增强CT鉴别诊断膀胱癌与腺性膀胱炎

目的 探讨增强CT鉴别诊断腺性膀胱炎（CG）与膀胱癌的价值。方法 对37例CG和41例膀胱癌患者行CT平扫及增强扫描，观察病灶位置、形态、大小（轴位最大径）、厚度、钙化、囊变坏死、边界、壁外浸润及区域淋巴结转移情况，测量病灶和正常膀胱壁动脉期、静脉期、延迟期CT值，计算病灶动脉期、静脉期、延迟期相对强化CT值。比较CG与膀胱癌定量及定性指标的差异，绘制ROC曲线，分析定量指标的鉴别诊断效能。结果 CG与膀胱癌病灶边界差异有统计学意义（P<0.01）；CG病灶动脉期、静脉期、延迟期CT值及相对强化CT值均低于膀胱癌（P均<0.01）。动脉期、静脉期相对强化CT值鉴别诊断CG和膀胱癌的AUC均高于其他指标（P均<0.01），而两者AUC差异无统计学意义（P=0.488）。以动脉期相对强化CT值=25.85 HU、静脉期相对强化CT值=26.85 HU为阈值鉴别诊断CG和膀胱癌的敏感度均为95.12%，特异度分别为91.89%、86.49%。结论 增强CT定量分析鉴别诊断CG和膀胱癌有一定价值。

Enhanced CT for differentiating cystitis glandular and bladder cancer

Objective To explore the value of enhanced CT in differential diagnosis of cystitis glandular (CG) and bladder cancer. Methods Totally 37 patients with CG and 41 patients with bladder cancer underwent CT plain and enhanced scanning. The location, form, size (maximum length of axis image), thickness, calcification, necrosis and cyst degeneration, the boundary of the lesions, the invasion of bladder wall and regional lymph node metastasis were observed. CT values of lesions and normal bladder wall in arterial phase, venous phase, and delayed phase were measured, and relative enhancement CT values of arterial phase, venous phase and delayed phase of the lesions were calculated. The differences of quantitative and qualitative indices between CG and bladder cancer were compared. ROC curve was applied to analyze the differential diagnosis efficacy of quantitative indices. Results There was statistically significant difference in the boundary of the lesions between CG and bladder cancer (P<0.01). CT values and the relative enhancement CT values of arterial phase, venous phase and delayed phase in CG patients were lower than those in bladder cancer patients (all P < 0.01). AUC of the relative enhancement CT values of the arterial phase and the venous phase in differential diagnosis of CG and bladder cancer were higher than the other indices (all P < 0.01), but there was no significant difference in AUC of the relative enhancement CT values of the arterial phase nor the venous phase (P=0.488). Taking relative CT value of arterial phase=25.85 HU, relative CT value of venous phase=26.85 HU as the thresholds, the sensitivity were both 95.12%, and the specificity were 91.89% and 86.49%, respectively. Conclusion Quantitative analysis of enhanced CT has great value in differential diagnosis of CG and bladder cancer.