| Objective:Through the analysis of the results of CT scan enhanced spiral bladder cancer patients before row,and by enhancing the CT results made by the preoperative staging and postoperative pathologic staging of bladder cancer control,study the multi-detector helical CT in daily clinical work,more accurate clinical staging of bladder cancer patients in order to guide further treatment mode selection.To guide the choice of treatment methods for patients with bladder cancer,to analyze the factors influencing preoperative staging and to propose a reliable method to improve the accuracy of multi-detector helical CT staging.Materials and methods 1.Using the retrospective analysis method,for the period from February 2010 to January 2017 in the Second Affiliated Hospital of Dalian Medical University,Department of Urology,surgical treatment was confirmed by pathology of bladder cancer in parallel multi-detector helical CT enhanced scans of 106 patients enrolled in this study,84 cases were male,22 were female,aged 45-89 years(mean age 69±6.2 old).Single lesion was found in 73 cases(68.8%),and multiple lesions were found in 33 cases(31.2%),with a total of 154 foci.There were 57 cases of painless gross hematuria in the study group(n = 53.8%),and there were only 9 cases of urinary tract irritation(n = 8.3%),while those with hematuria and urinary tract irritation(n = 19.8%)(n = 21).There was no distant metastasis.2.Instrument: 64 slice spiral CT scanner(SIEMENS Flash CT).Methods: enhanced CT scan(1)Before the patient was examined for 8 hours,the 1.5-2h of drinking water before 1000-1500 ml was checked,and the patient’s bladder was filled.(2)From the lower edge of pubic symphysis to the xiphoid level,multi-detector helical CT scan for patients,distance and layer thickness were 5mm.(3)Scan again after enhanced CT scanning,with the range of.Injection of 80-90 ml ioversol contrast agent with 3.5-4.0ml/s velocity.Scanning parameters: layer thickness 5mm,tube current 300 mA,tube voltage 120-140 kv,scanning speed 0.5s/360 degrees.In quiet breathing and breath hold scan patients,injection of ioversol contrast agent 20-25 s after arterial phase enhanced scanning,60-90 s venous phase scanning,3-5min scanning after the balance period.3.To observe the CT image by two physicians older using blind method,the results of CT examination,diagnosis and analysis.If the results of the CT staging are inconsistent,then two radiologists will discuss the results together.Result:All 106 patients in this group were found to be at CT.In 154 cases,multi-detector helical CT for infringement of the bladder wall(more than T3)the staging accuracy rate is 82.3%,and for muscle invasive bladder cancer(T2)staging accuracy rate was 40.7%.The accuracy of staging of bladder cancer confined to the bladder mucosa(stage T1)was 57.8%,and the total accuracy rate of CT in preoperative staging of bladder cancer was 65.8%.The results showed that the preoperative staging of multi-detector helical CT was not correlated with the postoperative pathological stage.Conclusion: 1.The limitation on the bladder wall(less than T2b)in the tumor,CT staging accuracy.The invasion of the bladder wall(more than T3)outside of the tumor,it can provide more accurate staging.2.A variety of factors can affect the preoperative CT staging of bladder cancer patients,The CT staging of tumors with diameter of 1.0-1.9cm or greater than 4cm is more accurate than that of 2-4cm tumor staging.The accuracy of side wall staging was higher and the top wall was lower.The accuracy of tumor staging was higher than that of wide base tumors. |
PDF Full Text Request