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目的:探讨低辐射CT仿真膀胱镜(低辐射CTVC)作为膀胱肿瘤的诊断和术后随访手段的临床应用价值。方法:2007年1月～2008年3月对68例血尿或膀胱肿瘤术后复发患者应用常规16排螺旋CT与管电流减半(120 mA)的螺旋CT进行膀胱容积扫描,并利用“F1y Through”软件进行仿真膀胱镜检查。所有患者均进行膀胱B超和膀胱镜检查。以膀胱镜检查和病理检查作为诊断黄金标准,分别计算低辐射CTVC、B超两种无创诊断方法对膀胱肿瘤诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值、假阳性率、假阴性率,比较常规CT与低辐射CT的辐射剂量差异。结果:61例膀胱镜检查发现肿瘤的患者,低辐射CTVC检查均发现肿瘤,而B超发现其中的58例有肿瘤;低辐射CTVC检查的灵敏度为100%,特异度为71.43%,阳性预测值为96.83%,阴性预测值为100%,假阳性率为28.57%,假阴性率为0,准确度为97.06%,Kappa值=0.817。B超检查的灵敏度为95.08%,特异度为85.71%,阳性预测值为98.31%,阴性预测值为66.67%,假阳性率为14.29%,假阴性率为4.29%,准确度为94.12%,Kappa值=0.717。常规CT平均辐射吸收当量为17.4 mSv,低辐射CT的平均辐射吸收当量为6.9 mSv,差异有统计学意义(P<0.05)。结论:低辐射CTVC对大于0.5 cm膀胱肿瘤灵敏度达100%。对小于0.5 cm膀胱肿瘤也能达到很高的灵敏度;低辐射CTVC适合于膀胱肿瘤患者早期诊断和长期随访检查。
Objective: To investigate the clinical value of low-radiation CT cystoscopy (low-radiation CTVC) as a diagnosis and postoperative follow-up of bladder cancer. Methods: From January 2007 to March 2008, 68 cases of postoperative recurrence of hematuria or bladder cancer were scored by volumetric scanning with conventional 16-slice spiral CT and spiral CT with half tube current (120 mA) Through "software for cystoscopy. All patients underwent bladder B and cystoscopy. Cystoscopy and pathological examination were used as the gold standard for diagnosis. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, false positive rate, False negative rate, comparing the radiation dose difference between conventional CT and low-radiation CT. Results: Tumors were found in 61 patients with cystoscopy and in low-radiation CTVC, and 58 of them were found by B-ultrasound. The sensitivity of low-radiation CTVC was 100% and the specificity was 71.43%. The positive predictive value The negative predictive value was 100%, the false positive rate was 28.57%, the false negative rate was 0, the accuracy was 97.06% and the Kappa value was 0.817. The sensitivity of B ultrasound was 95.08%, the specificity was 85.71%, the positive predictive value was 98.31%, the negative predictive value was 66.67%, the false positive rate was 14.29%, the false negative rate was 4.29% and the accuracy was 94.12% Value = 0.717. The average radiation absorption equivalent of conventional CT was 17.4 mSv, and the average radiation absorption equivalent of low-radiation CT was 6.9 mSv, the difference was statistically significant (P <0.05). Conclusion: The sensitivity of low-radiation CTVC to bladder tumors greater than 0.5 cm is 100%. For less than 0.5 cm bladder tumors can achieve high sensitivity; low-radiation CTVC suitable for early diagnosis of bladder cancer patients and long-term follow-up examination.