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目的采用诊断敏感性及ROC曲线评价多排螺旋CT泌尿系统造影常用三维重建方法诊断上尿路疾病的价值。方法前瞻性收集本院41例上尿路疾病患者,行多排螺旋CT泌尿系统造影(MDCTU)进行MPR、MIP以及VR重建。以金标准为对照,分别采用诊断敏感性指标及ROC曲线评价MDCTU、MPR、MIP及VR对上尿路疾病的诊断价值。结果①该41例患者共有49处上尿路病变。②MPR、MIP及VR对上尿路疾病的定位诊断敏感性分别为48/49(98.0%)、27/49(53.2%)及19/49(38.8%);定性诊断敏感性分别为47/49(95.9%)、17/49(34.7%)及13/49(26.5%);MPR与MIP、VR两者相比,其差异均有统计学意义(P<0.05)。③MPR、MIP及VR鉴别病变良恶性的ROC曲线下面积(AZ值)分别为0.998、0.736及0.669;MPR与MIP、VR两者相比,其差异也均有统计学意义(P<0.05)。④MPR与MDCTU有相同的诊断敏感性及Az值。结论多排螺旋CT泌尿系统造影常用的三维重建方法各有优缺点,其中以MPR的诊断效能最高,其与MDCTU相同,是诊断的基础;而MIP及VR立体感较强。由此可见,综合应用CTU中的三维重建方法对上尿路疾病的诊断及良恶性评估具有重要价值。
Objective To evaluate the value of diagnostic sensitivity and ROC curve in the diagnosis of upper urinary tract diseases by multi-slice spiral CT urography three-dimensional reconstruction. METHODS: Forty-one patients with upper urinary tract diseases were prospectively enrolled. Multiple-slice spiral CT urography (MDCTU) was performed for MPR, MIP and VR reconstruction. Using gold standard as control, the diagnostic sensitivity index and ROC curve were respectively used to evaluate the diagnostic value of MDCTU, MPR, MIP and VR in upper urinary tract diseases. Results ① The 41 patients had a total of 49 upper urinary tract lesions. ② The diagnostic sensitivity of MPR, MIP and VR in the diagnosis of upper urinary tract diseases were 48/49 (98.0%), 27/49 (53.2%) and 19/49 (38.8%), respectively. The sensitivity of qualitative diagnosis was 47/49 (95.9%), 17/49 (34.7%) and 13/49 (26.5%) respectively. There was significant difference between MPR and MIP and VR (P <0.05). (3) The area under the ROC curve (AZ value) of MPR, MIP and VR were 0.998, 0.766 and 0.669, respectively. The differences between MPR and MIP and VR were also statistically significant (P <0.05). ④ MPR and MDCTU have the same diagnostic sensitivity and Az value. Conclusions Multi-slice spiral CT urography three-dimensional reconstruction methods have their own advantages and disadvantages, of which the highest diagnostic efficiency of MPR, which is the same with MDCTU, is the basis of diagnosis; and MIP and VR stereo perception. Thus, the comprehensive application of three-dimensional CTU reconstruction method for the diagnosis of upper urinary tract diseases and benign and malignant evaluation of great value.