64排螺旋CT在小膀胱肿瘤诊断中的应用价值

目的 评价64排螺旋CT（64-MSCT）在小膀胱肿瘤诊断中的应用价值。 方法 采用64-MSCT对48例小膀胱肿瘤（直径≤1.5 cm）患者进行膀胱轴位平扫、动脉期、静脉期、延迟期增强扫描及图像多平面重建后处理，回顾性分析所获得的CT影像学资料。 结果 48例小膀胱肿瘤中，64-MSCT膀胱轴位平扫检出45例，检出率为93.75%，未检出3例，漏检率为6.25%，漏检病灶均＜0.5 cm；64-MSCT膀胱轴位平扫及动脉期、静脉期、延迟期增强扫描检出48例，检出率为100%。应用多平面重建后处理方法检查，有利于小膀胱肿瘤的定位，48例小膀胱肿瘤中，发生在膀胱壁44例、发生在膀胱憩室内4例。经手术及病理证实，48例小膀胱肿瘤中，膀胱原位癌2例、腺癌6例、移行上皮癌38例、乳头状瘤2例。小膀胱肿瘤的64-MSCT平扫表现为乳头状或菜花样小结节状软组织密度影，增强扫描表现为均匀、持续性强化。6例窄基底的带蒂病灶，64-MSCT均诊断为乳头状瘤，而病理诊断结果为乳头状瘤2例，移行上皮癌4例，64-MSCT误诊率为66.67%，表明64-MSCT对窄基底带蒂病灶的鉴别诊断存在一定难度。64-MSCT对诊断小膀胱肿瘤总的准确率为89.59%，误诊率为10.41%。 结论 64-MSCT基本能满足检出、诊断小膀胱肿瘤的要求，是一种无创伤地诊断小膀胱肿瘤较理想的方法。

Application value of 64 multi-detector helical CT for diagnosis of small bladder tumor

Objective To evaluate the application value of 64-multi detector spiral CT (64-MSCT)in the diagnosis of small bladder tumor. Methods Forty-eight patients with small bladder tumor(≤1.5 cm) were re-checked by bladder axial scans of 64-MSCT, arterial phase, venous phase, delayed phase enhancement scanning and multi planar reconstruction(MPR) reprocessing. CT imaging data were analyzed retrospectively. Results Among the 48 cases of small bladder tumor, 45 cases were detected through bladder axial scans of 64-MSCT, with the positive rate of 93.75%, and 3 cases were not detected, with the miss rate of 6.25%. While 48 cases were detected through bladder axial scans of 64-MSCT, arterial phase, venous phase and delayed enhancement scanning, the positive rate was 100%. The application of MPR reprocessing is favorable to the location of small bladder tumor. Among the 48 cases of small bladder tumor, 44 cases occurred on walls of urinary bladders, and 4 cases in vesical diverticulum. All the cases were confirmed by surgery and pathology. Among the 48 cases of small bladder tumour, 2 cases were demonstrated as carcinoma in situ, 6 cases as adenocarcinoma, 38 cases as transitional cell carcinoma, and 2 cases as papillary epithelioma. The signal intensities of small nodular soft tissues with the papillary or cauliflower-like structures were shown by axial scans of 64-MSCT, and uniform and constant reinforcement were appeared in delayed enhancement scanning. Six cases of narrow base pedunculated lesions were diagnosed as papillary epithelioma by 64-MSCT, while 2 cases were confirmed as papillary epithelioma, and 4 cases as transitional cell carcinoma by pathology. Four cases were misdiagnosed by 64-MSCT, with the misdiagnosis rate of 66.67%. There is some difficulty in differential diagnosis of 64-MSCT on narrow base pedunculated lesions. The accuracy rate of diagnosis of small bladder tumor by 64-MSCT was 89.59%, and the rate of misdiagnosis was 10.41%. Conclusion 64-MSCT can meet the needs of detection and diagnosis of small bladder tumor, and may be an ideal method for the non-invasive diagnosis of small bladder tumor.