현미경적 혈뇨의 원인 진단에 다검출기 CT를 이용한 요로조영술의 유용성 = Clinical Usefulness of Multi-Detector Computed Tomography inDiagnosis of Patients with Microscopic Hematuria

다국어 초록 (Multilingual Abstract)

Purpose: The number of patients with microscopic hematuria has increased for etiological reasons. The first diagnostic step for microscopic hematuria is usually intravenous pyelography (IVP). Nowadays, multi-detector computerized tomography urography (MDCT urography), which can evaluate the whole urinary tract, has been widely used. The objective of this study was to investigate the clinical usefulness of MDCT urography for diagnosis of microscopic hematuria in comparison with IVP.
Methods: 510 patients were selected randomly and underwent MDCT urography or IVP from October 2004 to September 2006 (MDCT 267 patients, IVP 243 patients).
Results: In 267 cases of MDCT urography, normal 158 (59%), simple renal cyst 75 (28%), renal stone 14 (5.3%), ureteral stone 8 (3%), and malignancy 7 (2.6%) (renal cell carcinoma 2, transitional cell carcinoma of ureter 2, bladder cancer 3) were detected. In 243 cases of IVP, normal 221 (91%), simple renal cyst 3 (1.2%), renal stone 4 (1.6%), ureteral stone 7 (2.9%), and malignancy 1 (0.4%) were detected. The detection rates of simple cyst, renal stone and urothelial carcinoma in MDCT urography were higher than those of IVP significantly (p<0.05), but the detection rate of ureteral stone between MDCT urography and IVP was not significantly different.
Conclusion: MDCT urography is a valuable modality for evaluation of patients with microscopic hematuria. It seems to have a high detection rate in simple renal cyst, renal stone, and urethelial carcinoma, although prospective studies for its efficacy are needed.

국문 초록 (Abstract)

목 적 : 현미경적 혈뇨는 여러 원인으로 발생하며 건강검진이 일반화되면서 환자가 증가하고 있다. 원인 진단의 첫 단계로 경정맥요로조영술 (IVP)이 시행되고 있으나, 최근 신장, 요로, 방광을 동시에 검사하기 위한 다검출기 CT (multi- detector computed tomography, MDCT)가 이용되고 있어 MDCT의 유용성을 평가하고자 하였다.
방 법 : 본 연구는 2004년 10월부터 2006년 9월까지 고립성 현미경적 혈뇨로 가톨릭대학교 성가병원 신장내과를 찾은 환자 510명을 무작위로 택하여 MDCT (267명)와 IVP (243명)를 실시하여 그 결과를 비교하였다.
결 과 : MDCT를 시행한 267명 중 정상 158명 (59%), 단순신낭종 75명(28%), 신결석 14명 (5.3%), 요로결석 8명 (3.0%), 비뇨상피종양 7명(2.6%)이였으며 7명의 악성종양은 각각 신세포암 2명, 요로이행상피암 2명, 방광암 3명이었다. IVP를 실시한 243명에서는 정상 221명 (91%), 단순신낭종 3명 (1.2%), 신결석 4명 (1.6%), 요로결석 7명 (2.7%), 비뇨상피종양 1명(0.4%)이었다. 요로결석의 빈도는 MDCT군과 IVP군 사이에 차이가 없었으며 단순 신낭종 및 요로상피종양의 빈도는 IVP군에 비해 유의하게 높았다 (p<0.05).
결 론 : 현미경적 혈뇨의 원인 진단 검사에 MDCT는 단일검사로서 유용하며, 특히 단순 신낭종, 신결석, 종양의 발견에 있어서 IVP에 비하여 상대적으로 높은 발견율을 보였다. 종양 발견 등의 중요성이 있으므로 향후 MDCT의 임상적 유용성 확립을 위해 다기관 전향적 공동연구가 필요하리라 사료된다.

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