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。

Clinical study of CT virtual endoscopy in staging diagnosis of bladder tumors

OBJECTIVE: To evaluate CT virtual endoscopy (CTVE) based on spiral CT in the staging diagnosis of bladder neoplasms and its clinical application. METHODS: Forty patients with bladder neoplasms and 10 normal patients underwent volume scanning using spiral CT. All images with thin collimation and overlapping reconstruction were transferred to computer workstation to obtain the images of CTVE. The results of all CTVE findings were compared with those of conventional CT, cystoscopy, operation and pathological data. RESULTS: CTVE showed the normal anatomical structure of bladder as actual cystoscopy. The size, configuration, location and extension of bladder neoplasms was detected by CTVE scans agreed with that of actual cystoscopy. CTVE revealed the structure of trigone of urinary bladder that were not available in actual cystoscopy, and they were confirmed operatively and compared with the pathological results according to the TNM classification of malignant neoplasms. The sensitivity of CTVE for bladder tumors and accuracy in preoperative neoplasms staging was 98% (39/40) and 85% (33/39), respectively. The sensitivity of mass detection of diameter > or = 0.5 cm was 100%. The results were studied in a blind way. CONCLUSIONS: CTVE is a noninvasive, safe and reliable procedure in the staging diagnosis of bladder neoplasms. CTVE can well show bladder neck anatomy and serve as an important complementary method to conventional cystoscopy. The limitation of CTVE is that it can not observe change of mucosal appearances and perform biopsy.