低剂量CT尿路成像在小儿肾积水检查中的应用

doi:10.3877/cma.j.issn.1673-5250.2013.04.012

目的

探讨低剂量CT尿路成像(CTU)及后处理方法在小儿肾积水检查中的应用。

方法

选取2011年9月1日至2012年5月31日在本院就诊并经超声检查提示为肾积水患儿，且接受CTU检查者43例为研究对象，年龄为生后4个月～13岁。先行中下腹CT平扫，按肾积水程度分别制定CTU检查延时方案：轻度者肾排泄期延迟(5～10)min；中度延迟(30～90)min；重度则延迟(3～5)h。每例肾排泄期图像均进行多平面重组(MPR)及容积重建(VR)。由2位放射科医师对图像质量进行等级评分(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批准，并与受试对象监护人签署临床研究知情同意书)。

结果

本组43例肾积水患儿的肾积水程度，轻度为20例(46.51%)，中度为11例(25.58%)，重度为12例(27.91%)。轻度患儿图像质量平均分最高，且评优图像组内比例最高(80.00%)；重度组图像平均分最低，且评优图像组内比例最低(29.16%)，两者比较，差异有统计学意义(χ²＝17.599, P<0.001)。2位医师的评分一致性检验为优(κ＝0.811)。

结论

低剂量CTU可为小儿肾积水的诊断及手术治疗提供确切依据。

关键词: 螺旋CT, 尿路造影, 小儿, 肾积水

Objective

To study the scanning techniques of low-dose CT urography (CTU) and post-processing in children with hydronephrosis.

Methods

From September 2011 to May 2012, a total of 43 children with hydronephrosis, aged from 4-month-old to 13-year-old received CTU in our hospital. First, the abdominal plain CT scan was implement, then 43 cases were divided into three degrees according to degrees of hydronephrosis, mild, moderate and sever. Then CTU delay scan program was conducted according to different groups, renal excretion period of mild group delayed (5~10) min, moderate group delayed (30~90) min, severe group delayed (3~5) h. After scanning, the multiplanar reformation (MPR) and volume rendering (VR) for each case were carried out, with the original data of renal excretion period images on the post-processing workstation. Post-processing image rating score were measured by two physicians. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital. Informed consent was obtained from all participates.

Results

The degrees of hydronephrosis were below, 20 cases for mild group (46.51%), 11 cases for moderate group (25.58%), 12 cases for severe group (27.91%). The highest average score of post-processing CTU image was mild group, with the highest satisfaction of diagnosis (80.00%); and severe group with the minimum of images average and the lowest percentage of the appraised image (29.2%); the difference between mild group and severe group was statistically significant(χ²=17.599, P<0.001). Consistency test which was measured by two physicians was excellent (κ value was 0.811).

Conclusions

Low-dose CTU can provide accurate diagnostic basis for pediatric patients with hydronephrosis and surgical treatment.

Key words: spiral CT, urography, child, hydronephrosis

表1 肾积水不同程度图像评级评分结果[n(%)]

Table 1 Rating score results of different degree of hydronephrosis image[n(%)]

肾积水程度	n	优	良	差
轻度	40	32(80.00)	8(20.00)	0 (0.00)
中度	22	12(54.55)	8(36.36)	2 (9.09)
重度	24	7(29.16)	13(54.17)	4(16.67)

表1 肾积水不同程度图像评级评分结果[n(%)]

Table 1 Rating score results of different degree of hydronephrosis image[n(%)]

肾积水程度	n	优	良	差
轻度	40	32(80.00)	8(20.00)	0 (0.00)
中度	22	12(54.55)	8(36.36)	2 (9.09)
重度	24	7(29.16)	13(54.17)	4(16.67)

表2 两位医师评分结果一致性分析

Table 2 The consistency analysis of the results of the two physicians rated

?	?	乙			?
?	?	优	良	差	总计
甲	优	23	1	0	24
?	良	4	12	0	16
?	差	0	0	3	3
合计	?	27	13	3	43

表2 两位医师评分结果一致性分析

Table 2 The consistency analysis of the results of the two physicians rated

?	?	乙			?
?	?	优	良	差	总计
甲	优	23	1	0	24
?	良	4	12	0	16
?	差	0	0	3	3
合计	?	27	13	3	43

图1 超声提示重度肾积水，CT增强扫描示肾盂输尿管交界处梗阻(男性，11岁。A：注药60 s后扫描，经后处理得冠状面MPR图像；B，C：注药后3 h肾排泄期图像，经后处理得VR图像，后者进行去骨及图像立体旋转处理)

Figure 1 Ultrasound prompted severe hydronephrosis, CT enhanced scan shows ureteropelvic junction obstruction (male, 11 years old. A: Scan after 60 seconds delay, the post-processing coronal MPR image; B, C: 3 hours after injection, the renal excretion image , the post-processing VR image, which is boneless and three-dimensional image rotation processing)

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摘要

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Application of Low-Dose Computed Tomography Urography in Children With Hydronephrosis

模态框（Modal）标题

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Application of Low-Dose Computed Tomography Urography in Children With Hydronephrosis