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Galtung KF, Lauritzen PM, Sandbæk G, Bay D, Baco E, Rud E. Urinary stone assessment in a single-phase may replace the unenhanced and multiphase computed tomography protocol in painless visible haematuria. Scand J Urol 2024; 59:147-155. [PMID: 39268780 DOI: 10.2340/sju.v59.40679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Painless visible haematuria (VH) necessitates a computed tomography (CT) usually consisting of one unenhanced and two to three contrast enhanced acquisitions to detect urinary tract stones and malignancy. Recently, we demonstrated that a single nephrographic phase (NP) CT sufficed in detecting malignancy in patients with painless VH. Now, we aim to evaluate the diagnostic performance of single NP CT in stone detection and size measurements in the same cohort. MATERIAL AND METHODS "A Prospective Trial for Examining Haematuria using Computed Tomography" (PROTEHCT) was a single-center prospective diagnostic study in patients with painless VH between September 2019 and June 2021. All underwent four-phase CT (reference standard) from which a single NP CT (experimental) was extracted. Two randomised readers independently assessed the experimental CT for urinary stones and size. Statistical analysis included diagnostic accuracies and inter-reader agreement (kappa) of experimental CT, and size correlation (Spearman's ρ) between experimental CT and reference standard. RESULTS In 308 included patients (median age: 68 years, 250 males), urinary stones (median size 5 mm) were diagnosed in 21%. The per-patient experimental CT sensitivity was 86% (97% for stones ≥ 5 mm), specificity was 98% and accuracy was 96%. The experimental CT sensitivity for detecting kidney stones was 78% (89% for stones ≥ 5 mm), and 100% for bladder and ureteral stones. No missed stone required active treatment. The inter-reader agreement was almost perfect (96%, k = 0.85). The correlation in stone size was very strong (ρ = 0.91). Conclusions: A single NP CT is sufficient in detecting and measuring urinary stones in patients with painless VH.
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Affiliation(s)
- Kristina Flor Galtung
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Peter Mæhre Lauritzen
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Gunnar Sandbæk
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dag Bay
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Eduard Baco
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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Limaye W, Fenwick A, Mason R, Costa AF. Is the excretory phase necessary to identify upper tract urothelial neoplasms at CT urography? A 10-year population-based study. Abdom Radiol (NY) 2024; 49:2296-2304. [PMID: 38760531 DOI: 10.1007/s00261-024-04382-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE To assess the proportion of upper tract urothelial carcinomas (UTUC) that are evident without the excretory phase at CT urography (CTU), and the proportion of potentially avoidable radiation. METHODS UTUCs diagnosed between January 2008-December 2017 were retrospectively identified from a population-based cancer registry. For each patient, US, non-urographic CT, and MRI exams were assessed for a primary mass and secondary imaging findings (hydronephrosis, urinary tract thickening, luminal distention, fat stranding, and lymphadenopathy/metastatic disease). CTUs were assessed for primary and secondary findings, and whether the tumor was evident as a filling defect on excretory phase. The dose-length product (DLP) of potentially avoidable excretory phases was calculated as a fraction of total DLP. RESULTS 288 patients (mean age, 72±11 years, 165 males) and 545 imaging examinations were included. Of 192 patients imaged with 370 non-urographic CTs, a primary mass was evident in 154 (80.2%), secondary findings were evident in 172 (89.6%), and primary or secondary findings were evident in 179 (93.2%). Of 175 CTUs, primary and secondary findings were evident in 157 (89.7%) and 166 (94.9%) examinations, respectively, and primary or secondary findings were evident in 170/175 (97.1%). 131/175 (74.9%) UTUCs were evident as a filling defect, including the 5/175 (2.9%) UTUCs without primary or secondary findings. Of 144 CTUs with available DLP data, the proportion of potentially avoidable radiation was 103.7/235.8 (44.0%) Gy⋅cm. CONCLUSION In our population, almost all UTUCs were evident via primary or secondary imaging findings without requiring the excretory phase. These results support streamlining protocols and pathways.
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Affiliation(s)
- Warda Limaye
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Andrew Fenwick
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Ross Mason
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Victoria General Building, 5th floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
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Galtung KF, Lauritzen PM, Rud E. Reply to Fabio Zattoni, Fabrizio Dal Moro, Iliana Bednarova, and Giacomo Novara's Letter to the Editor re: Kristina F. Galtung, Peter M. Lauritzen, Gunnar Sandbæk, et al. Is a Single Nephrographic Phase Computed Tomography Sufficient for Detecting Urothelial Carcinoma in Patients with Visible Haematuria? A Prospective Paired Noninferiority Comparison. Eur Urol Open Sci 2023;55:1-10. EUR UROL SUPPL 2024; 61:54-55. [PMID: 38357532 PMCID: PMC10864753 DOI: 10.1016/j.euros.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
| | - Peter M. Lauritzen
- Department of Radiology, Oslo University Hospital, Oslo, Norway
- Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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Zattoni F, Dal Moro F, Bednarova I, Novara G. Re: Kristina F. Galtung, Peter M. Lauritzen, Gunnar Sandbæk, et al. Is a Single Nephrographic Phase Computed Tomography Sufficient for Detecting Urothelial Carcinoma in Patients with Visible Haematuria? A Prospective Paired Noninferiority Comparison. Eur Urol Open Sci 2023;55:1-10. EUR UROL SUPPL 2024; 61:52-53. [PMID: 38357531 PMCID: PMC10864751 DOI: 10.1016/j.euros.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Fabio Zattoni
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Iliana Bednarova
- Radiology Unit, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Giacomo Novara
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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Galtung KF, Lauritzen PM, Sandbæk G, Bay D, Ponzi E, Baco E, Cowan NC, Naas AM, Rud E. Computed tomography for visible haematuria - a single nephrographic phase is sufficient for detecting renal cell carcinoma. Scand J Urol 2024; 59:10-18. [PMID: 38226799 DOI: 10.2340/sju.v59.18467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/30/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES No previous studies have compared two computed tomography (CT) protocols in patients presenting with visible haematuria, and most patients undergo a multiphase CT in order to detect upper tract malignancies. We aimed to prospectively compare the diagnostic performance of single- and four-phase CT for detecting renal cell carcinoma (RCC) in patients with visible haematuria. MATERIALS & METHODS 'A Prospective Trial for Examining Hematuria using Computed Tomography' (PROTEHCT) was a single-centre prospective paired diagnostic study in patients referred for CT due to painless visible haematuria between September 2019 and June 2021. All patients underwent four-phase CT (control) from which a single nephrographic phase dual energy CT (experimental) was extracted. Both were independently assessed for RCC by randomised radiologists. Histologically verified RCC defined a positive reference standard. Follow-up ascertainment of RCC diagnosis was completed in May 2022. Descriptive statistics were used to calculate the accuracies. Inter-reader agreement was assessed by kappa statistics. RESULTS A total of 308 patients (median age, 68 years [interquartile range 53-77, range 18-96], 250 males) were included for analysis. RCC was diagnosed in seven (2.3%) patients during a median follow-up time of 19 months (interquartile range: 15-25). For the control and experimental CT, sensitivity was 100% versus 100%, specificity was 97% versus 98% and accuracy 97% versus 97%. The positive predictive value was 44% versus 50%, and the negative predictive value was 100% versus 100%. The agreement between the control and experimental CT was 98% (k = 0.79). CONCLUSION A single nephrographic phase dual energy CT is sufficient for detecting RCC in patients with visible haematuria.
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Affiliation(s)
- Kristina Flor Galtung
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
| | - Peter Mæhre Lauritzen
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Gunnar Sandbæk
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Dag Bay
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Erica Ponzi
- Department of Research Support for Clinical Trials, Clinical Trial Unit, Oslo University Hospital, Oslo, Norway; Oslo Center for Biostatistics and Epidemiology (OCBE), Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Eduard Baco
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway
| | | | | | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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