied with NCHCT followed by an IVU. An IVU was regarded as positive if any of the following were identified: delayed filling, hydronephrosis, hydroureter, ureteral calculus, or extravasation of contrast. A NCHCT was regarded as positive if any of the following were identified: hydronephrosis, hydroureter, ureteral calculus, or perinephric or ureteral inflammatory change. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) were reported using the clinical outcome as the gold standard, by either observation of passage or retrieval of calculus. Bladder distention was noted on NCHCT relative to the level of the acetabulum. The charts were also reviewed retrospectively for the results of urinalysis. Results: One hundred sixty-eight patients had both examinations interpreted. Nineteen positive NCHCT and IVU studies were eliminated due to lack of observation or retrieval of calculus, leaving 149 studies for interpretation. NCHCT had Se 0.98, Sp 0.95, PPV 0.98, and NPV 0.95. IVU had Se 0.83, Sp 0.95, PPV 0.97, and NPV 0.67. In 13/168 (8 %) cases, and in 9/37 (24 %) negative cases, NCHCT offered an alternative diagnosis. Ureterovesical junction (UVJ) calculus was identified on 84 NCHCT scans, with near-even distribution between well, partially, and poorly distended bladder. No UVJ calculus was identified on IVU that was not present on NCHCT. Absence of hematuria was found in 26 % of patients with proven urolithiasis. Conclusion: NCHCT is superior to IVU for the evaluation of renal colic. NCHCT identifies significant pathology in 24 % of cases negative for ureteral obstruction/calculus. Bladder distention does not play an important role in detection of UVJ calculus. Hematuria is not universally present in patients with painful urolithiasis.     

Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi

The aim of our study was to compare noncontrast spiral CT, US and intravenous urography (IVU) in the evaluation of patients with renal colic for the diagnosis of ureteral calculi. During a period of 17 months, 112 patients with renal colic were examined with spiral CT, US and IVU. Fifteen patients were lost to follow-up and excluded. The remaining 97 patients were defined to be either true positive or negative for ureterolithiasis based on the follow-up data. Sensitivity, specificity, positive and negative predictive value and accuracy of spiral CT, US and IVU were determined, and secondary signs of ureteral stones and other pathologies causing renal colic detected with these modalities were noted. Of 97 patients, 64 were confirmed to have ureteral calculi based on stone recovery or urological interventions. Thirty-three patients were proved not to have ureteral calculi based on failure to recover a stone and diagnoses unrelated to ureterolithiasis. Spiral CT was found to be the best modality for depicting ureteral stones with a sensitivity of 94 % and a specificity of 97 %. For US and IVU, these figures were 19, 97, 52, and 94 %, respectively. Spiral CT is superior to US and IVU in the demonstration of ureteral calculi in patients with renal colic, but because of its high cost, higher radiation dose and high workload, it should be reserved for cases where US and IVU do not show the cause of symptoms. Received 20 May 1997; Revision received 18 July 1997; Accepted 22 July 1997     

Evaluation of the role of echography in the positive diagnosis of renal colic secondary to kidney stone

To evaluate sensitivity and specificity of ultrasound in detecting urinary calculus in renal colic, a prospective study of 31 patients examined by both ultrasound and intravenous urography (IVU) was undertaken. Of the 27 cases of renal colic proved by IVU and/or recovery of a calculus, ultrasound correctly diagnosed urinary calculus in 26 cases with a sensitivity of 96.3%. In the 4 cases in which the sonographic examination demonstrated neither calculi nor unilateral obstruction, further evaluation confirmed the absence of calculi. Specificity of ultrasound was 100%. The results of this study support the use of ultrasound in detecting renal calculus and point out the important place of ultrasound in initial evaluation of renal colic.     

US for detecting renal calculi with nonenhanced CT as a reference standard.

PURPOSE: To determine the sensitivity and specificity of ultrasonography (US) for detecting parenchymal and renal pelvis calculi and to establish the accuracy of US for determining the size and number of calculi. MATERIALS AND METHODS: A total of 123 US and computed tomographic (CT) examinations were compared retrospectively for the presence of renal calculi. The sensitivity of US was determined for individual calculi and at least one calculus per examination. Retrospective findings were compared with the original US interpretation. The sizes of calculi in longest axis were compared on US and CT images, and the US detection of calculi in the left and right kidneys was compared. The use of US for detecting the full extent of calculus burden was evaluated in patients with multiple calculi. RESULTS: US depicted 24 of 101 calculi identified at CT, yielding a sensitivity of 24% and a specificity of 90%. There was no substantial difference for the detection of calculi in the right and left kidneys. The sensitivity of US for any calculi in a patient was 44%, equal to that of the original US interpretation. US enabled identification of 39% of patients with multiple calculi and demonstrated all calculi in 17% of these patients. The mean size of calculi detected with US was 7.1 mm +/- 1.2 (95% CI); 73% of calculi not visualized at US were less than 3.0 mm in size. Calculus size based on US and CT measurements was concordant in 79% of cases and differed by a mean of 1.5 mm +/- 0.7. CONCLUSION: US is of limited value for detecting renal calculi.     

Combined magnetic resonance urography and targeted helical CT in patients with renal colic: a new approach to reduce delivered dose

PURPOSE: To determine whether magnetic resonance urography (MRU), obtained before helical computed tomography (CT) in patients with acute renal colic, can help delimit the obstructed area to be subsequently examined by a targeted CT scan, thus reducing the dose of radiation. MATERIALS AND METHODS: Patients (51) with symptoms of acute renal colic underwent MRU and a total urinary tract helical CT. CT images from the 5 cm below the level of ureteral obstruction as demonstrated by MRU were selected out. Combined interpretation of MRU and selected CT images constituted protocol A. Protocol B consisted of the entire unenhanced helical CT of the urinary tract. The two protocols were compared regarding the following points: 1) sensitivity in diagnosing the presence of obstructing urinary stones, and 2) the delivered radiation dose. RESULTS: Protocol A and protocol B had, respectively, 98% and 100% sensitivity in demonstrating ureteral stone as a cause of renal colic. Estimated average dose calculated from phantom study was 0.52 mSv for protocol A and 2.83 mSv for protocol B. Therefore, the effective radiation dose was 5.4 times lower in protocol A compared to protocol B. CONCLUSION: Combined MRU and short helical CT has a high sensitivity in detecting ureteral calculi with a reduced radiation dose.     

Trends in the use of unenhanced helical CT for acute urinary colic

OBJECTIVE: Unenhanced helical CT for urolithiasis detection is a limited CT examination that was designed specifically for the detection of urolithiasis. The purpose of this study was to repeat a prior study to assess whether clinicians had broadened the indications and changed the yield and findings of unenhanced helical CT. MATERIALS AND METHODS: One hundred consecutive patients with suspected renal colic or flank pain referred for unenhanced helical CT were selected for this study. We reviewed the original radiographic reports for each patient and recorded the presence of ureteral calculi. Other urinary abnormalities and extraurinary lesions were also recorded and compared with the results of the previous study. RESULTS: In this study, 56% of the patients who underwent unenhanced helical CT had symptoms of urinary colic, and 44% of patients had unspecified flank pain, compared with 100% of patients with symptoms of urinary colic 1 year earlier. The sensitivity and specificity of unenhanced helical CT in detecting ureteral calculi were 96% and 99%, respectively. Ureteral calculi were identified in only 28% of the patients versus 49% of patients (p < .01) 1 year earlier. Extraurinary lesions were identified in 45% of the patients versus 16% (p < .01) 1 year before. CONCLUSION: As clinicians developed familiarity with this technique, the indications for performance of unenhanced helical CT were expanded with a consequent reduction in the rate of detection of stone disease and identification of an increased number of extraurinary lesions, which suggests a demand for emergency abdominal CT studies.     

Functional evaluation of the urinary tract by color-Doppler ultrasonography (CDU) in 100 patients with renal colic

INTRODUCTION AND OBJECTIVE: To evaluate if the addition of a renal color-Doppler ultrasonography (CDU) in the setting of acute renal colic improves the sensitivity of conventional sonography. MATERIALS AND METHODS: Between July 2002 and June 2003, 100 patients (median 49 years) with renal colic have been evaluated. Within 24 h of the admission, a CDU study of the urinary tract was performed using a sonograph GE Logiq 500 PRO with a multifrequency (3-5 MHz) convex probe. The following parameters were evaluated: ultrasonography (US) of both kidneys, ureters and bladder; resistive index (RI) of the arciform arteries of both kidneys in three different parenchymal areas; ureteric jets in response to hydration. A renal RI>0.70 and/or a 10% difference between the kidneys were considered as diagnostic of obstructive uropathy; an asymmetric and/or reduced ureteric jet from the ureteric orifices was an additional indicator of obstruction. All patients underwent a CT scan both with and without the administration of contrast medium. RESULTS: Enhanced helical CT demonstrated an urinary stone in 90 out of the 100 patients (90%): 29 pyelic, 28 at the pyelo-ureteral junction, 23 lumbo-iliac and 10 juxtavesical stones. Among 90 patients with urolithiasis, the stone was undetectable with US in 11 cases (12.2%); in 8 cases (8.9%) pyelocalicectasis was absent, and in 6 patients (6.6%) a non-obstructive hydronephrosis was present. Median RI in obstructed and non-obstructed kidney was 0.73 (range 0.71-0.87) versus 0.62 (0.50-0.68), respectively; in two, obstructed kidneys RI was <0.70 but greater than 10% compared with normal side. Sensitivity and specificity of US, CDU (RI+ureteric jet), unenhanced helical CT and CDU in association with unenhanced helical CT were 94.8 and 55.5, 98.9 and 90.9, 100 and 100%, respectively. DISCUSSION AND CONCLUSIONS: CDU in patients with renal colic and/or pelvicalicectasis improves the diagnostic accuracy of US in distinguishing between obstructive and non-obstructive dilatation. Combined with unenhanced CT, CDU has a 100% sensitivity and specificity. Moreover, due to the absence of contraindications and side-effects, CDU is indicated for the follow-up of patients after ESWL, pregnant women and children.     

Ultrasound vs CT for the detection of ureteric stones in patients with renal colic.

The aim of our study was to compare the accuracy of non-contrast spiral CT with ultrasound (US) for the diagnosis of ureteral calculi in the evaluation of patients with acute flank pain. 62 consecutive patients with flank pain were examined with both CT and US over a period of 9 months. All patients were prospectively defined as either positive or negative for ureterolithiasis, based on follow-up evaluation. 43 of the 62 patients were confirmed as having ureteral calculi based on stone recovery or urological interventions. US showed 93% sensitivity and 95% specificity in the diagnosis of ureterolithiasis; CT showed 91% and 95%, respectively. Pathology unrelated to urinary stone disease was demonstrated in six patients. Although both modalities were excellent for detecting ureteral stones, consideration of cost and radiation lead us to suggest that US be employed first and CT be reserved for when US is unavailable or non-diagnostic.     

Unenhanced spiral CT for the assessment of renal colic. How does limiting the referral base affect the discovery of additional findings not related to urinary tract calculi?

The value of unenhanced spiral CT (UESCT) for investigating acute flank pain suggestive of urinary tract calculi is increasingly appreciated in the last few years. Recent studies have identified the advantages of UESCT in recognizing alternative findings within or outside the urinary tract. We sought to determine how narrowing the referral base for the UESCT would affect the discovery of potentially significant alternative findings in patients with acute flank pain suggestive of renal colic. Between January 1999 and December 1999, 425 patients, 271 (63.8%) men and 154 (36.2%) women who were 1-90 years old (mean 45.7 years old) with acute flank pain were studied with UESCT. CT studies were solely ordered by urologists, and only patients with intractable renal colic or patients that returned more than once to the emergency room with the complaint of acute flank pain were studied. A calculus within the ureter was diagnostic of an obstructive stone. Any other abnormality within the abdomen and pelvis was reported. A ureteral calculus was detected on 251 (59%) CT scans. Nineteen (4.5%) CT scans were consistent with recent excretion of a stone. In 112 (26.3%) CT scans, the cause for the patient's acute flank pain could not be explained. Forty-three (10.1%) alternative significant diagnoses that explain the patient's complaints were found. Nineteen (44%) were findings related to the urinary tract, and 24 (56%) were not related to the urinary tract. Ninety-seven (22.3%) additional findings not significant to the patient's current complaint were also reported. Even when narrowing the indications for the UESCT, about 10% of significant alternative findings to urinary stones were encountered. The variety of diagnoses found unexpectedly on the UESCT that alter a patient's management demonstrates the pivotal role of UESCT in triaging these patients rapidly towards optimal therapy. The UESCT can be used as a useful screening tool, sometimes revealing the exact pathology and sometimes directing the radiologist to the modality by which to continue.