1
|
Assessment of the ability of CT urography with low-dose multi-phasic excretory phases for opacification of the urinary system. PLoS One 2017; 12:e0174800. [PMID: 28384174 PMCID: PMC5383231 DOI: 10.1371/journal.pone.0174800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 03/15/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To prospectively evaluate the ability of CT urography with a low-dose multi-phasic excretory phase for opacification of the urinary system. Materials and methods Thirty-two patients underwent CT urography with low-dose multi-phasic s using adaptive iterative dose reduction 3D acquired at 5-, 10-, and 15-minute delays. Opacification scores of the upper urinary tracts and the urinary bladder were assigned for each excretory phase by two radiologists, who recorded whether adequate (>75%) or complete (100%) opacification of the upper urinary tract and urinary bladder was achieved in each patient. Adequate and complete opacification rates of the upper urinary tracts and the urinary bladder were compared among three excretory phases and among combined multi-phasic excretory phases using Cochran's Q test. Results There was no significant difference among three excretory phases with 5-, 10-, and 15-minute delays in adequate (56.3, 43.8, and 63.5%, respectively; P = 0.174) and complete opacification rates (9.3, 15.6, and 18.7%, respectively; P = 0.417) of the upper urinary tracts. Combined tri-phasic excretory phases significantly improved adequate and complete opacification rates to 84.4% and 43.8%, respectively (P = 0.002). In contrast, there were significant differences among three excretory phases for the rate of adequate (31.3, 84.4, and 93.8%, respectively; P<0.001) and complete opacification (21.9, 53.1, and 81.3%, respectively; P<0.001) of the urinary bladder. Multi-phasic excretory phases did not improve these rates because opacification was always better with a longer delay. Conclusion Although multi-phasic acquisition of excretory phases is effective at improving opacification of the upper urinary tracts, complete opacification is difficult even with tri-phasic acquisition.
Collapse
|
2
|
Sun H, Xue HD, Liu W, Wang X, Chen Y, Jin ZY. Effects of Saline Administration, Abdominal Compression, and Prolongation of Acquisition Delay on Image Quality Improvement of CT Urography. ACTA ACUST UNITED AC 2012; 27:201-6. [DOI: 10.1016/s1001-9294(13)60002-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
3
|
Seifert S, Mueller-Lisse U, Degenhart C, Jundt K, Mourched F, Stief C, Reiser M, Mueller-Lisse U. CT-Urographie bei Frauen mit primären oder rezidivierenden Beckentumoren. Radiologe 2011; 51:602-9. [DOI: 10.1007/s00117-011-2188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
4
|
Takeyama N, Ohgiya Y, Hayashi T, Takahashi T, Yoshiaki S, Takasu D, Nakashima J, Kato K, Kinebuchi Y, Hashimoto T, Gokan T. CT urography in the urinary bladder: to compare excretory phase images using a low noise index and a high noise index with adaptive noise reduction filter. Acta Radiol 2011; 52:692-8. [PMID: 21508198 DOI: 10.1258/ar.2011.100152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although CT urography (CTU) is widely used for the evaluation of the entire urinary tract, the most important drawback is the radiation exposure. PURPOSE To evaluate the effect of a noise reduction filter (NRF) using a phantom and to quantitatively and qualitatively compare excretory phase (EP) images using a low noise index (NI) with those using a high NI and postprocessing NRF (pNRF). MATERIAL AND METHODS Each NI value was defined for a slice thickness of 5 mm, and reconstructed images with a slice thickness of 1.25 mm were assessed. Sixty patients who were at high risk of developing bladder tumors (BT) were divided into two groups according to whether their EP images were obtained using an NI of 9.88 (29 patients; group A) or an NI of 20 and pNRF (31 patients; group B). The CT dose index volume (CTDI(vol)) and the contrast-to-noise ratio (CNR) of the bladder with respect to the anterior pelvic fat were compared in both groups. Qualitative assessment of the urinary bladder for image noise, sharpness, streak artifacts, homogeneity, and the conspicuity of polypoid or sessile-shaped BTs with a short-axis diameter greater than 10 mm was performed using a 3-point scale. RESULTS The phantom study showed noise reduction of approximately 40% and 76% dose reduction between group A and group B. CTDI(vol) demonstrated a 73% reduction in group B (4.6 ± 1.1 mGy) compared with group A (16.9 ± 3.4 mGy). The CNR value was not significantly different (P = 0.60) between group A (16.1 ± 5.1) and group B (16.6 ± 7.6). Although group A was superior (P < 0.01) to group B with regard to image noise, other qualitative analyses did not show significant differences. CONCLUSION EP images using a high NI and pNRF were quantitatively and qualitatively comparable to those using a low NI, except with regard to image noise.
Collapse
Affiliation(s)
- Nobuyuki Takeyama
- Department of Radiology, Showa University Fujigaoka Hospital, Yokohama
| | | | - Takaki Hayashi
- Department of Radiology, Showa University Fujigaoka Hospital, Yokohama
| | - Toshiyuki Takahashi
- Department of Radiological Technology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Suzuki Yoshiaki
- Department of Radiological Technology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Daisuke Takasu
- Department of Radiological Technology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Junya Nakashima
- Department of Radiological Technology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kyoichi Kato
- Department of Radiological Technology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yuko Kinebuchi
- Department of Radiology, Showa University Fujigaoka Hospital, Yokohama
| | - Toshi Hashimoto
- Department of Radiology, Showa University Fujigaoka Hospital, Yokohama
| | - Takehiko Gokan
- Department of Radiology, Showa University School of Medicine, Tokyo
| |
Collapse
|
5
|
Delineation of upper urinary tract segments at MDCT urography in patients with extra-urinary mass lesions: retrospective comparison of standard and low-dose protocols for the excretory phase of imaging. Eur Radiol 2010; 21:378-84. [DOI: 10.1007/s00330-010-1935-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/08/2010] [Accepted: 06/20/2010] [Indexed: 10/19/2022]
|
6
|
Washburn ZW, Dillman JR, Cohan RH, Caoili EM, Ellis JH. Computed Tomographic Urography Update: An Evolving Urinary Tract Imaging Modality. Semin Ultrasound CT MR 2009; 30:233-45. [DOI: 10.1053/j.sult.2009.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
7
|
Stacul F, Rossi A, Cova MA. CT urography: The end of IVU? Radiol Med 2008; 113:658-69. [DOI: 10.1007/s11547-008-0281-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 09/06/2007] [Indexed: 12/17/2022]
|
8
|
Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CCA, Takahashi S, Cohan RH. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol 2007; 18:4-17. [DOI: 10.1007/s00330-007-0792-x] [Citation(s) in RCA: 255] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 09/08/2007] [Accepted: 09/14/2007] [Indexed: 12/14/2022]
|
9
|
Roy C, Jeantroux J, Irani FG, Sauer B, Lang H, Saussine C. Accuracy of intermediate dose of furosemide injection to improve multidetector row CT urography. Eur J Radiol 2007; 66:253-61. [PMID: 17646072 DOI: 10.1016/j.ejrad.2007.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 05/09/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Evaluate the usefulness of intermediate dose furosemide to improve visualization of the intrarenal collecting system and ureter using MDCTU. MATERIALS AND METHODS Two groups of 100 patients without urinary tract disease or major abdominal pathology underwent MDCTU. Group I (various abdominal indications) was performed without any additional preparation and Group II (suspicion of urinary tract disease) 10 min after injection of furosemide (20mg). MIP images of the excretory phase were post-processed. Maximal short-axis diameter of the pelvis and ureter were measured on axial images for all phases. Visualization of the collecting system wall and the identification of the whole ureter were assessed. RESULTS Mean pelvic diameter before contrast was (7.4mm, S.D.+/-2.7; 13.4mm, S.D.+/-4.1), on cortico-medullary phase (8.4mm, S.D.+/-4.2; 14.3mm, S.D.+/-4), on nephrographic phase (8.1mm, S.D.+/-2.5; 14.8mm, S.D.+/-4) and on excretory phase (9.7 mm, S.D.+/-3.4; 14.9 mm, S.D.+/-4.5), respectively, for Groups I and II. Intrarenal collecting system wall was clearly identified on both corticomedullary and nephrographic phases in 91% of Group II against 20% of Group I. Opacification of the entire ureter was excellent on excretory phase in 96% of Group II against 13% of Group I. The difference between the mean values for the two groups was statistically significant for all phases (p<10(-9)). CONCLUSION Intermediate-dose furosemide (20mg) before MDCTU is a very simple add-on for accurate depiction of pelvicalyceal details and collecting system wall without artefacts. The procedure is associated with a constant and complete visualisation of the entire urete.
Collapse
Affiliation(s)
- Catherine Roy
- Department of Radiology B, Universitary Hospital of Strasbourg-Civil Hospital, 1, Place de l'Hopital BP 426, 67091 Strasbourg Cedex, France.
| | | | | | | | | | | |
Collapse
|
10
|
Cowan NC, Turney BW, Taylor NJ, McCarthy CL, Crew JP. Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour. BJU Int 2007; 99:1363-70. [PMID: 17428251 DOI: 10.1111/j.1464-410x.2007.06766.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate multidetector computed tomography urography (MDCTU) for diagnosing upper urinary tract (UUT) urothelial tumour by comparison with retrograde ureteropyelography (RUP). PATIENTS AND METHODS MDCTU and RUP were used in a selected series of adult patients presenting with haematuria. Entry criteria were based on findings on intravenous urography and were chosen to ensure a high prevalence of UUT urothelial tumour to allow a valid retrospective comparison of the diagnostic techniques. MDCTU and RUP studies were scored for the presence and absence of UUT urothelial tumour by two radiologists, retrospectively and independently, and while unaware of the demographic and clinical information. The reference standards were the histopathology and clinical follow-up. RESULTS MDCTU and RUP were used in 106 patients over a 24-month period. RUP was attempted in 151 of 212 UUTs; the corresponding MDCTU for each UUT was reviewed. MDCTU was a true-positive (TP) for urothelial tumour in 31, true-negative (TN) in 111, false-positive (FP) in eight and false-negative (FN) in one UUT, giving a sensitivity of 0.97, a specificity of 0.93, a positive predictive value (PPV) of 0.79 and a negative PV (NPV) of 0.99. RUP was technically successful and diagnostic in 96% of the UUTs (143/151). For diagnosing urothelial tumour, RUP was TP in 26, TN in 112, FP in four and FN in one UUT, giving a sensitivity of 0.97, specificity of 0.93, a PPV of 0.79 and NPV of 0.99. CONCLUSION This study validates quantitatively the use of MDCTU for diagnosing UUT urothelial tumour.
Collapse
Affiliation(s)
- Nigel C Cowan
- Department of Radiology, The Churchill Hospital, Oxford, UK.
| | | | | | | | | |
Collapse
|
11
|
Mueller-Lisse UG, Mueller-Lisse UL, Hinterberger J, Schneede P, Meindl T, Reiser MF. Multidetector-row computed tomography (MDCT) in patients with a history of previous urothelial cancer or painless macroscopic haematuria. Eur Radiol 2007; 17:2794-803. [PMID: 17404743 DOI: 10.1007/s00330-007-0609-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 11/10/2006] [Accepted: 02/02/2007] [Indexed: 11/24/2022]
Abstract
The sensitivity and specificity of MDCT for depiction and localization of urothelial carcinoma (UC) was determined retrospectively. Axial and coronal four-row MDCT of the urinary tract (unenhanced, contrast-enhanced nephrographic, CT urography) was independently reviewed for UC by a radiologist (R1) and a urologist (R2), without other patient information, in 27 patients (22 male, five female; age, 72 +/- 11 years) with previous UC and/or painless macroscopic haematuria. Urinary tract segments included bladder, right and left upper, middle, and lower caliceal groups, renal pelvis, uretero-pelvic junction, upper, middle, and lower ureter. MDCT findings were corroborated by surgery, other invasive procedures, and 1-year follow-up, including MDCT, intravenous urography, and cystoscopy. Receiver-operating characteristic analysis was undertaken and the the area under the curve (AUC) calculated. Eighteen of 27 patients had evidence of UC (pTa, n = 3; pT1-pT3, n = 15; TNM 2002). Tumor was correctly located by both R1 and R2 in 17 patients (sensitivity, 94%; 95% confidence interval, 84-100%) and ruled out in seven (specificity, 78%; 95% confidence interval, 51-100%), with complete agreement. Each detected ten of 11 upper urinary tracts affected by UC. For 35 urinary tract segments with UC and 308 without, the AUC was 0.910 +/- 0.035 (R1) and 0.74 +/- 0.055 (R2), z = 2.4772, Bonferroni-corrected P = 0.022. MDCT depicts urinary tracts affected by UC with high sensitivity and substantial agreement between readers with different training.
Collapse
Affiliation(s)
- Ullrich G Mueller-Lisse
- Department of Clinical Radiology, University of Munich, Ziemssenstrasse 1, 80336, Muenchen, Germany.
| | | | | | | | | | | |
Collapse
|
12
|
Coppenrath E, Meindl T, Herzog P, Khalil R, Mueller-Lisse U, Krenn L, Reiser M, Mueller-Lisse UG. Dose reduction in multidetector CT of the urinary tract. Studies in a phantom model. Eur Radiol 2006; 16:1982-9. [PMID: 16568267 DOI: 10.1007/s00330-005-0138-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 10/16/2005] [Accepted: 12/16/2005] [Indexed: 10/24/2022]
Abstract
A novel ureter phantom was developed for investigations of image quality and dose in CT urography. The ureter phantom consisted of a water box (14 cm x 32 cm x 42 cm) with five parallel plastic tubes (diameter 2.7 mm) filled with different concentrations of contrast media (1.88-30 mg iodine/ml). CT density of the tubes and noise of the surrounding water were determined using two multidetector scanners (Philips MX8000 with four rows, Siemens Sensation 16 with 16 rows) with varying tube current-time product (15-100 mAs per slice), voltage (90 kV, 100 kV, 120 kV), pitch (0.875-1.75), and slice thickness (1 mm, 2 mm, 3.2 mm). Contrast-to-noise ratio as a parameter of image quality was correlated with dose (CTDI) and was compared with image evaluation by two radiologists. The CT densities of different concentrations of contrast media and contrast-to-noise ratio were significantly higher when low voltages (90 kV versus 120 kV, 100 kV versus 120 kV) were applied. Smaller slice thickness (1 mm versus 2 mm) did not change CT density but decreased contrast-to-noise ratio due to increased noise. Contrast phantom studies showed favourable effects of low tube voltage on image quality in the low dose range. This may facilitate substantial dose reduction in CT urography.
Collapse
Affiliation(s)
- E Coppenrath
- Clinical Radiology, Ludwig-Maximilians University of Munich, Ziemssenstrasse 1, 80336, Munich, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Coppenrath EM, Mueller-Lisse UG. Multidetector CT of the kidney. Eur Radiol 2006; 16:2603-11. [PMID: 16568265 DOI: 10.1007/s00330-006-0212-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 01/22/2006] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
The technological development of multidetector CT offers new possibilities for better imaging of organic structures that can be used in diagnosis of the kidney. The thinner slices allow a better spatial resolution, and slice fusion allows improved contrast resolution. The isotropic voxel has been realized in the latest 64-channel scanners. The image quality of arbitrarily reconstructed planes has arrived at the image quality of the scan plane. Faster scanning allows studies in different contrast phases, which is helpful for better discrimination of benign or malignant lesions especially in the highly vascularized kidney. Different phases of contrast uptake can be differentiated (arterial, cortico-medullary, nephrographic, and excretory phase). Multidetector CT brings along the risk of increased dose due to thinner slice collimation and overranging phenomena. Indications for CT investigation of the kidney include urolithiasis, tumor diagnosis and staging, renal trauma, and vascular disease. Even in children, special indications for CT of the kidney remain in polytrauma and tumor staging. Multidetector CT of the kidney has become a very valuable tool in urology, but a careful protocol strategy is mandatory.
Collapse
Affiliation(s)
- E M Coppenrath
- Clinical Radiology, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
| | | |
Collapse
|