静脉肾盂造影和CT尿路造影对泌尿系统疾病诊断价值的比较研究

目的 评估静脉肾盂造影(IVP)和多层螺旋CT尿路造影(MSCTU)对泌尿系统疾病的诊断价值.方法 检索Cochrane图书馆、PubMed、OVID、Embase数据库1990～2008年公开发表的英文文献,以及中国期刊网1998～2008年的中文文献,按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献,提取纳入研究的特征信息.对2种方法 进行异质性检验,并选择相应的效应模型对所有研究加权定量合并,计算汇总灵敏度和特异度及其95%可信区间.绘制汇总受试者工作特征曲线(SROC)并计算曲线下面积,进行敏感性分析.统计学分析采用Meta-Test和SPSS11.0软件.结果 按照纳入标准共获取文献13篇,其中有关MSCT诊断泌尿系统疾病者7篇,IVP为2篇,二者共同研究者4篇.2组研究均有异质性,但异质性均在允许范围内,按照随机效应模型对纳入文献行汇总分析.结果 显示, MSCTU与IVP扫描的汇总灵敏度和特异度及95%可信区间分别为0.95(0.93～0.96)/0.95(0.85～0.98)、0.94(0.91～0.96)/0.61(0.57～0.65);二者的SROC曲线下面积(%)分别为:98.88%和68.57%.结论 汇总分析MSCT平扫加尿路造影与IVP扫描诊断泌尿系统疾病的研究显示,前者的诊断价值明显高于后者.     

DCE-MRI对孤立性肺结节良恶性诊断价值的Meta分析

目的 采用Meta分析方法评价动态增强磁共振成像(DCE-MRI)对孤立性肺结节(SPN)良恶性的鉴别诊断价值.方法 计算机检索PubMed、EBSCO、Cochrane Library、Ovid、CBM、VIP、万方和CNKI数据库,检索关于DCE-MRI用来诊断SPN的中英文文献.按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究文献的特征信息.文献评价采用诊断研究评价工具QUADAS-2.数据采用Stata 12.0和Meta-Disc 1.4软件进行Meta分析,检验异质性和发表偏倚,根据异质性的结果选择相应效应量,计算汇总敏感度、特异度、阳性似然比、阴性似然比以及诊断比值比,绘制汇总受试者工作特征(SROC)曲线并计算曲线下面积(AUC).结果 共纳入17篇文献,包含了1255个病灶,Meta分析结果显示:DCE-MRI对SPN良恶性的诊断价值的汇总灵敏度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.95、0.81、4.9、0.06、85.SROC曲线AUC为0.97.结论 DCE-MRI对SPN良恶性的鉴别诊断具有较高的灵敏度和特异度,是一种诊断效能较高的影像学检查方法.     

CT动脉造影对肺动脉栓塞诊断价值的Meta分析

目的 对以肺动脉造影为金标准，研究CT肺动脉造影(CTPA)诊断肺动脉栓塞(PE)的文献进行Meta汇总分析，评价CTPA对PE的临床诊断价值。方法 检索Cochrane图书馆、PubMed，OVID数据库和中国期刊网中的英文和中文文献，按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献，并对纳入文献进行质量评估，提取纳入研究的特征信息。数据分析采用Meta-Test version0．9软件，检验异质性，并根据异质性结果选择相应的效应模型。对所有研究予以加权定量合并，计算灵敏度和特异度及其95％可信区间。绘制汇总受试者工作特征曲线(SROC)，并计算曲线下面积。最后进行敏感性分析。结果 共纳入10篇英文文献，其中7篇为A级，3篇为B级。研究对象共计855人，CTPA诊断PE的灵敏度的范围是0．57～1．00，特异度的范围是0．78～1．00。纳入研究存在异质性。按照随机效应模型计算汇总灵敏度和特异度及95％可信区间分别为0．84(0．73，0．91)和0．91(0．87，0．94)。SROC曲线下面积为94．95％。纳入文献稳定性好。结论 汇总目前关于CTPA诊断PE的研究显示，CTPA是一种灵敏度和特异度较高的无创性检查方法，还需要高质量的前瞻性研究以更准确地评价其临床价值。     

磁共振胰胆管造影对肝移植性胆道并发症诊断价值的META分析

目的 探讨磁共振胰胆管造影(MRCP)对于肝移植性胆道并发症的诊断效果.方法 检索PubMed、EBSCO、Cochrane Database Systematic Reviews)数据库、CNKI,筛查相关研究文献;运用QUSDAS-2工具对研究对象进行系统评价;提取纳入文献的真、假阳性数,真、假阴性数,进行异质性检测,合并统计量,绘制受试者工作特征曲线(SROC).结果 本研究共纳入文献11篇,纳入文献均表现较高质量,较低偏倚风险和临床适用性风险.合并灵敏度、特异度、阳性似然比、阴性似然比分别为0.96(95％ CI:0.94～0,98),0.94(95％ CI:0.90～0.97),9.90(95％ CI:6.08～16.12),0.06(95％ CI:0.03 ～0.09),257.19 (95％ CI:117.63～562.30).SROC下面积为0.98,Q指数为0.9431.结论 MRCP对于肝移植性胆道并发症诊断拥有较高灵敏度和特异度,可以作为肝移植性胆道并发症诊断的有效方法.     

尿路造影后立即做CT尿路成像诊断输尿管梗阻性病变

目的:在静脉尿路造影(IVU)无法明确输尿管梗阻原因时,评价多层螺旋CT(MSCT)泌尿系成像技术对输尿管梗阻病变的诊断价值。方法:40例经IVU显示为不明原因输尿管梗阻患者即刻接受MSCT平扫,将所得数据资料传至工作站,采用最大强度投影(MIP)、多平面重组(MPR)、曲面重组(CPR)、表面遮盖显示(SSD)或容积重组(VR)等后处理技术,重组泌尿系三维立体图像。结果:40例IVU无法明确输尿管梗阻原因患者中采用MSCT轴面结合三维重组图像能从多个角度清楚地显示尿路全程及其周围组织结构,并显示输尿管梗阻部位的状况,MSCT尿路造影(MSCTU)可很好地弥补IVU检查的不足。结论:与IVU比较,MSCTU图像清晰,对输尿管梗阻性病变有着很高的临床应用价值,可使输尿管病变诊断准确率得到明显提高。     

DWI与DCE-MRI联合应用对乳腺良恶性病变鉴别诊断价值的Meta分析

目的 运用Meta分析方法研究近几年在最新技术条件下扩散加权成像(DWI)与动态对比增强磁共振成像(DCE-MRI)联合应用对乳腺良恶性病变的鉴别诊断价值.方法 检索PubMed、EMbase、Web of Science、Cochrane图书馆、中国期刊网(CNKI)的英文和中文文献,按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究的特征信息.文献评价采用诊断研究评价工具QUADAS-2.数据分析采用Meta-DiSc1.4软件,检验异质性,并根据异质性结果选择相应的效应模型.对所有研究进行加权定量合并,计算汇总灵敏度(Se)、汇总特异度(Sp).绘制汇总受试者工作特征曲线(SROC),并计算曲线下面积(AUC).结果 纳入28项研究,共1 707例患者、1 857个病灶.28项研究存在异质性,按照随机效应模型计算汇总Se、汇总Sp分别为93％、88％,SROC的AUC为0.96.结论 DWI与DCE-MRI联合应用对乳腺良恶性病变的鉴别诊断具有很高的灵敏度和特异度,是一种诊断效能较高的检查方法.     

磁共振成像对膝关节前交叉韧带损伤诊断价值的Meta分析

目的:系统评价磁共振成像诊断前交叉韧带(ACL)损伤的临床价值。方法:全面收集1991年1月～2009年6月有关MRI诊断ACL损伤,以关节镜作为金标准,可直接或间接提取真阳性、假阳性、真阴性、假阴性值的诊断性研究。对纳入的研究进行质量评价及异质性检验,根据异质性结果选择相应效应模型,计算出汇总敏感度和特异度,绘出综合受试者操作特征曲线(SROC),并按照磁场强度对所纳入的研究进行亚组分析,比较亚组之间诊断准确率差异有无统计学意义。结果:共纳入文献34篇,采用随机效应模型进行汇总分析,汇总的诊断指标和SROC分析显示MRI诊断膝关节ACL损伤合并敏感度(SEN)、合并特异度(SPE)、合并阳性似然比(+LR)和合并阴性似然比(-LR)分别为93.6%、92.4%、8.467和0.090,SROC曲线下面积(AUC)为0.970 0。亚组分析结果:MRI磁场强度的高低对膝关节ACL损伤诊断准确性的差异无统计学意义(Z值为0.762 5,P值为0.777 1)。结论:当前证据表明,MRI是临床上诊断ACL损伤非常有效的方法;但是尚没有足够证据表明更高磁场强度MRI检查对膝关节ACL损伤具有更高的诊断价值。     

比较MSCTU与IVU诊断输尿管病变的价值

目的:比较多层螺旋CT尿路造影(MSCTU)与静脉尿路造影(IVU)诊断输尿管病变的价值。材料和方法:31例患者分别行腹部加压IVU及腹部加压MSCTU。将MSCTU获得的图像传输至独立工作站,并进行三维(3D)、最大密度投影(M IP)、多平面重组(MPR)、曲面重建(CPR)等技术处理。结果:MSCTU诊断符合率、肾脏显影率及输尿管梗阻扩张显示率分别比IVU高41.9%、16.1%和6.5%。结论:MSCTU诊断输尿管病变的诊断、判断肾功能和显示输尿管梗阻扩张程度均优于IVU。     

螺旋CT尿路造影和静脉尿路造影诊断泌尿系梗阻性的临床分析

目的探讨螺旋CT尿路造影(MSCTU)和静脉尿路造影(IVP)技术在泌尿系梗阻性疾病诊断中的效果。方法对40例泌尿系梗阻性疾病患者,均接受螺旋CT尿路造影和静脉尿路造影技术检查。结果 40例患者顺利完成检查,与病理结果比较,螺旋CT尿路造影检出25例泌尿系结石、5例肿瘤、6例尿路狭窄、4例输尿管畸形,诊断符合率为100.00%,静脉尿路造影检出19例泌尿系结石,1例肿瘤,1例尿路狭窄,4例输尿管畸形,诊断符合率为62.50%;螺旋CT尿路造影对梗阻性积水显示准确率100.00%,较对照组的80.00%显著提高,差异存在统计学意义(P0.05)。结论螺旋CT尿路造影诊断效果优于静脉尿路造影技术,从定位、定性不同角度观察病变部位及周边情况。     

CT尿路造影在泌尿系统疾病的诊断价值

目的：探讨IVU后CT尿路造影（CTU）在诊断泌尿系统疾病及评估IVU不显影肾的肾功能应用价值。方法：对IVU 120min单侧肾不显影或IVU显示泌尿系统形态结构异常，但不能确诊的60例作IVU后CT扫描。结果：CTU对IVU不显影或不能确诊的疾病做出明确诊断；对IVU不显影的梗阻肾的肾功能做出进一步评估。结论：IVU后CT尿路造影把IVU与CT结合为一体，可作为IVU的一种重要补充检查方法，具有重要的临床应用价值。     

CT urography and MR urography

CT urography and MR urography are an evolving concept and developing technique. As the technology matures, CT urography will combine the ultimate diagnostic capabilities of intravenous urography and CT. In the near future, many intravenous urograms will be replaced by CT urography to evaluate patients with hematuria and other genitourinary conditions. MR urography currently serves as an alternative imaging technique to intravenous urography and CT urography for children and pregnant women and for patients with contraindications to iodinated contrast media.     

CT urography

With the advent of multi-detector row CT scanners, evaluation of the urothelium of the entire urinary tract with high-resolution thin sections during a single breath-hold has become a reality. Multidetector CT urography (MDCTU) is a single examination that allows evaluation of potential urinary tract calculi, renal parenchymal masses, and both benign and malignant urothelial lesions. Initial results with this new technique are encouraging. Current investigations of MDCTU focus on methods to improve opacification and distension of the upper urinary tract-the collecting systems, pelvis, and ureters. The role of abdominal compression, infusion of saline and/or furosemide, and optimal time delay of excretory phase imaging is being explored. Upper tract urothelial malignancies, including small lesions less the 5 mm in diameter, can be detected with high sensitivity. Methods to reduce radiation exposure are being explored, including split-bolus contrast injection techniques that combine nephrographic and excretory phases into a single phase. It is likely that in the near future, radiological evaluation of significant unexplained hematuria or of known or prior urothelial malignancy will consist of a single examination—MDCTU.     

CT urography

With the advent of multi-detector row CT scanners, evaluation of the urothelium of the entire urinary tract with high-resolution thin sections during a single breath-hold has become a reality. Multidetector CT urography (MDCTU) is a single examination that allows evaluation of potential urinary tract calculi, renal parenchymal masses, and both benign and malignant urothelial lesions. Initial results with this new technique are encouraging. Current investigations of MDCTU focus on methods to improve opacification and distension of the upper urinary tract-the collecting systems, pelvis, and ureters. The role of abdominal compression, infusion of saline and/or furosemide, and optimal time delay of excretory phase imaging is being explored. Upper tract urothelial malignancies, including small lesions less the 5 mm in diameter, can be detected with high sensitivity. Methods to reduce radiation exposure are being explored, including split-bolus contrast injection techniques that combine nephrographic and excretory phases into a single phase. It is likely that in the near future, radiological evaluation of significant unexplained hematuria or of known or prior urothelial malignancy will consist of a single examination--MDCTU.     

Patient radiation dose at CT urography and conventional urography

PURPOSE: To measure and compare patient radiation dose from computed tomographic (CT) urography and conventional urography and to compare these doses with dose estimates determined from phantom measurements. MATERIALS AND METHODS: Patient skin doses were determined by placing a thermoluminescent dosimeter (TLD) strip (six TLD chips) on the abdomen of eight patients examined with CT urography and 11 patients examined with conventional urography. CT urography group consisted of two women and six men (mean age, 55.5 years), and conventional urography group consisted of six women and five men (mean age, 58.9 years). CT urography protocol included three volumetric acquisitions of the abdomen and pelvis. Conventional urography protocol consisted of acquisition of several images involving full nephrotomography and oblique projections. Mean and SD of measured patient doses were compared with corresponding calculated doses and with dose measured on a Lucite pelvic-torso phantom. Correlation coefficient (R(2)) was calculated to compare measured and calculated skin doses for conventional urography examination, and two-tailed P value significance test was used to evaluate variation in effective dose with patient size. Radiation risk was calculated from effective dose estimates. RESULTS: Mean patient skin doses for CT urography measured with TLD strips and calculated from phantom data (CT dose index) were 56.3 mGy +/- 11.5 and 54.6 mGy +/- 4.1, respectively. Mean patient skin doses for conventional urography measured with TLD strips and calculated as entrance skin dose were 151 mGy +/- 90 and 145 mGy +/- 76, respectively. Correlation coefficient between measured and calculated skin doses for conventional urography examinations was 0.95. Mean effective dose estimates for CT urography and conventional urography were 14.8 mSv +/- 90.0 and 9.7 mSv +/- 3.0, respectively. Mean effective doses estimated for the pelvic-torso phantom were 15.9 mSv (CT urography) and 7.8 mSv (conventional urography). CONCLUSION: Standard protocol for CT urography led to higher mean effective dose, approximately 1.5 times the radiation risk for conventional urography. Patient dose estimates should be taken into consideration when imaging protocols are established for CT urography.