診斷阻塞性無尿症,CT的效果最好

準確率95%,靈敏度100%

  2002年6月10日─6月份的《Urology》雜誌報導的一篇研究的結果顯示,非對比性電腦斷層成像(Noncontrast computed tomography,NCCT)診斷無尿症患者的輸尿管阻塞,準確率為95%,靈敏度為100%。而聯合採用KUB與超聲(US)的標準診斷方法,準確率僅為77%。

  埃及Mansoura大學的Ahmed A. Shokeir醫師,PhD及其同事寫道:「對於患有梗阻性無尿症的患者,傳統的KUB與US方法,不能辨別大約40%的患者輸尿管阻塞的原因。」

  作者比較了連續40位阻塞性無尿症的患者,以及與其年齡以及性別都匹配的對照組中,NCCT以及傳統診斷方法的效果。對照組包括同一研究時間內,連續57位因為急性後腰部疼痛,而進行KUB, US以及NCCT檢查的患者,採用他們的對側正常腎臟,作為對照。診斷阻塞原因的標準是進行或者不進行輸尿管鏡或者開放性手術的逆行或者順行輸尿管造影術。

  由於有8位患者雙側梗阻,32位患者單側梗阻,因此研究小組比較了48套腎臟系統。42例結石阻塞的腎臟系統中,NCCT確認了所有的結石的位置,而KUB與US聯合診斷,只確認了其中25例的位置。因此NCCT的靈敏度為100%,而標準方法的靈敏度僅為59.5%(P = 0.0001)。

  六例因其他原因的阻塞中,NCCT與US都診斷出了三例阻塞的原因。因此,NCCT總的靈敏度是94%,而KUB與US聯合治療的總靈敏度為58%(P = 0.0001)。儘管NCCT的特異度與KUB與US聯合治療的特異度無顯著性差異(分別為96.5%及93%),NCCT總體精確率為95%,而KUB與US聯合治療則為77%(P = 0.0003)。

  儘管在NCCT的結果解釋中,可能存在一些潛在的缺陷,但作者得出結論說:「這種可以診斷引起後腰部疼痛的很多種疾病的能力,仍然是NCCT的明顯優勢。」

CT Best for Diagnosing Obstructive Anuria

95% Accurate, 100% Sensitive

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

June 10, 2002 -- Noncontrast computed tomography (NCCT) was 95% accurate and 100% sensitive in diagnosing ureteral obstructions in anuric patients, according to results of a study in the June issue of Urology. The standard protocol of combined KUB and ultrasound (US) was only 77% accurate.

"In patients with obstructive anuria, conventional KUB and US could not identify the cause of ureteral obstruction in about 40% of the patients," write Ahmed A. Shokeir, MD, PhD, and colleagues from Mansoura University in Egypt.

The authors compared NCCT and standard workup in 40 consecutive patients with obstructive anuria with an age- and sex-matched control group. Controls included the normal contralateral kidneys of 57 consecutive patients who had KUB, US, and NCCT for acute flank pain during the same study period. The gold standard for diagnosing the cause of obstruction was retrograde or antegrade ureterography with or without ureteroscopy or open surgery.

Because obstruction was bilateral in 8 patients and unilateral in 32, the study group comprised 48 renal units. Of 42 renal units with calculus obstruction, the site of stone impaction was identified in all renal units by NCCT and in only 25 by combined KUB and US. Sensitivity was therefore 100% for NCCT and only 59.5% for standard workup (P = 0.0001).

Of the 6 renal units with obstruction from other causes, both NCCT and US diagnosed the cause of obstruction in 3. The overall sensitivity was therefore 94% for NCCT and 58% for combined KUB and US (P = 0.0001). Although the specificity of NCCT was not significantly different from that of combined KUB and US (96.5% vs. 93%, respectively), the overall accuracy was 95% for NCCT and 77% for combined KUB and US (P = 0.0003).

Despite potential pitfalls in the interpretation of NCCT, the authors conclude that "the ability to diagnose a wide range of disease entities that result in flank pain remains a distinct advantage of NCCT."

© 2002 WebMD Inc. All rights reserved.

    



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