螺旋CT仿真内窥镜技术诊断膀胱肿瘤(附15例报告)

目的：评价CT仿真内窥镜技术（CTVE）在诊断膀胱肿瘤中的价值。方法：对15例拟诊断膀胱肿瘤患者行螺旋CT扫描,将获得的CT容积数据进行后处理,重建类似纤维膀胱镜的图像。结果15例均示膀胱肿瘤,其中2例病灶位于纤维膀胱镜检的盲区。结论CTVE为一种无创检查,无盲区,可观察到肿瘤浸润深度,但缺乏组织特异性,不能进行活检,故不能完全替代纤维膀胱镜。     

螺旋CT仿真内窥镜技术在膀胱肿瘤分期诊断中的应用

目的 探讨螺旋CT仿真内窥镜(CTVE)对膀胱肿瘤分期诊断的作用。方法 对10例正常对照和40例经手术病理检查证实的膀胱肿瘤患者术前采用多层面螺旋CT机进行容积扫描,将所得扫描数据转入工作站利用三维重建检查软件进行后处理,获得膀胱CTVE三维图像。将重建图像分别与冠状或轴位CT扫描、膀胱镜检查所见、手术中所见及病理检查结果进行比较分析。结果 CTVE对膀胱肿瘤检出率及分期准确率分别为98％(39／40)和85％(33／39),直径≥0．5cm的肿瘤显示率为100%。可观察尿道内口及膀胱颈部病变,弥补膀胱镜视野盲区,但不能显示膀胱黏膜的表浅病变及进行活检。结论 CTVE具有无创优点,在膀胱肿瘤临床分期及膀胱镜视野盲区的肿瘤诊断方面是膀胱镜较好的替代和补充方法。     

螺旋CT三维成像技术在膀胱肿瘤诊断中的价值

目的 探讨螺旋CT仿真内窥镜技术(CT virtual endoscope,CTVE)在诊断膀胱肿瘤中的临床价值.方法 回顾性分析我院经手术或膀胱镜病理证实的40例膀胱肿瘤的影像学资料.CT检查方法 是用导尿管排出尿液后,向膀胱内注入气体行螺旋CT扫描,图像传至工作站,行三维仿真内窥镜重建.结果 40例行CTVE检查均发现膀胱肿瘤,与膀胱镜检查结果 基本一致.结论 CTVE作为一种微创检查,无盲区,可观察到肿瘤浸润深度,结合多平面重建,能达到与纤维膀胱镜检查同样的敏感度和特异性,是一种无创而有效的方法.     

经尿道腔内超声在膀胱肿瘤诊断和分期中的价值

目的　探讨经尿道腔内超声在膀胱肿瘤诊断和分期中的价值。　方法　总结 70例膀胱癌患者经尿道腔内超声诊断及分期的结果 ,并与膀胱镜、经腹壁超声、CT、MRI、术后病理结果对比。　结果　经尿道腔内超声肿瘤检出率 99.1% ,高于膀胱镜和经腹壁超声检出率 ;膀胱肿瘤分期与病理符合率 :T110 0 .0 %、T2 95 .8%、T3 82 .4 %、T45 5 .6 %。　结论　经尿道腔内超声能清晰显示早期膀胱肿瘤及其浸润深度 ,是早期膀胱肿瘤诊断及分期的重要方法之一     

多层面螺旋CT仿真膀胱镜对膀胱肿瘤的诊断价值

目的：探讨多层面螺旋CT仿真膀胱镜(multi—slice spiral CT virtual cystoscopy，MSCTVC)对膀胱肿瘤的诊断价值。方法：对以血尿为主诉，经B超发现膀胱内占位性病变的20例患者行MSCTVC和传统膀胱镜检查。通过导尿管将4．8％泛影葡胺注入膀胱，行盆腔CT扫描，将资料传至工作站，采用Voyager。软件angios—copy模式行仿真膀胱镜影像重建。结果：传统膀胱镜证实的25处膀胱内病变MSCTVC显示23处，准确率92％。输尿管口和尿道内口均清晰显示。结论：MSCTVC具有重建图像清晰逼真、大视野、无盲区等特点，能较准确地发现膀胱内占位性病变，可作为尿道狭窄、严重血尿或拒绝行传统膀胱镜检等特定条件下替代常规膀胱镜的检查方法之一。     

螺旋CT三维膀胱造影对膀胱肿瘤的诊断

利用螺旋CT进行快速容积扫描,在膀胱充盈的情况下,静脉注射对比剂后分别于动脉期和延迟期进行快速扫描,并在工作站实施三维图像重建,使膀胱肿瘤显像更为明显,提高螺旋CT对膀胱肿瘤的诊断价值。     

多层螺旋CT双期增强扫描结合仿真内镜成像在膀胱癌术前分期中的诊断价值

目的 探讨多层螺旋CT双期增强扫描结合仿真内镜成像在膀胱癌术前分期中的诊断价值.方法 经纤维膀胱镜或手术病理证实为膀胱癌患者75例.对患者术前螺旋CT双期增强扫描图像和仿真内镜图像进行分析,比较多层螺旋CT分期与病理分期的准确率.结果 75例患者共发现病灶94个.螺旋CT分期:T1 26例、T2a 27例、T2b 13例、T3 12例、T4 16例;病理分期:pT1 28例、pT2a 24例、pT2b 14例、pT3 12例、pT4 16例.螺旋CT双期增强扫描诊断膀胱癌准确率为89.4%(84/94);腔内息肉样病变,仿真内镜诊断敏感性96.6%(84/87);膀胱壁无蒂隆起性病变诊断敏感性为90.9%(10/11).螺旋CT双期增强扫描结合仿真内镜诊断膀胱癌分期准确率为94.5%(91/94),当肿瘤局限于膀胱壁内(≤T2b)时,诊断准确率为91.2%(51/56);肿瘤侵犯膀胱壁外结构时(≥T3),诊断准确率达100.0%(28/28).结论 多层螺旋CT双期增强扫描结合仿真内镜成像对膀胱癌术前临床分期具有重要价值.     

螺旋CT仿真膀胱镜在膀胱肿瘤诊断中的应用

目的：探讨螺旋CT仿真膀胱镜（CTVC）在膀胱肿瘤诊断中的应用和临床价值。方法：使用GE Hispeed CT/i螺旋CT扫描机对38例可疑膀胱肿瘤患者行平扫，增强扫描后再延迟扫描（层厚3－5mm)，螺距1．5mm，重建率60．0％－66．6％，并利用GE AW3．1工作站Navigator软件生成仿真内窥镜影像。结果：CTVC检查的准确度为94．4％，特异度为99．9％，敏感度为96．0％，CTVC对病变形态的显示与纤维膀胱镜和标本具有良好的对应性，结论：CTVC是一种新的非侵袭检查手段，有一定的临床使用价值。     

膀胱根治性切除术后继发尿道癌的临床分析

目的总结膀胱癌行根治性膀胱切除术后继发尿道癌的临床特点,以提高诊治能力。方法回顾性分析2000年至2014年98例膀胱癌行根治性膀胱切除术后继发尿道癌6例的临床资料,其中3例行可控回结肠代膀胱术,1例行原位膀胱术,2例行回肠膀胱术。发生尿道癌时间为术后5~36个月。行尿道膀胱镜检查4例位于后尿道残端,2例位于前尿道,活检证实均为尿道尿路上皮癌,1例CT发现后尿道癌浸润周围组织及盆腔和腹股沟淋巴结的转移。4例行经会阴全尿道切除术,1例行经尿道肿瘤电切术,6例均行化疗或辅助性化疗。结果本组根治性膀胱切除术后尿道癌的发生率为6.1%,手术过程顺利。1例出现切口感染,经治疗后愈合。随访8~60个月,1例出现全身骨转移,1例出现双侧腹股沟淋巴结转移(经淋巴结活检证实),另4例未发现远处转移。结论根治性膀胱切除术后继发尿道癌发生率较低。尿道血性分泌物及肉眼血尿是尿道癌的主要临床表现。尿道膀胱镜检查是诊断尿道癌的重要手段,活检能够明确诊断,利用输尿管镜能提高活检的阳性率。CT和MR能明确肿瘤浸润的深度,并明确有无腹股沟及盆腔淋巴结的转移。全尿道切除术辅助化疗能提高膀胱癌行根治性膀胱切除术后继发尿道癌的生存期。     

静脉尿路造影辅助CT仿真内窥镜诊断膀胱肿瘤

目的　探讨IVU造影辅助CT仿真内窥镜 (CTVC)诊断膀胱肿瘤的临床价值。　方法　经IVU、CT仿真内窥镜检查 2 2例膀胱肿瘤病人 ,获得的图像信息与膀胱镜所见及手术结果比较分析。　结果　 2 2例病人经CTVC发现浅表乳头状瘤 18个 ,结节、团块乳头状瘤 11个 ,浸润性肿瘤1个。肿瘤直径最小 3.0mm。与膀胱镜检查及手术结果完全符合。根据CTVC图像结合断层CT扫描分析参照膀胱镜分型将膀胱肿瘤分为 3型 :(1)浅表乳头状瘤 ,(2 )结节、团块状乳头状瘤 ,(3)浸润性肿瘤。　结论　CTVC是一种新的无创检查方法 ,可以显示直径 >3.0mm突入膀胱的肿瘤和肿瘤表面特征、肿瘤与输尿管口及膀胱颈的关系、膀胱粘膜情况 ,对膀胱肿瘤诊断有较高的实用价值     

螺旋CT仿真内窥镜技术对膀胱肿瘤的诊断价值

目的：探讨螺旋CT仿真内窥镜（CTVE）的成像技术及其对膀胱肿瘤的诊断价值。方法：应用螺旋CT对35例膀胱肿瘤患者进行膀胱容积扫描,所得数据在工作站利用软件进行后处理,形成CTVE影像,并用“Fly THrough”软件从多角度观察膀胱,所有患者均行纤维膀胱镜检查及手术治疗,并将术中所见及病理检查结果作为最后诊断标准。结果：所有患者均取得了高质量的CTVE图像,除1例（肿瘤直径＜0．5cm)漏诊外,其余患者均得到了明确诊断,并与手术或病理检查结果符合,其中2例位于膀胱前壁近前列腺部的肿瘤,纤维膀胱镜检查未能发现,而CTVE则明确显示。结论：CTVE对膀胱肿瘤是一种较可靠的非侵入性检查手段,具有一定的优越性,可作为泌尿系统常规检查方法的有益补充。     

计算机断层扫描螺旋尿路成像与仿真内窥镜技术的临床应用

目的 探讨螺旋CT尿路成像（SCTU）与CTVE）的检查方法、成像技术以及在泌尿外科疾病中的应用价值,提高诊断水平。方法 应用螺旋CT对46例泌尿系统疾病患者（包括肾肿瘤2例,肾盂旁囊肿2例,输尿管结石6例,输尿管狭窄4例,输尿管肿瘤2例,重复肾重复输尿管畸形1例,膀胱肿瘤28例,膀胱子宫内膜异位症1例）行容积扫描,所得数据在工作站利用软件进行后处理,获得泌尿系立体图像;并对6例输尿管疾病、29例膀胱疾病患者进行了CT仿真内窥镜（CTVE）成像。所有图像均与B超、静脉尿路造影、逆行肾盂造影、常规CT扫描、膀胱镜检查等比较。并将术中所见或病理结果作为诊断的金标准。结果 所有患者均取得了高质量的泌尿系图像,除1例膀胱肿瘤（肿瘤直径为4mm）漏诊外,其余患者均得到了明确诊断,并与手术或病理结果相符合。结论 SCTU与CTVE是较可靠的非侵入性检查手段,具有一定的优越性,可作为泌尿系常规检查方法的有益补充。     

Computed tomographic virtual cystoscopy for the detection of urinary bladder neoplasms

OBJECTIVE: To evaluate the role of computed tomographic virtual cystoscopy (CTVC) in the detection of bladder neoplasms and to compare CTVC at conventional and reduced milliAmperes-second (mAs) settings. METHODS: Twenty-four patients with known bladder neoplasms from previous conventional cystoscopy were examined with CTVC. The urinary bladder was insufflated with room air and helical CT data were obtained. Virtual images were created using volume rendering algorithms. In eight patients we used both regular (240) and reduced (70) mAs values. The lesions were recorded on transverse tomographic slices and virtual images and compared with conventional cystoscopy, operative and pathology results. RESULTS: All bladder lesions (30) seen on conventional cystoscopy were demonstrated with CTVC. Two lesions detected on imaging studies and subsequently found at operation were not seen on conventional cystoscopy. In a third case of a neobladder, conventional cystoscopy was impossible due to neoplastic involvement of the penis. In all cases the lesions were equally conspicuous with conventional and low mAs values. CONCLUSIONS: Computed tomographic virtual cystoscopy is a minimally invasive technique that can provide comprehensive information about urinary bladder tumors. Furthermore, low mAs studies are equally effective for the examination of such patients.     

低辐射CT仿真膀胱镜诊断膀胱肿瘤的应用价值

目的：探讨低辐射CT仿真膀胱镜（低辐射CTVC）作为膀胱肿瘤的诊断和术后随访手段的临床应用价值。方法：2007年1月～2008年3月对68例血尿或膀胱肿瘤术后复发患者应用常规16排螺旋CT与管电流减半（120mA）的螺旋CT进行膀胱容积扫描,并利用“Fly Through”软件进行仿真膀胱镜检查。所有患者均进行膀胱B超和膀胱镜检查。以膀胱镜检查和病理检查作为诊断黄金标准,分别计算低辐射CTVC、B超两种无创诊断方法对膀胱肿瘤诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值、假阳性率、假阴性率,比较常规CT与低辐射CT的辐射剂量差异。结果：61例膀胱镜检查发现肿瘤的患者,低辐射CTVC检查均发现肿瘤,而B超发现其中的58例有肿瘤;低辐射CTVC检查的灵敏度为100％,特异度为71．43％,阳性预测值为96．83％,阴性预测值为100％,假阳性率为28．57％,假阴性率为0,准确度为97．06％,Kappa值=0．817。B超检查的灵敏度为95．08％,特异度为85．71％,阳性预测值为98．31％,阴性预测值为66．67％,假阳性率为14．29％,假阴性率为4．29％,准确度为94．12％,Kappa值=0．717。常规CT平均辐射吸收当量为17．4mSv,低辐射CT的平均辐射吸收当量为6．9mSv,差异有统计学意义（P〈0．05）。结论：低辐射CTVC对大于0．5cm膀胱肿瘤灵敏度达100％。对小于0．5cm膀胱肿瘤也能达到很高的灵敏度;低辐射CTVC适合于膀胱肿瘤患者早期诊断和长期随访检查。     

Virtual cystoscopy from computed tomography: a pilot study

OBJECTIVE: To assess the feasibility of virtual cystoscopy reconstructed from helical computed tomography (CT) obtained using an intravenous contrast agent, and to correlate the findings with flexible (FC) and rigid cystoscopy (RC) in patients with bladder tumours. PATIENTS AND METHODS: Eighteen patients (16 men and two women, mean age 72 years, range 59-80) with haematuria and found to have a bladder tumour on FC were included in a pilot study. Contrast-enhanced helical CT scans were taken and based on these datasets, virtual cystoscopy (VC) images were reconstructed by a radiologist unaware of the findings at cystoscopy. All patients had RC and a biopsy taken. The VC images were compared with the findings from FC and RC. RESULTS: At FC, VC and RC, 32, 34 and 36 lesions were identified, respectively; 33 (92%) of the abnormal lesions at RC were correctly identified at VC. At VC, all lesions of >4 mm were identified but only one of three <4 mm was seen. There were two false-positive finding at VC; VC correctly identified 17 (94%) of 18 abnormal bladders. Only 25% of the ureteric orifices were seen. Carcinoma in situ and urethral tumours were not visualized. CONCLUSION: CT-based VC has a high sensitivity for detecting bladder lesions and is comparable with FC; it may have a potential role as a single imaging tool for haematuria. Further larger studies are required to assess its clinical role.     

Virtual cystoscopy: the evaluation of bladder lesions with computed tomographic virtual cystoscopy

Purpose

Our objective was to assess the accuracy of computed tomographic virtual cystoscopy (CTVC) in the detection of urinary bladder lesions.

Methods

Twenty-five patients were examined using CTVC. Bladder scanned using multislice CT at a slice thickness of 1 mm. The data were transferred to a workstation for interactive navigation using surface rendering. Findings obtained from CTVC were compared with results from conventional cystoscopy and with pathological findings.

Results

Thirty-eight lesions were identified. The smallest was 0.2 × 0.3 cm; the largest was 7 × 4.5 cm. Both CTVC and conventional cystoscopy were used. Conventional cystoscopy detected the same number of lesions that were detected by CTVC. On morphological examination, 26 of the lesions were polypoid, 7 were sessile and 5 were bladder wall-thickening. While one of the polypoid lesions was reported as an inverted papilloma, 2 of the 5 lesions that were identified as wall-thickening were malignant and 3 were benign. The sensitivity of using CTVC to identify neoplasias was 100%; the accuracy was 89%.

Conclusion

Although the definitive diagnosis of some suspected urinary bladder tumours is only possible with conventional cystoscopy and biopsy, CTVC is a minimally invasive technique which provides beneficial information about urinary bladder lesions.     

The role of 3-dimensional sonography and virtual sonographic cystscopy in detection of bladder tumors

Introduction

Bladder cancer is the second most common genitourinary malignancy. Recent technological advances have led to the development of virtual endoluminal internal views similar to those obtained with conventional endoscopy (virtual cystoscopy).