多排螺旋CT对诊断膀胱癌的价值

目的：探讨联合应用多排螺旋CT（MDCT）多种后处理技术对诊断膀胱癌的不同价值，建立完善合理的膀胱癌CT检查程序.方法：对临床怀疑膀胱癌患者34例进行MDCT检查，在膀胱充分充盈后，行CT平扫和增强扫描（包括动脉晚期、平衡期、排泄期）.将不同时相的数据分别应用多平面重组（MPR）及仿真内窥镜（CTVE）等后处理方式顺序观察膀胱壁各部，分别记录病变的数目、位置、大小等.评价MDCT各种图像对膀胱肿瘤的检出情况.应用SAS软件对评价结果进行统计学分析.结果：34例膀胱癌患者于CT检查1周内手术，证实58枚肿瘤，其中2例并发输尿管癌.平扫MPR、动脉晚期/平衡期MPR、排泄期MPR、CTVE、联合平衡期MPR和CTVE五种方式对膀胱癌的检出率分别为70.7%、86.2%、89.7%、87.9%、100%.平扫MPR的检出率明显低于其他四种方式（P＜0.05）.平衡期MPR和CTVE两种图像相结合较其他四种方式具有更高的检出率（P＜0.05）.动脉晚期/平衡期MPR、排泄期MPR、CTVE三种方式对膀胱癌的检出率无统计学差异.结论：膀胱MDCT检查可不进行平扫和动脉期扫描，只行平衡期、排泄期检查，扫描范围应包括全部泌尿系统，并联合应用MPR与CTVE等后处理技术，是诊断、评价膀胱肿瘤可靠、无创的方法.

The Value of Multidetector Row CT in the Detection of Bladder Cancer

Objective:To investigate the value of various postprocessing techniques'in the detec- tion of bladder cancer by MDCT and to propose an improved protocol for CT examination in bladder cancer cases.Methods:MDCT,including unenhanced scans and contrast-enhanced scans(late artery- phase,equilibrium-phase,and excretory-phase),was performed with an adequately distended bladder for 34 patients who were clinically suspected of bladder cancer.On the MPR and CTVE images gener- ated from the volumetric data of the different phases,various locations of the bladder wall were ob- served in turn.The number,location,and size of the lesions were recorded.The interpretations of the MPR and CTVE images were compared.Results:All patients underwent surgery within 1 week after CT scanning,and 58 bladder cancers were found including two combined tumors of the ureter.The de- tection rate of unenhanced MPR,late artery-phase/equilibrium-phase MPR,excretory-phase MPR, CTVE,and the combination of MPR and CTVE images were 70.7%,86.2%,89.7%,87.9%,and 100%, respectively.The detection rate of unenhanced MPR was lower than that of the other means(P<0.05). The detection rate of the combined MPR and CTVE images was higher compared to that of the other methods(P<0.05).There was no significant difference in the detection rate among the late artery-phase/ equilibrium-phase MPR,excretory-phase MPR and CTVE images(P>0.05).Conclusion:For detecting bladder tumors,it is best to use CT examination that covers the entire urinary system.The combination of MPR and CTVE images generated from the equilibrium-phase and excretory-phase by MDCT data can provide comprehensive information for the detection of bladder cancer.