ABSTRACT
Objective To evaluate the clinical value of CT urography (CTU) in quantitative analysis of single?kidney renal glomerular filtration rate (GFR) in patients with renal tumor and hydronephrosis.Methods A total of 49 patients with renal tumor or hydronephrosis from January 2018 to September 2018 in the Second Hospital of Tianjin Medical University were prospectively collected. In all cases, the CT urography and 99mTc?DTPA renal dynamic imaging data and related clinical data were collected. All patients were divided into two groups: the experimental group (39 patients with a total of 78 kidneys) and the validation group (10 patients with a total of 20 kidneys). According to the presence or absence of renal diseases, the kidneys of the experimental group and the validation group were further divided into four groups, namely, the single kidney group, the tumor group, the stagnant water group and the healthy group. The CT urography protocol consisted of noncontrast, arterial phase, nephrographic, and excretory phase imaging. The total renal GFR was determined by CT measurement of renal clearance of contrast media (CM), and the total CT?GFR was then split into single?kidney CT?GFR by a left and right kidney proportionality factor. Differences between CT?GFR and SPECT?GFR measurements in each group of the experimental group was compared by paired?sample t test. Correlations between CT?GFR and SPECT?GFR in the experimental group and their correlations with RPV was analyzed by Pearson method. The Bland?Altman mapping method was used to evaluate the consistency between CT?GFR and SPECT?GFR in the experimental group. Results Paired difference between single?kidney CT?GFR (48.76 ± 18.50) ml·min-1·1.73 m-2 and single?kidney SPECT?GFR (45.68±17.95) ml·min-1·1.73 m-2 in the experimental group, P<0.05, demonstrating 6.8% systemic overestimation. A good correlation(r=0.80, P<0.01) and consistency (± 22.50 ml·min-1·1.73 m-2, ± 49.2% measurement deviations) was revealed between both measurements. There were positive correlations between CT?GFR and SPECT?GFR in the renal tumor group, hydronephrosis group, and healthy kidney group (r=0.67, 0.92, 0.80; P<0.01) respectively, and with good agreement (95% CI measurement deviation<30 ml·min-1·1.73 m-2). In all validation groups, there was no statistical difference between the estimated and true values of the Gates?GFR (all P>0.05). Pearson Correlation analysis showed that the correlations between CT?GFR and RPV in all experimental groups were better than the correlation between Gates?GFR and RPV (P<0.05). Conclusions This study demonstrated the feasibility of using CT urography to measure single?kidney GFR, verifying its application value in diseases such as kidney tumors and obstructive hydronephrosis, and proved that the proposed single?kidney CT?GFR correlates better than the SPECT?GFR with RPV.
ABSTRACT
Objective To evaluate the influence of the CT enterography (CTE) in different scan phases of small intesti?nal wall and arteriovenous vessels, and to confirm the diagnostic efficiency thereof. Methods A total of 286 patients under?went CTE were collected, and their CT image of three scan phases, including 20 s, 40 s and 60 s after injection, were record?ed. Values of reinforcement of the intestinal wall and arteriovenous enhancing degree in all phases were collected. A statisti?cal analysis was used to confirm the best phase for showing the structure. The diagnostic efficiency of the best phase of CT image was evaluated for the clinical diagnosis of small intestine and vascular lesions. Results (1) The CT value of the small intestinal wall in the intestinal phase was significantly higher than other two phases (Pintestinal phase, and there is no statistical difference between the intestinal phase and oth?er two phases. The result of CT value of ileum vein showed that intestinal phase>portal phase>arterial phase (P<0.05). (3) The sensitivity was 95.8%, the specificity was 94.9%, the accuracy was 95.1%, the positive predictive value was 79.3%and the negative predictive value was 99.1%using CT image of intestinal period for diagnosing small intestinal diseases. (4) The intestinal period showed small intestinal lesions and confirmed by pathology including 22 cases of small intestinal lympho?ma, 10 cases of stromal tumor, 1 case adenoma, cavernous 3 cases hemangioma and 8 cases of Crohn's disease. The diagno?sis of hemangioma should be combined with arterial phase. Conclusion Small intestinal wall and blood vessels have better display performance in the intestinal phase of multiphase CT enterography, using the arterial phase and intestinal phase scan?ning, we can make an accurate diagnosis for the majority of small intestinal diseases.
ABSTRACT
Objective To evaluate the efficacy of lumbar discectomy,radiofrequency ablation and annuloplusty performed with Disc-FX system under the guidance of C-arm in treatment of discogenic low back pain.Methods Twenty-eight patients with discogenic low back pain,with VAS score greater than 7,aged 27-73 yr,underwent lumbar discectomy,radiofrequency ablation and annuloplusty performed using Disc-FX system under the guidance of C-arm.The patients were followed up for 2 months after surgery and pain was assessed using VAS score.VAS scores were recorded before surgery,and at 7 and 14 days and 1 and 2 months after surgery.The effective analgesia was recorded according to VAS scores.The therapeutic effect was evaluated according to Macnab standard 2 months after surgery.Results VAS scores were significantly lower at each time point after surgery than before surgery (P ＜ 0.05).The rate of effective analgesia was 93 % at 2 months after surgery.The excellent and good rate of the therapeutic effect evaluated was 93 %.One female patient developed injury to lumbar venous plexus,and no patients developed infection of intervertebral disk,nerve root injury or spinal cord injury.Conclusion The excellent and good rate is 93 % when lumbar discectomy,radiofrequency ablation and annuloplusty performed using Disc-FX system is used for treatment of discogenic low back pain under the guidance of C-arm,with fewer side effects.