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Choi MH, Lee SW, Pak S. Low-dose versus conventional CT urography using dual-source CT with different time-current product values and the same tube voltage: image quality and diagnostic performance in various diagnoses. Br J Radiol 2024; 97:399-407. [PMID: 38308025 DOI: 10.1093/bjr/tqad029] [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: 04/27/2023] [Revised: 10/05/2023] [Accepted: 11/14/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To compare the image quality and diagnostic performance of low-dose CT urography to that of concurrently acquired conventional CT using dual-source CT. METHODS This retrospective study included 357 consecutive CT urograms performed by third-generation dual-source CT in a single institution between April 2020 and August 2021. Two-phase CT images (unenhanced phase, excretory phase with split bolus) were obtained with two different tube current-time products (280 mAs for the conventional-dose protocol and 70 mAs for the low-dose protocol) and the same tube voltage (90 kVp) for the two X-ray tubes. Iterative reconstruction was applied for both protocols. Two radiologists independently performed quantitative and qualitative image quality analysis and made diagnoses. The correlation between the noise level or the effective radiation dose and the patients' body weight was evaluated. RESULTS Significantly higher noise levels resulting in a significantly lower liver signal-to-noise ratio and contrast-to-noise ratio were noted in low-dose images compared to conventional images (P < .001). Qualitative analysis by both radiologists showed significantly lower image quality in low-dose CT than in conventional CT images (P < .001). Patient's body weight was positively correlated with noise and effective radiation dose (P < .001). Diagnostic performance for various diseases, including urolithiasis, inflammation, and mass, was not different between the two protocols. CONCLUSIONS Despite inferior image quality, low-dose CT urography with 70 mAs and 90 kVp and iterative reconstruction demonstrated diagnostic performance equivalent to that of conventional CT for identifying various diseases of the urinary tract. ADVANCES IN KNOWLEDGE Low-dose CT (25% radiation dose) with low tube current demonstrated diagnostic performance comparable to that of conventional CT for a variety of urinary tract diseases.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Seongyong Pak
- Siemens Healthineers Ltd, Seoul 06620, Republic of Korea
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Galluzzo A, Danti G, Bicci E, Mastrorosato M, Bertelli E, Miele V. The role of Dual-Energy CT in the study of urinary tract tumours: review of recent literature. Semin Ultrasound CT MR 2023; 44:136-144. [DOI: 10.1053/j.sult.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Eusebi L, Masino F, Gifuni R, Fierro D, Bertolotto M, Cova MA, Guglielmi G. Role of Multiparametric-MRI in Bladder Cancer. CURRENT RADIOLOGY REPORTS 2023. [DOI: 10.1007/s40134-023-00412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Abstract
Purpose of Review
This narrative review article aims to show the actual role of imaging, in particular MRI, and the role of VI-RADS Score, in recognition and follow-up of the tumor.
Recent Findings
A team of professionals created VI-RADS with the goal of standardizing the acquisition and interpretation of multiparametric-MRI in bladder cancer.
Summary
Bladder cancer is the most common cancer involving the urinary system. It is the fourth most common urological cancer in men and the second most frequent cancer affecting the urinary tract. Main risks factors are advanced age, male sex, and cigarette smoking. Bladder cancer ranges from unaggressive and usually non-invasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. At the time of diagnosis, 70% of patients are experiencing non-muscle-invasive bladder cancer. Vesical imaging-reporting and data system score (VI-RADS) is a scoring system useful to standardize the approach to multiparametric-MRI interpretation, and reporting for bladder cancer.
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Bicci E, Mastrorosato M, Danti G, Lattavo L, Bertelli E, Cozzi D, Pradella S, Agostini S, Miele V. Dual-Energy CT applications in urinary tract cancers: an update. TUMORI JOURNAL 2022; 109:148-156. [PMID: 35442120 DOI: 10.1177/03008916221088883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Urothelial tumours are the fourth most common cancer in the world and account for the majority of tumours involving the bladder. The symptom that often leads to diagnosis is the presence of haematuria. Diagnosis is made by cystoscopy, which is currently the gold standard in bladder cancer. Computed tomography (CT) performed with pre- and post-contrastographic phases is essential in order to assess the loco-regional and distant extension of disease. The diagnosis and staging of upper tract urothelial cancer (UTUC) are best done with computed tomography urography and flexible ureteroscopy (URS). In the acquisition protocol of this type of tumour, a urographic phase is mandatory, which allows for an accurate diagnostic assessment of the renal pelvis, ureter and bladder, especially in papillary forms. The use of multiple acquisition phases, especially in this type of patient who will have to perform follow-up CTs, leads to the problem of overexposure to ionising radiation, as well as the frequent administration of iodinated contrast medium. For this reason, in recent year, the focus has been put on advanced technologies such as dual-energy CT (DECT), that is a method that can offer some advantages for both radiologist and patient, in the diagnosis of cancer and, in particular, urinary tract disease.
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Affiliation(s)
- Eleonora Bicci
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | | | - Ginevra Danti
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Lorenzo Lattavo
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Elena Bertelli
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Diletta Cozzi
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
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Xu Y, Ma X, Ai X, Gao J, Liang Y, Zhang Q, Ma T, Mao K, Zheng Q, Wang S, Jiao Y, Zhang X, Li H. A Urine-Based Liquid Biopsy Method for Detection of Upper Tract Urinary Carcinoma. Front Oncol 2021; 10:597486. [PMID: 33634022 PMCID: PMC7901537 DOI: 10.3389/fonc.2020.597486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background Conventional clinical detection methods such as CT, urine cytology, and ureteroscopy display low sensitivity and/or are invasive in the diagnosis of upper tract urinary carcinoma (UTUC), a factor precluding their use. Previous studies on urine biopsy have not shown satisfactory sensitivity and specificity in the application of both gene mutation or gene methylation panels. Therefore, these unfavorable factors call for an urgent need for a sensitive and non-invasive method for the diagnosis of UTUC. Methods In this study, a total of 161 hematuria patients were enrolled with (n = 69) or without (n = 92) UTUC. High-throughput sequencing of 17 genes and methylation analysis for ONECUT2 CpG sites were combined as a liquid biopsy test panel. Further, a logistic regression prediction model that contained several significant features was used to evaluate the risk of UTUC in these patients. Results In total, 86 UTUC− and 64 UTUC+ case samples were enrolled for the analysis. A logistic regression analysis of significant features including age, the mutation status of TERT promoter, and ONECUT2 methylation level resulted in an optimal model with a sensitivity of 94.0%, a specificity of 93.1%, the positive predictive value of 92.2% and a negative predictive value of 94.7%. Notably, the area under the curve (AUC) was 0.957 in the training dataset while internal validation produced an AUC of 0.962. It is worth noting that during follow-up, a patient diagnosed with ureteral inflammation at the time of diagnosis exhibiting both positive mutation and methylation test results was diagnosed with ureteral carcinoma 17 months after his enrollment. Conclusion This work utilized the epigenetic biomarker ONECUT2 for the first time in the detection of UTUC and discovered its superior performance. To improve its sensitivity, we combined the biomarker with high-throughput sequencing of 17 genes test. It was found that the selected logistic regression model diagnosed with ureteral cancer can evaluate upper tract urinary carcinoma risk of patients with hematuria and outperform other existing panels in providing clinical recommendations for the diagnosis of UTUC. Moreover, its high negative predictive value is conducive to rule to exclude patients without UTUC.
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Affiliation(s)
- Yansheng Xu
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Urology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xing Ai
- Department of Urology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiangping Gao
- Department of Urology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yiming Liang
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Qin Zhang
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Tonghui Ma
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Kaisheng Mao
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Qiaosong Zheng
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Sizhen Wang
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Yuchen Jiao
- State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Zhang
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongzhao Li
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Split-bolus injection protocol with optimized timings of contrast medium injection and CT scanning for 3D CT angio-venography before laparoscopic gastrectomy. Jpn J Radiol 2020; 39:395-403. [PMID: 33222108 DOI: 10.1007/s11604-020-01069-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To propose an optimization method of contrast medium injection for the split-bolus protocol based on the contrast medium pharmacokinetics and investigate the utility of the optimized split-bolus protocol in 3D CT angio-venography for laparoscopic gastrectomy. MATERIALS AND METHODS A pharmacokinetic relationship between injection duration and time to the peak enhancement was taken into account in the protocol design. The first 20 consecutive patients underwent a multi-phase scan with a single-bolus injection (single-bolus protocol), and the next 20 underwent the proposed split-bolus protocol. CT attenuations of the arteries and veins and dose-length products (DLPs) were compared between the two protocols. Two radiologists visually assessed arterial and venous depictions and the misregistrations. RESULTS Mean arterial CT attenuations were not significantly different between the two protocols. Though mean venous CT attenuations for the split-bolus protocol were 7-11% lower than those of the single-bolus protocol, they were visually evaluated as similar. The mean DLP of the split-bolus protocol was 46% lower than that of the single-bolus protocol. Misregistration between the arteries and veins occurred 35-80% during the single-bolus protocol, but was not indicated in the split-bolus protocol. CONCLUSION The split-bolus protocol with optimized timing was more effective for providing improved image quality with reduced radiation dose compared with the single-bolus protocol in 3D CT angio-venography for laparoscopic gastrectomy.
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Je H, Lee SK, Jung JW, Jang Y, Chhoey S, Choi J. Split-bolus CT urography with synchronous nephrographic and excretory phase in dogs: comparison of image quality with three-phase CT urography and optimal allocation ratio of contrast medium. J Vet Sci 2020; 21:e55. [PMID: 32735093 PMCID: PMC7402936 DOI: 10.4142/jvs.2020.21.e55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Computed tomography urography (CTU), based on the excretion of contrast medium after its injection, allows visualization of the renal parenchyma and the renal collecting system. OBJECTIVES To determine the optimal contrast medium dose allocation ratio to apply in split-bolus CTU in dogs. METHODS This prospective, experimental, exploratory study used 8 beagles. In 3-phase CTU, unenhanced-, nephrographic-, and excretory-phase images were obtained with a single injection of 600 mg iodine/kg iohexol. In split-bolus CTU, two different contrast medium allocation ratios (30% and 70% for split CTU 1; 50% and 50% for split CTU 2) were used. Unenhanced phase image and a synchronous nephrographic-excretory phase image were acquired. RESULTS Although the attenuation of the renal parenchyma was significantly lower when using both split CTUs than the 3-phase CTU, based on qualitative evaluation, the visualization score of the renal parenchyma of split CTU 1 was as high as that of the 3-phase CTU, whereas the split CTU 2 score was significantly lower than those of the two others. Artifacts were not apparent, regardless of CTU protocol. The diameter and opacification of the ureter in both split CTUs were not significantly different from those using 3-phase CTU. CONCLUSIONS Split-bolus CTU with a contrast medium allocation ratio of 30% and 70% is feasible for evaluating the urinary system and allows sufficient enhancement of the renal parenchyma and appropriate distention and opacification of the ureter, with similar image quality to 3-phase CTU in healthy dogs. Split-bolus CTU has the advantages of reducing radiation exposure and the number of CT images needed for interpretation.
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Affiliation(s)
- Hyejin Je
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Sang Kwon Lee
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Jin Woo Jung
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Youjung Jang
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Saran Chhoey
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea.
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Utilization and Yield of CT Urography: Are the American Urological Association Guidelines for Imaging of Patients With Asymptomatic Microscopic Hematuria Being Followed? AJR Am J Roentgenol 2020; 216:106-110. [PMID: 32755213 DOI: 10.2214/ajr.20.22998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this study were to determine whether patients with asymptomatic microscopic hematuria undergoing CT urography (CTU) meet the American Urological Association criteria for radiologic evaluation and to determine the yield of CTU for upper tract malignancy. MATERIALS AND METHODS A retrospective review was conducted of consecutive CTU examinations performed for asymptomatic microscopic hematuria in adult patients. Patients with clinical evidence suggestive of a benign cause of hematuria (stone, urinary tract infection, trauma) or prior urologic malignancy were excluded. The study group included 419 patients (173 men, 246 women). CT reports were reviewed to identify causes of hematuria in all cases. Evaluate for appropriateness was conducted with 200 randomly allocated patients. Urinalysis results were reviewed, and appropriate use of CTU was defined as more than 3 RBCs per high-power field in the absence of urinary tract infection. Cystoscopy results after CTU were noted. RESULTS In total, 58 of 200 patients (29.0%; 95% CI, 23.2-35.6%) did not meet American Urological Association criteria for radiologic evaluation. Fifteen (7.5%) received dipstick analysis only. Thirty-eight (19.0%) had urinalysis results showing 0-2 RBCs per high-power field. Five patients (2.5%) were found to have urinary tract infections. No upper tract urothelial neoplasms were identified (0/419; 95% CI, 0.0-0.9%). One solid renal mass was identified without pathologic confirmation. One possible bladder mass was seen at CTU but not visualized at subsequent cystoscopy. CONCLUSION In 29.0% of examinations, CTU is performed for patients who do not meet the criteria for radiologic evaluation. The yield of CTU for upper urinary tract malignancy is low.
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Azam A, Rottenberg G. Multimodality Imaging Findings Postcystectomy: Postoperative Anatomy, Surgical Complications, and Surveillance Imaging. Semin Ultrasound CT MR 2020; 41:392-401. [PMID: 32620229 DOI: 10.1053/j.sult.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Various surgical techniques exist for urinary diversion post cystectomy and each have different imaging features. This diverse range of surgical procedures can make imaging interpretation difficult and so familiarity with the postoperative anatomy is essential. Multiple imaging modalities and techniques are available for the radiologist's assessment including fluoroscopic studies, computed tomography, magnetic resonance, and radionuclide imaging. Knowledge of when each of these modalities is indicated and the typical imaging appearances is essential for early identification of postoperative complications and detection of tumor recurrence. This information enables the radiologist to make an accurate and early diagnosis and subsequently guide the management pathway for these patients.
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Affiliation(s)
- Aishah Azam
- Department of Radiology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Giles Rottenberg
- Department of Radiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
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Kim C, Lee SK, Je H, Jang Y, Jung JW, Choi J. Assessment of a split-bolus computed tomographic enterography technique for simultaneous evaluation of the intestinal wall and mesenteric vasculature of dogs. Am J Vet Res 2020; 81:122-130. [PMID: 31985284 DOI: 10.2460/ajvr.81.2.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the diagnostic usefulness of split-bolus CT enterography in dogs. ANIMALS 6 healthy Beagles. PROCEDURES CT enterography was performed in all dogs in a nonrandomized crossover study design involving 3 techniques: a dual-phase technique and 2 techniques involving splitting of the administered contrast agent dose (ie, split technique and split-bolus tracking technique). For the 2 techniques involving dose splitting (ie, split CT enterography), contrast agent was injected twice, with the first injection consisting of 60% of the total dose, followed by injection of the remaining 40%. Then, a single set of CT images was obtained when the arterial and venous phases matched (dual-phase and split techniques) or when enhancement of the abdominal aorta reached 100 HU (split-bolus tracking technique). Enhancement of the intestinal wall and mesenteric vessels was assessed qualitatively and quantitatively. RESULTS The total number of images required for interpretation was significantly lower for the split technique than for the dual-phase technique. The amount of time needed to complete CT enterography was significantly less for the split-bolus tracking technique than for the other 2 techniques. For all 3 techniques, adequate contrast enhancement of the mesenteric vessels and intestinal wall was achieved. The split technique provided contrast enhancement of the intestinal wall and mesenteric vessels similar to that provided with the dual-phase technique, whereas contrast enhancement of these structures was lowest for the split-bolus tracking technique. CONCLUSIONS AND CLINICAL RELEVANCE Split-bolus CT enterography at a contrast agent allocation ratio of 60:40 enabled simultaneous evaluation of the enhanced intestine wall and mesenteric vessels and yielded image quality similar to that of dual-phase CT enterography in healthy dogs.
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Leung VJ, Godfrey EM, Biddle DJ, Al-Khatib A. Split-bolus single-pass CT for vascular complications in acute pancreatitis: assessment of radiation dose and multi-phasic contrast enhancement compared to single-bolus multi-pass CT. Clin Radiol 2020; 75:644.e1-644.e6. [PMID: 32560906 DOI: 10.1016/j.crad.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
AIM To assess vascular contrast enhancement and radiation dose of split-bolus single-pass computed tomography (CT) compared to single-bolus multi-pass CT for acquiring a multi-phasic study. MATERIALS AND METHODS Patients who underwent CT for acute pancreatitis were included retrospectively. Thirty consecutive patients scanned with a split-bolus protocol were compared to 30 consecutive patients scanned with a single-bolus protocol. Data were collected on attenuation measurements (aorta, portal vein and spleen) and images were assessed for subjective vascular enhancement quality and splenic homogeneity. Radiation dose was measured by dose-length product (DLP). RESULTS There was no significant difference in the aortic (p = 0.88) or portal vein (p = 0.35) attenuation values between the two groups. The percentage of examinations reaching the target aortic and portal attenuation in the split-bolus group were 96.7% and 93.3%, and in the single-bolus group were 96.7% and 85.7%, respectively. The mean DLP was 492 mGy.cm for the single-bolus group and 940 mGy.cm for the split-bolus group (p < 0.0001). Subjective assessment revealed higher rates of splenic heterogeneity in the split-bolus group. DISCUSSION In acute pancreatitis, split-bolus imaging can produce arterial and venous enhancement comparable to a multi-pass technique with a significant reduction in radiation dose. Loss of temporal resolution and increased splenic heterogeneity are the main disadvantages. The low prevalence of pseudoaneurysms favours the lower-dose imaging technique.
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Affiliation(s)
- V J Leung
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - E M Godfrey
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - D J Biddle
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - A Al-Khatib
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
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Gershan V, Homayounieh F, Singh R, Avramova-Cholakova S, Faj D, Georgiev E, Girjoaba O, Griciene B, Gruppetta E, Hadnadjev Šimonji D, Kharuzhyk S, Klepanec A, Kostova-Lefterova D, Kulikova A, Lasic I, Milatovic A, Paulo G, Vassileva J, Kalra MK. CT protocols and radiation doses for hematuria and urinary stones: Comparing practices in 20 countries. Eur J Radiol 2020; 126:108923. [DOI: 10.1016/j.ejrad.2020.108923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
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Manoharan D, Sharma S, Das CJ, Kumar R, Kumar P. Split bolus dual-energy CT urography after urine dilution: a one-stop shop for detection and characterisation of urolithiasis. Clin Radiol 2020; 75:643.e11-643.e18. [PMID: 32345438 DOI: 10.1016/j.crad.2020.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
AIM To determine the diagnostic performance of split-bolus dual-energy computed tomography (CT) urography (SBDECTU) in the detection and characterisation of urolithiasis. MATERIALS AND METHODS This single-centre Institute Ethics Committee (IEC)-approved prospective study was conducted from April 2014 to November 2015. One hundred and thirty consenting adults with microscopic haematuria underwent dual-energy true non-enhanced CT (DETNE) of the whole abdomen followed by a SBDECTU. The SBDECTU protocol consisted of synchronous nephrogram-urogram acquisition following urine dilution by oral hydration and normal saline injection. Calculi were detected and characterised using virtual non-enhanced (VNE) images derived from SBDECT were compared with DETNE (the reference standard). The subjective image quality and radiation dose were compared. RESULTS Twenty-six participants had one or more calculi (total 129 calculi) detected on DETNE CT. The sensitivity and specificity of VNE on a per-patient basis were 100%. Of the 129 calculi, 118 were detected on VNE, with a sensitivity of 91.47% and an accuracy of 91.47%. Of the calculi, 83.9% (99/118) could be characterised on SBDECTU images. On VNE images, complete iodine subtraction was seen in 73.1% (19/26). By omitting DETNE CT, the mean dose-length product of 537.6±152.9 mGy and volume CT dose index of 10.9±2.9 mGy•cm2 could have been saved. CONCLUSION SBDECTU has high diagnostic accuracy in the detection and characterisation of clinically significant urinary calculi at potentially half the radiation dose.
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Affiliation(s)
- D Manoharan
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - S Sharma
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India.
| | - C J Das
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - R Kumar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - P Kumar
- Department of Medical Physics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Split-bolus CTA for mesenteric ischemia with a single scan opacifying arterial and mesenteric venous systems. Eur Radiol 2020; 30:3987-3995. [PMID: 32157410 DOI: 10.1007/s00330-020-06769-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of split-bolus single-scan computed tomography angiography (CTA) protocol for evaluation of acute mesenteric ischemia and alternate diagnoses. MATERIALS AND METHODS In this IRB-approved, HIPAA-compliant retrospective study, consecutive patients from 21 October 2016 to 6 May 2018 evaluated for mesenteric ischemia with split-bolus CTA (a single scan in concurrent arterial and portal venous phase) in a single tertiary academic institution were included. Intravenous contrast was administered on weight-based basis. Quantitative and qualitative assessments of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) attenuation and patency were performed by two independent reviewers. CT imaging findings were correlated with clinical reference outcomes. RESULTS One hundred fifty-four patients (age 66.3 ± 14.1 years, BMI 27.3 ± 6, 86 (56%) female) were included. CTA studies were performed with a volumetric CT dose index of 15.9 ± 5.5 mSv and dose length product of 1042.9 ± 389.4 mGy cm. Average intravenous contrast volume administered was 164.3 ± 12.1 cc. SMA attenuation was 263.6 ± 92.4HU, SMV was 190 ± 50.2HU. Qualitative assessment of SMA and SMV showed good opacification in all patients. 17/154 (11%) patients were diagnosed on CT with mesenteric ischemia; in 6/154 (4%), CTA studies were indeterminate; in 131/154 (85%), CTA confidently ruled out mesenteric ischemia. Alternate diagnoses were made in 38/154 (25%) patients. Using composite clinical outcomes as a reference standard, sensitivity of split-bolus CTA protocol for diagnosis of mesenteric ischemia is 100% (95% CI 79-100%), and specificity is 99% (95% CI 96-100%). CONCLUSIONS Split-bolus CTA has high sensitivity and specificity for diagnosis of acute mesenteric ischemia. KEY POINTS • Split-bolus CTA protocol for mesenteric ischemia has great diagnostic accuracy with lower radiation exposure and fewer images to interpret compared with standard multiphasic CTA.
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Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease. Abdom Radiol (NY) 2019; 44:3874-3885. [PMID: 31440804 DOI: 10.1007/s00261-019-02173-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Urothelial carcinoma of the upper urinary tract (UUT) is a relatively uncommon genitourinary malignancy, accounting for about 5-7% of urothelial tumors. The significant features of this tumor are multifocality and high rate of recurrence. Computed tomography urography (CTU) has replaced excretory urography (EU) and retrograde pyelography (RP) for imaging of upper tract urothelial carcinoma. While many studies have confirmed high sensitivity (88-100%) and specificity (93-100%) of CTU, an optimized CT protocol is of critical importance in screening, staging, and post-operative follow-up of patients (Chlapoutakis, Eur J Radiol 73(2):334-338, 2010; Caoli and Cohan, Abdom Radiol (NY) 41(6):1100-1107, 2016). The key element of the CT protocol is to have adequate distension of the collecting system with excreted contrast, to detect subtle lesions at an early stage. In this article, we discuss the background of upper urinary tract TTC, pathogenesis, CT protocol and the role of imaging in evaluation of this malignancy, staging, as well as different imaging appearances.
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Cheng K, Cassidy F, Aganovic L, Taddonio M, Vahdat N. CT urography: how to optimize the technique. Abdom Radiol (NY) 2019; 44:3786-3799. [PMID: 31317210 DOI: 10.1007/s00261-019-02111-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Computed tomography urography (CTU) has emerged as the modality of choice for imaging the urinary tract within the past few decades. It is a powerful tool that enables detailed anatomic evaluation of the urinary tract in order to identify primary urothelial malignancies, benign urinary tract conditions, and associated abdominopelvic pathologies. As such, there have been extensive efforts to optimize CTU protocol. METHODS This article reviews the published literature on CTU protocol optimization, including contrast bolus timing, dose reduction, reconstruction algorithms, and ancillary practices. CONCLUSION There have been many advances in CTU techniques, which allow for imaging diagnosis of a wide spectrum of diseases while minimizing radiation dose and maximizing urinary tract distension and opacification.
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Affiliation(s)
- Karen Cheng
- Department of Radiology, University of California, San Diego, 200 W. Arbor Drive, San Diego, CA, 92103, USA
| | - Fiona Cassidy
- Department of Radiology, University of California, San Diego, 200 W. Arbor Drive, San Diego, CA, 92103, USA
| | - Lejla Aganovic
- Department of Radiology, University of California, San Diego, 200 W. Arbor Drive, San Diego, CA, 92103, USA
| | - Michael Taddonio
- Department of Radiology, University of California, San Diego, 200 W. Arbor Drive, San Diego, CA, 92103, USA
| | - Noushin Vahdat
- Department of Radiology, University of California, San Diego, 200 W. Arbor Drive, San Diego, CA, 92103, USA.
- Department of Radiology, VA Medical Center, San Diego, 3350 La Jolla Village Drive, Mail Code: 114, San Diego, CA, 92161, USA.
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Examining the upper urinary tract in patients with hematuria-time to revise the CT urography protocol? Eur Radiol 2019; 30:1664-1670. [PMID: 31748856 DOI: 10.1007/s00330-019-06521-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Three-phase CT urography (CTU) is the gold standard for evaluating the upper urinary tract in patients with hematuria. We aimed to evaluate the accuracy of CTU for detecting upper urothelial cell carcinomas (UCC) in patients with hematuria and negative cystoscopy. Secondly, we aimed to determine the tumor visibility on each CTU phase. MATERIAL AND METHODS This retrospective study included all patients with hematuria referred to CTU after a negative cystoscopy during 2016 and 2017. The original CTU reports were dichotomized as negative or positive. All patient charts were reviewed after a minimum of 18-month follow-up in order to register missed cancers. The results of biopsies and clinical follow-up were used as the reference standard. Two reviewers retrospectively evaluated the tumor visibility of each CT sequence in all true-positive CTUs. RESULTS We included 376 patients with hematuria who underwent CTU after a negative cystoscopy. Macroscopic and microscopic hematuria occurred in 87% (327) and 13% (49), respectively. The incidence of upper urothelial cell carcinoma was 1.9% (7), and the sensitivity of CTU was 100% (95% CI, 59-100), specificity was 99% (95% CI, 98-100), positive predictive value was 88% (95% CI, 47-99), and negative predictive value was 100% (95% CI, 99-100). The accuracy was 99% (95% CI, 90-100). All UCCs were visible on the nephrographic phase for both reviewers. CONCLUSION CTU is highly accurate for detecting upper UCCs. All cases were seen on the nephrographic phase. This suggests that the CTU protocol can be simplified. KEY POINTS • CT urography is highly accurate for detecting upper urothelial cell carcinomas. • All cancers were seen on the nephrographic phase. • All cancers were detected in patients with macroscopic hematuria.
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Borkmann S, Geterud K, Lundstam S, Hellström M. Frequency and radiological characteristics of previously overlooked renal cell carcinoma. Acta Radiol 2019; 60:1348-1359. [PMID: 30700094 DOI: 10.1177/0284185118823362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Simon Borkmann
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kjell Geterud
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven Lundstam
- The Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- The Sahlgrenska University Hospital, Gothenburg, Sweden
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Abstract
Hematuria is common in the primary care setting. It is classified as either gross or microscopic. Hematuria warrants a thorough history and physical to determine potential causes and assess risk factors for malignancy. Risk of malignancy with gross hematuria is greater than 10%, and prompt urologic referral is recommended. Microscopic hematuria most commonly has benign causes, such as urinary tract infection, benign prostatic hyperplasia, and urinary calculi. If no benign cause for microscopic hematuria is found, the work-up includes laboratory tests to rule out intrinsic renal disease, imaging of the urinary tract, and referral to nephrology and urology subspecialists.
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Affiliation(s)
- Leah M Peterson
- Smoky Hill Family Medicine Residency Program, Salina, KS, USA.
| | - Henry S Reed
- Internal Medicine/Nephrology, Mowery Clinic, 737 East Crawford, Salina, KS 67401, USA
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Rawashdeh M, McEntee MF, Zaitoun M, Abdelrahman M, Brennan P, Alewaidat H, Lewis S, Saade C. Knowledge and practice of computed tomography exposure parameters amongst radiographers in Jordan. Comput Biol Med 2018; 102:132-137. [PMID: 30278337 DOI: 10.1016/j.compbiomed.2018.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the knowledge and practice of computed tomography (CT) radiographers working in Jordan. MATERIALS AND METHODS This Institutional Review Board (IRB) approved study disseminated a questionnaire via social media and recruited 54 Jordanian CT radiographers. The questionnaire comprised 36 questions divided into four sections: demographics; an evaluation of knowledge regarding CT exposure; modifications to CT exposure for paediatric patients; dose units and diagnostic reference levels (DRLs). Descriptive and inferential statistics including Chi-square tests, Mann-Whitney U tests, independent samples t-tests and Kruskal-Wallis H tests were employed. Statistical significance was considered below p < 0.05. RESULTS The 54 participants had various qualifications, with the majority holding a Bachelor's degree (n = 35, 64.8%) and the rest holding a Diploma (n = 19, 35.2%). In order to pass the questionnaire, participants needed to score 13 correct answers. The overall number of radiographers who correctly passed the questionnaire was 48 (88.9%). None of the participants correctly stated all the DRL values for chest, abdomen and brain CT. However, four out of 54 respondents (7.4%) knew the chest DRL value, three (5.6%) participants correctly estimated the abdominal DRL value but only two (3.7%) knew the DRL for the brain. CONCLUSION Good general knowledge was found amongst radiographers regarding the relationship of each exposure parameter to the image quality and patient dose. However, there was poor knowledge of diagnostic reference levels and the order of the organ radiation sensitivity. The need for CT radiographers to undertake further education that focuses on radiation exposure in CT is highlighted.
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Affiliation(s)
- Mohammad Rawashdeh
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Mark F McEntee
- Medical Image Optimisation and Perception Group (MIOPeG), Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Maha Zaitoun
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mostafa Abdelrahman
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Patrick Brennan
- Medical Image Optimisation and Perception Group (MIOPeG), Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Haytham Alewaidat
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Sarah Lewis
- Medical Image Optimisation and Perception Group (MIOPeG), Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Charbel Saade
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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van Oostenbrugge TJ, Fütterer JJ, Mulders PFA. Diagnostic Imaging for Solid Renal Tumors: A Pictorial Review. KIDNEY CANCER 2018; 2:79-93. [PMID: 30740580 PMCID: PMC6364093 DOI: 10.3233/kca-180028] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The prognosis of renal tumors depends on histologic subtype. The increased use of abdominal imaging has resulted in an increase in the number of small renal incidentaloma in recent decades. Of these incidentally discovered tumors, 20% are benign lesions warranting conservative management, but most are renal cell carcinomas that warrant a more aggressive therapeutic approach due to their malignant potential. Dedicated diagnostic renal imaging is important for characterization of renal tumors to facilitate treatment planning. This review discusses the ability to detect and differentiate renal cell carcinoma subtypes, angiomyolipoma and oncocytoma based on ultrasound imaging, computed tomography, multiparametric magnetic resonance, and nuclear imaging.
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Affiliation(s)
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter F A Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Raman SP, Fishman EK. Upper and Lower Tract Urothelial Imaging Using Computed Tomography Urography. Urol Clin North Am 2018; 45:389-405. [PMID: 30031461 DOI: 10.1016/j.ucl.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Computed tomography (CT) urography is the best noninvasive method of evaluating the upper urinary tract for urothelial malignancies. However, the utility of CT urography is heavily contingent on the use of proper image acquisition protocols. This article focuses on the appropriate protocols for optimizing CT urography acquisitions, including contrast administration and the timing of imaging acquisitions, as well as the use of ancillary techniques to increase collecting system distention. In addition, imaging findings are discussed that should raise concern for urothelial carcinoma at each of the 3 segments of the urinary tract: the intrarenal collecting systems, ureters, and bladder.
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Affiliation(s)
- Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 North Caroline Street, Baltimore, MD 21287, USA.
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 North Caroline Street, Baltimore, MD 21287, USA
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Manoharan D, Sharma S, Das CJ, Kumar R, Singh G, Kumar P. Single-Acquisition Triple-Bolus Dual-Energy CT Protocol for Comprehensive Evaluation of Renal Masses: A Single-Center Randomized Noninferiority Trial. AJR Am J Roentgenol 2018; 211:W22-W32. [DOI: 10.2214/ajr.17.18786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Science, New Delhi 110029, India
| | - Sanjay Sharma
- Department of Radiology, All India Institute of Medical Science, New Delhi 110029, India
| | - Chandan J. Das
- Department of Radiology, All India Institute of Medical Science, New Delhi 110029, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Science, New Delhi, India
| | - Geetika Singh
- Department of Pathology, All India Institute of Medical Science, New Delhi, India
| | - Pratik Kumar
- Department of Medical Physics, All India Institute of Medical Science, New Delhi, India
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Abstract
PURPOSE To evaluate split-bolus single scan CTA protocol for evaluation of acute mesenteric ischemia. MATERIALS AND METHODS In this HIPAA-compliant IRB-approved study, consecutive patients evaluated for mesenteric ischemia between 11/2015 and 10/2016 were included. Patients scanned prior to 4/2016 were scanned with multiphasic CTA protocol and after with split-bolus single scan CTA. Objective and subjective evaluation was performed by three board-certified readers. Findings were correlated to composite clinical reference outcome. RESULTS Eighty patients were included: 40 with split-bolus and 40 with multiphasic CTA protocol with similar age (60.3 ± 16.2 years vs. 64.7 ± 17.0 years, p = 0.19) and BMI (28.0 ± 6.7 vs. 27.0 ± 8.7, p = 0.56). SMA attenuation was higher in multiphasic protocol compared to split-bolus protocol (336.5 ± 97.5 HU vs. 258.0 ± 67.3 HU, p < 0.001) with similar SMV attenuation (multiphasic 213.7 ± 58.4 HU vs. split-bolus 194.2 ± 52.2 HU, p = 0.14). Optimal phase of bowel, liver, and spleen enhancement was seen in similar high proportion (94-99%) in both protocols. There were 8/40 (20%) positive cases of mesenteric ischemia in each group. There was no difference in the diagnostic confidence of the readers for evaluation of the mesenteric vessels and bowel ischemia. There were no missed cases of mesenteric ischemia in either group. Mean effective dose was 42% lower in the split-bolus group, p < 0.001. There was a higher number of axial images to review in multiphasic protocol compared to split-bolus protocol (437.9 ± 48.7 vs. 263.5 ± 31.2, p < 0.001). CONCLUSIONS The split-bolus protocol for evaluation of mesenteric ischemia is clinically feasible with confident and accurate diagnostic ability, while reducing number of images and decreasing radiation exposure to the patient.
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Abstract
For a variety of head and neck cancers, specifically those of the oropharynx, larynx, and hypopharynx, minimally invasive trans-oral approaches have been developed to reduce perioperative and long-term morbidity. However, in trans-oral surgical approaches anatomical deformation due to instrumentation, specifically placement of laryngoscopes and retractors, present a significant challenge for surgeons relying on preoperative imaging to resect tumors to negative margins. Quantifying the deformation due to instrumentation is needed in order to develop predictive models of operative deformation. In order to study this deformation, we used a CT/MR-compatible laryngoscopy system in concert with intraoperative CT imaging. 3D models of preoperative and intraoperative anatomy were generated. Mandible and hyoid displacements as well as tongue deformations were quantified for eight patients undergoing diagnostic laryngoscopy. Across patients, we found on average 1.3 cm of displacement for these anatomic structures due to laryngoscope insertion. On average, the maximum displacement for certain tongue regions exceeded 4 cm. The anatomical deformations quantified here can serve as a reference for describing how the upper aerodigestive tract anatomy changes during instrumentation and may be helpful in developing predictive models of intraoperative upper aerodigestive tract deformation.
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26
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Will L, Giesel FL, Freitag MT, Berger AK, Mier W, Kopka K, Koerber SA, Rathke H, Kremer C, Kratochwil C, Kauczor HU, Haberkorn U, Weber TF. Integration of CT urography improves diagnostic confidence of 68Ga-PSMA-11 PET/CT in prostate cancer patients. Cancer Imaging 2017; 17:30. [PMID: 29262870 PMCID: PMC5738706 DOI: 10.1186/s40644-017-0132-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/08/2017] [Indexed: 01/04/2023] Open
Abstract
Background To prove the feasibility of integrating CT urography (CTU) into 68Ga-PSMA-11 PET/CT and to analyze the impact of CTU on assigning focal tracer accumulation in the ureteric space to either ureteric excretion or metastatic disease concerning topographic attribution and diagnostic confidence. Methods Ten prostate cancer patients who underwent 68Ga-PSMA-11 PET/CT including CTU because of biochemical relapse or known metastatic disease were retrospectively analyzed. CTU consisted of an excretory phase 10 min after injection of 80 mL iodinated contrast material. Ureter opacification at CTU was evaluated using the following score: 0, 0% opacification; 1, < 50%; 2, 50–99%; 3, 100%. Topographic attribution and confidence of topographic attribution of focal tracer accumulation in the ureteric space were separately assessed for 68Ga-PSMA-11 PET/CT without and with CTU. Diagnostic confidence was evaluated using the following score: 0, < 25% confidence; 1, 26–50%; 2, 51–75%; 3, 76–100%. Results At CTU, mean ureter opacification score was 2.6 ± 0.7. At 68Ga-PSMA-11 PET/CT without CTU, mean confidence of topographic attribution of focal tracer accumulation was 2.5 ± 0.7 in total and 2.6 ± 0.7 for metastatic disease. At 68Ga-PSMA-11 PET/CT with CTU, mean confidence of topographic attribution of focal areas of tracer accumulation was significantly higher with 2.9 ± 0.2 in total and 2.7 ± 0.9 for metastatic disease (p < 0.001). In 4 of 34 findings (12%) attribution to either ureteric excretion or metastatic disease was discrepant between 68Ga-PSMA-11 PET/CT without and with CTU (n.s). Conclusions Integration of CTU into 68Ga-PSMA-11 PET/CT is feasible and increases diagnostic confidence of assigning focal areas of tracer accumulation in the ureteric space to either metastatic disease or ureteric excretion.
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Affiliation(s)
- Leon Will
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Cooperation Unit Nuclear Medicine, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Martin T Freitag
- Division of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Anne K Berger
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Walter Mier
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Klaus Kopka
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hendrik Rathke
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christophe Kremer
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Cooperation Unit Nuclear Medicine, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Tim F Weber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Weatherspoon K, Smolinski S, Rakita D, Valdes C, Garb J, Podsiadlo V, Waslick M, Kreychman A. Intravenous vs. oral hydration administration for optimal ureteral opacification in computer tomographic urography. Abdom Radiol (NY) 2017; 42:2890-2897. [PMID: 28674793 DOI: 10.1007/s00261-017-1231-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Computed tomographic urography (CTU) is the gold standard in the radiologic detection of urinary tract disease. The goals of CTU protocols are to garner fully distended and opacified collecting systems, ureters, and bladder for adequate evaluation. Multiple techniques have been reported in the literature to optimize urinary tract visualization and enhance genitourinary assessment. However, currently no strict guidelines exist regarding the preferred method for optimal urinary tract opacification in CTU. MATERIALS AND METHODS During the year 2013, a retrospective chart review of CTU examinations were done at either an academic institution where IV hydration was routinely administered or at an outpatient imaging center where oral hydration was preferred. Two attending radiologists experienced in cross-sectional body imaging, retrospectively reviewed all the images, blinded to the method of hydration. The reviewers were asked to quantify ureteral distension as well as to grade urinary tract opacification. RESULTS A total of 176 patients and 344 ureters were analyzed. Mean maximal ureteral widths were largest in the mid ureter, followed closely by the proximal ureter. Mean opacification scores showed no statistical significance between hydration methods, stratified by ureteral segment. CONCLUSION Our study results show that oral hydration is easy to implement, produces ureteral distention and opacification similar to CTU studies with IV hydration, without loss of diagnostic quality in our select patient population. Although not statistically significant, the oral hydration protocol is more cost effective, requires less hospital resources, and may be a useful step toward cost-containment strategies pertinent in today's healthcare landscape.
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Split-Bolus Injection Producing Simultaneous Late Arterial and Portal Venous Phases in CT Enterography: Preliminary Results. AJR Am J Roentgenol 2017; 209:1056-1063. [PMID: 28813197 DOI: 10.2214/ajr.17.18034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the image quality and added value of split-bolus contrast agent injection combining late arterial and portal venous phases compared with single-bolus contrast agent injection late arterial phase CT enterography. MATERIALS AND METHODS Consecutive patients who underwent CT enterography before and after implementation of a single-bolus CT enterography protocol were included. Attenuation and contrast-to-noise ratio (CNR) were assessed by ROI measurements of the bowel wall and arterial and venous structures. Subjective enhancement of the bowel wall (1, arterial; 2, mucosal; 3, transmural; 4, transmural with mucosal hyperenhancement) and bowel abnormalities were assessed by two independent readers. MR enterography examinations, endoscopy reports, and surgery reports within 30 days after CT enterography were used to produce a composite outcome. RESULTS Sixty-six patients were included in our study: 33 (mean [± SD] age, 46.0 ± 19.8 years) who underwent split-bolus CT enterography and 33 (mean age, 49.9 ± 19.0 years) who underwent single-bolus CT enterography. Bowel wall attenuation and CNR were higher for split-bolus CT enterography than for single-bolus CT enterography at 120 kVp (enhancement, 98.7 ± 23.1 HU vs 85.1 ± 23.3 HU; CNR, 6.4 ± 2.5 vs 4.4 ± 2.3; p < 0.01). Subjective ratings of bowel wall enhancement were higher with the split-bolus CT enterography than the single-bolus CT enterography (2.6 ± 0.8 vs 2.3 ± 0.6; p < 0.001). Split-bolus CT enterography led to a higher detection rate of mucosal hyperenhancement than did single-bolus CT enterography in patients with active inflammatory bowel disease (100.0% [7/7; 95% CI, 59.0-100.0%] vs 33.3% [2/6; 95% CI, 4.3-77.7%]; p = 0.02), whereas both protocols had a specificity of 100.0% (9/9). CONCLUSION Split-bolus CT enterography led to improved CNR (47%) compared with single-bolus CT enterography and significantly increased the detection rate of mucosal hyperenhancement in patients with active inflammatory bowel disease.
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Abstract
PURPOSE To determine the accuracy of split-bolus CT urogram (SB-CTU) without special maneuvers for ureteral distention in diagnosing upper urinary tract urothelial carcinoma (UCA). MATERIALS AND METHODS A hospital database was searched from 1/1/10, to 9/1/15, for SB-CTU exams without special maneuvers for ureteral distention. Accuracy of SB-CTU for detecting upper and lower urinary tract UCA was computed by comparing the prospective radiology report with cystoscopy, ureteroscopy, and/or urologic clinical follow-up. Patients with less than 12 months of clinical follow-up were excluded. RESULTS 339 studies were identified in 334 patients (60% male 40% female, avg. age 64). 119 studies were performed for microhematuria, 150 for gross hematuria, 13 for hematuria not otherwise specified, 57 for history of UCA, and one for a collecting system mass on a prior CT. There were five upper tract and 33 bladder tumors with overall prevalence of 1.5% and 9.7%, respectively. The prevalence varied significantly with patient age and clinical indication for SB-CTU. There were one false negative and four false positives for upper urinary tract UCA. Sensitivity, specificity, positive predictive value, and negative predictive value for detecting upper tract and bladder tumors were 80%, 99%, 44%, and 100%, respectively, and 55%, 98%, 78%, and 95%, respectively. CONCLUSION Based on this study, SB-CTU without special maneuvers for ureteral distention is highly sensitive for detecting upper tract UCA, although with a low positive predictive value, false positives do occur. The clinical utility of increasing accuracy in diagnosing this low-prevalence disease through other more complex CT urogram protocols should be weighed against the added cost and radiation dose associated with these protocols.
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Eisenhardt A, Heinemann D, Rübben H, Heß J. Haematuria work-up in general care-A German observational study. Int J Clin Pract 2017; 71. [PMID: 28750476 DOI: 10.1111/ijcp.12982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Haematuria is a common finding in the population and the diagnostic workflow of this symptom represents a large proportion of "work-load" in the urological outpatient clinic. AIMS The intention of this study was to verify if the intensive diagnostic procedures of haematuria patients is justified by detection of a significant proportion of genito-urinary tract cancers. MATERIALS AND METHODS In a retrospective design 1049 consecutive patients, who presented themselves with macro- or microhaematuria in the outpatient clinic PURR in the time from 2011 to 2012, were included in the study and the diagnostic procedures including ultrasound, intravenous urography, computed tomography of the abdomen and urethrocystoscopy as well as therapeutic consequences with its results were analysed. RESULTS The study group comprised 570 women (54.3%) and 479 men (45.7%) with a median age of 58 years and macrohaematuria occurred in 89 patients. Diagnostics revealed seven patients with renal cell cancer, six patients with urothelial cell cancer of the renal pelvis, four patients with urothelial cell cancer of the ureter, 65 patients with urothelial cell cancer of the lower urinary tract and 17 patients with prostate cancer. Age, male gender and macrohaematuria were associated with a higher risk of cancer. CONCLUSIONS The high incidence of urinary tract cancer in the data presented here support the rationale for diagnostic work-up of patients with micro- or macrohaematuria. Prospective randomised trials are necessary to identify index patients for second work-up after a primarily negative investigation as well as the role of molecular markers, which possibly enable to omit invasive work-up.
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Affiliation(s)
- Andreas Eisenhardt
- Urological Outpatient-Clinic PURR, Mülheim an der Ruhr, Germany
- Urological Department of the University of Duisburg-Essen, Essen, Germany
| | | | - Herbert Rübben
- Urological Department of the University of Duisburg-Essen, Essen, Germany
| | - Jochen Heß
- Urological Department of the University of Duisburg-Essen, Essen, Germany
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Kim YH, Kim MJ, Shin HJ, Yoon H, Lee MJ. Simplified split-bolus intravenous contrast injection technique for pediatric abdominal CT. Clin Imaging 2017; 46:28-32. [PMID: 28688244 DOI: 10.1016/j.clinimag.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/25/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate pediatric abdominal CT using a simplified split-bolus (Split group) contrast injection compared with a single bolus (Control group). METHODS Radiation dose, image quality and diagnostic accuracy were compared. RESULTS Split group demonstrated lower effective dose (2.46 vs. 2.85mSv, p=0.002) and noise levels in aorta, liver and portal vein (p<0.001). There was one false-negative case of portal vein obliteration in the Split group. CONCLUSIONS A simple method of split-bolus intravenous contrast injection technique can provide adequate and homogeneous enhancement in pediatric abdominal CT.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
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Optimization of Split-Bolus CT Urography: Effect of Differences in Allocation of Contrast Medium and Prolongation of Imaging Delay. AJR Am J Roentgenol 2017; 209:W10-W17. [DOI: 10.2214/ajr.16.16459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Löbig N, Wezel F, Martini T, Schröppel B, Bolenz C. [Microscopic hematuria : Reasonable and risk-adapted diagnostic evaluation]. Urologe A 2017. [PMID: 28643107 DOI: 10.1007/s00120-017-0432-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microscopic hematuria that is not explained by an obvious underlying condition is a frequent and often an incidental finding that commonly triggers urological or nephrological evaluation. Potential underlying conditions range from benign to severe malignant diseases of the kidneys and urinary tract. MATERIALS AND METHODS A nonsystematic literature search was performed, focusing on potential urological and nephrological causes of hematuria. National and international guidelines were considered and diagnostic as well as follow-up strategies are discussed. We provide a recommendation for practices in the clinical evaluation of hematuria. RESULTS The overall prevalence for microscopic hematuria is estimated at approximately 2%, whereas risk populations show an increase to around 30%. In 13-35% of patients presenting with microscopic hematuria, a medical or surgical intervention is required. Malignant tumors of the kidneys or urinary tract can be diagnosed in 2.6-4% of all patients and in up to 25.8% of at-risk populations. "Idiopathic microscopic hematuria" without an obvious underlying medical condition accounts for approximately 80% of patients with asymptomatic hematuria. After exclusion of nephrological diseases, standard diagnostic procedures by means of medical history, physical and laboratory examination as well as ultrasound of the kidneys and the urinary tract should be performed. In the presence of risk factors, an extended diagnostic work-up using cystoscopy, urinary cytology, and cross-sectional imaging of the upper urinary tract is indicated. CONCLUSION Evidence-based strategies of a risk-adapted diagnostic evaluation for microscopic hematuria are not available. The development of reliable clinical and molecular markers offers great potential for the identification of patients at higher risk for harboring severe diseases.
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Affiliation(s)
- N Löbig
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - F Wezel
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - T Martini
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - B Schröppel
- Klinik für Innere Medizin I, Sektion Nephrologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - C Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland.
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Fujibayashi S, Otsuki B, Kimura H, Tanida S, Masamoto K, Matsuda S. Preoperative assessment of the ureter with dual-phase contrast-enhanced computed tomography for lateral lumbar interbody fusion procedures. J Orthop Sci 2017; 22:420-424. [PMID: 28202301 DOI: 10.1016/j.jos.2017.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/16/2016] [Accepted: 01/13/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Performing the minimally invasive lateral lumbar interbody fusion (LIF), such as the extreme lateral interbody fusion (XLIF) and oblique lateral interbody fusion (OLIF), through a retroperitoneal approach has become increasingly popular. Although urological injury is a major complication of LIF, the anatomical location of the ureter and its risk of injury have not been assessed. The purpose of this study was to evaluate the efficacy of dual-phase contrast-enhanced computed tomography for assessing the location of the ureter and risk of its injury in consecutive LIF cases. METHODS 27 cases (12 men and 15 women) were enrolled in the study. Dual-phase contrast-enhanced CT was performed preoperatively, and the risk of ureteral injury was assessed. The location of the ureter was classified using the psoas muscle and vertebral body as reference structures for OLIF and XLIF procedures, respectively. During the OLIF procedures, the location of the ureter was additionally assessed with direct vision and manual palpation in all cases. Simultaneously, potential vascular anomalies were assessed with both 3D and axial images of CT. RESULTS A total of 125 among 162 ureters, excluding 13 with insufficient enhancement and 24 (44.4%) within the kidney at the L2-L3 level, were assessed preoperatively; 113 ureters (90.4%) were classified as anatomically close to the surgical corridor for OLIF, and 20 ureters (16.0%) as having a potential risk of injury during XLIF. In one case, OLIF was converted to a conventional posterior procedure because of a vascular anomaly. Intraoperative findings showed that ureters moved anteriorly with the peritoneum in all cases, as assessed by manual palpation under direct vision. CONCLUSIONS Dual-phase contrast-enhanced CT is useful in assessing the location of the ureter, kidney, and vascular structures simultaneously. Both OLIF and XLIF have a potential risk of urological injury.
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Affiliation(s)
- Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shimei Tanida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kazutaka Masamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Upper and Lower Tract Urothelial Imaging Using Computed Tomography Urography. Radiol Clin North Am 2017; 55:225-241. [DOI: 10.1016/j.rcl.2016.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols. Abdom Radiol (NY) 2017; 42:676-687. [PMID: 27888303 DOI: 10.1007/s00261-016-0966-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To standardize workflow for dual-energy computed tomography (DECT) involving common abdominopelvic exam protocols. MATERIALS AND METHODS 9 institutions (4 rsDECT, 1 dsDECT, 4 both) with 32 participants [average # years (range) in practice and DECT experience, 12.3 (1-35) and 4.6 (1-14), respectively] filled out a single survey (n = 9). A five-point agreement scale (0, 1, 2, 3, 4-contra-, not, mildly, moderately, strongly indicated, respectively) and utilization scale (0-not performing and shouldn't; 1-performing but not clinically useful; 2-performing but not sure if clinically useful; 3-not performing it but would like to; 4-performing and clinically useful) were used. Consensus was considered with a score of ≥2.5. Survey results were discussed over three separate live webinar sessions. RESULTS 5/9 (56%) institutions exclude large patients from DECT. 2 (40%) use weight, 2 (40%) use transverse dimension, and 1 (20%) uses both. 7/9 (78%) use 50 keV for low and 70 keV for medium monochromatic reconstructed images. DECT is indicated for dual liver [agreement score (AS) 3.78; utilization score (US) 3.22] and dual pancreas in the arterial phase (AS 3.78; US 3.11), mesenteric ischemia/gastrointestinal bleeding in both the arterial and venous phases (AS 2.89; US 2.79), RCC exams in the arterial phase (AS 3.33; US 2.78), and CT urography in the nephrographic phase (AS 3.11; US 2.89). DECT for renal stone and certain single-phase exams is indicated (AS 3.00). CONCLUSIONS DECT is indicated during the arterial phase for multiphasic abdominal exams, nephrographic phase for CTU, and for certain single-phase and renal stone exams.
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Sountoulides P, Mykoniatis I, Metaxa L. Non-visible asymptomatic haematuria: a review of the guidelines from the urologist’s perspective. Expert Rev Anticancer Ther 2017; 17:203-216. [DOI: 10.1080/14737140.2017.1284589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Petros Sountoulides
- Department of Urology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Ioannis Mykoniatis
- 1st Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Linda Metaxa
- Department of Radiology, St. Bartholomew’s Hospital, London, England
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Power SP, Moloney F, Twomey M, James K, O’Connor OJ, Maher MM. Computed tomography and patient risk: Facts, perceptions and uncertainties. World J Radiol 2016; 8:902-915. [PMID: 28070242 PMCID: PMC5183924 DOI: 10.4329/wjr.v8.i12.902] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/29/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Since its introduction in the 1970s, computed tomography (CT) has revolutionized diagnostic decision-making. One of the major concerns associated with the widespread use of CT is the associated increased radiation exposure incurred by patients. The link between ionizing radiation and the subsequent development of neoplasia has been largely based on extrapolating data from studies of survivors of the atomic bombs dropped in Japan in 1945 and on assessments of the increased relative risk of neoplasia in those occupationally exposed to radiation within the nuclear industry. However, the association between exposure to low-dose radiation from diagnostic imaging examinations and oncogenesis remains unclear. With improved technology, significant advances have already been achieved with regards to radiation dose reduction. There are several dose optimization strategies available that may be readily employed including omitting unnecessary images at the ends of acquired series, minimizing the number of phases acquired, and the use of automated exposure control as opposed to fixed tube current techniques. In addition, new image reconstruction techniques that reduce radiation dose have been developed in recent years with promising results. These techniques use iterative reconstruction algorithms to attain diagnostic quality images with reduced image noise at lower radiation doses.
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Strategies to Lessen the Radiation Risk from CT: A Multination Perspective. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Wang W, Liu L, Zeng H, Sun C, Huang N, Zhang M. Utility of virtual unenhanced images and split-bolus injection using spectral multidetector CT for the assessment of renal cell carcinoma conspicuity and radiation dose. Int J Clin Pract 2016; 70 Suppl 9B:B56-63. [PMID: 27577516 DOI: 10.1111/ijcp.12859] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/15/2016] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the radiation dose and renal cell carcinoma conspicuity with virtual unenhanced images and split-bolus injection from spectral multidetector CT (MDCT). MATERIAL AND METHODS This prospective study was approved by the Ethics Committee, and informed consent was obtained. Ninety suspected patients of renal cell carcinoma diagnosed by abdominal ultrasonography and CEUS were randomly divided into two groups by a radiographer. Patients of the first group underwent spectral MDCT with virtual unenhanced imaging and split-bolus injection, while patients in the second group underwent conventional unenhanced as well as tri-phasic enhanced CT. Group A (split-bolus spectral MDCT group): The contrast material was administered at a dose of 1.5 mL/kg body weight at a flow rate of 4 mL/s, with a ratio of 7 to 5 before the CT scan with an interval of 60 seconds. Virtual unenhanced images were generated using a standard three-material decomposition algorithm, and the best mono-energy (keV) was calculated to show the tumour, renal artery and renal vein. Group B (conventional tri-phasic enhanced CT group): the contrast agent was injected with a dose of 1.5 mL/kg body weight at a flow rate of 4 mL/s. The corticomedullary phase scanning was performed once the arterial CT value reached 100 HU; the nephrographic phase was scanned 60 seconds later. And the excretory phase was scanned 5 min after onset of contrast injection. The LKR (lesion kidney ratio), CNR, and CT value of the corticomedullary and nephrographic phase were measured. The opacification of the renal collection system (including calices, infundibula and renal pelvis) was scored. The radiation dose was recorded. Statistical analysis was performed using Student's t-test, Fisher's exact test, the Mann-Whitney U-test, and k statistics. RESULTS There were no statistically significant differences between the two groups in age, sex and body mass index (BMI), but there was significant difference in treatment methods. The best mono-energy was 58 keV for showing the tumour and renal artery and 67 keV for showing the renal vein. There were no differences in the mean attenuations of normal renal parenchyma, renal tumour, CNR, and imaging quality between true unenhanced images and virtual unenhanced images from the combined corticomedullary and nephrographic phase. The LKR of the mono-energy at 58 keV from the combined corticomedullary and nephrographic phase was significantly better than the corticomedullary phase of the conventional enhanced CT scan (0.74±0.18 vs 1.08±0.34, P<.01), but there was no difference in CNR (2.31±1.74 vs 2.79±1.83, P>.05). There were no differences in the CT values of the renal tumour, normal renal parenchyma and renal artery between the two groups (P>.05). The CT value of the renal vein at mono-energy (67 keV) (200.55±43.38) from the combined corticomedullary and nephrographic phase was higher than the conventional CT scan (140.90±42.64) in the nephrographic phase. The Kappa scores of the rate of the renal collection system for the conventional CT and spectral CT were 0.68 (95% confidence interval [CI]: 0.35-0.89) and 0.54 (95% CI: 0.30-0.88), respectively. The radiation dose (735±162 mGy·cm) of Group A was significantly less than that of Group B (1032±324 mGy·cm) (P<.01). CONCLUSION Conspicuity with virtual unenhanced imaging and split-bolus injection from spectral multidetector CT is better than or equal to the conventional three-phase enhanced CT scan in showing the RCC, renal artery and renal vein, while the radiation dose can be reduced by 28.78%.
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Affiliation(s)
- Wei Wang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lin Liu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hong Zeng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Changjiang Sun
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ning Huang
- GE Healthcare, Life Science, Beijing, China
| | - Mengchao Zhang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
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Wong KY, Chaudhry M, Hamm R, Belfield J. Radiological investigation of haematuria in 2016. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816659406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kee Y Wong
- Department of Urology, the Royal Liverpool and Broadgreen University Hospital NHS Trust, UK
| | - Mubeen Chaudhry
- Department of Radiology, the Royal Liverpool and Broadgreen University Hospital NHS Trust, UK
| | - Rebecca Hamm
- Department of Urology, the Royal Liverpool and Broadgreen University Hospital NHS Trust, UK
| | - Jane Belfield
- Department of Radiology, the Royal Liverpool and Broadgreen University Hospital NHS Trust, UK
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Diagnostic Performance of Split-Bolus Portal Venous Phase Dual-Energy CT Urography in Patients With Hematuria. AJR Am J Roentgenol 2016; 206:1013-22. [DOI: 10.2214/ajr.15.15112] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Split-Bolus Portal Venous Phase Dual-Energy CT Urography: Protocol Design, Image Quality, and Dose Reduction. AJR Am J Roentgenol 2016; 205:W492-501. [PMID: 26496571 DOI: 10.2214/ajr.14.13687] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the image quality of split-bolus portal venous phase urography and the potential reduction of radiation dose by using a second-generation dual-source dual-energy CT (DECT) scanner. MATERIALS AND METHODS DECT urography was performed in 84 patients. Unenhanced CT was performed 20 minutes after drinking 800 mL of water. The split-bolus protocol consisted of a sequence of injections, as follows: 200 mL of normal saline (2.0 mL/s), 50 mL of contrast medium (2.5 mL/s) at 0 second, 70 mL of contrast medium (2.5 mL/s) at 360 seconds, and a saline flush of 25 mL. The scan was started at 420 seconds. Virtual unenhanced images were reconstructed from contrast-enhanced images. The mean CT density and signal-to-noise ratio (SNR) of the renal parenchyma, vessels, upper urinary tract, normal reference tissues, and tumors were measured for image quantitative analysis. Image quality and opacification of the collecting systems were rated by two radiologists using 3- or 4-point scales. RESULTS The SNR of all measured sites, except the renal pelvis, showed a statistically significant correlation (p < 0.001) between the true unenhanced and virtual unenhanced images. The overall sensitivity of stone detection was 87.5% (28/32) in virtual unenhanced images. Image quality of the renal parenchyma, arteries, and veins was excellent in 59.5%, 75.0%, and 97.6% of cases, respectively. Opacification of the intrarenal collecting systems, proximal, middle, and distal ureters, and bladder was complete in 92.9%, 83.9%, 78.6%, 77.4%, and 26.2% of patients, respectively. Omitting the unenhanced scan can reduce the mean radiation dose from 15.6 to 6.7 mSv. CONCLUSION Portal venous phase split-bolus DECT urography provides sufficient image quality with potential to reduce radiation exposure.
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Mohapatra A, Vemana G, Bhayani S, Baty J, Vetter J, Strope SA. Trends in the utilization of imaging for upper tract urothelial carcinoma. Urol Oncol 2016; 34:236.e23-8. [PMID: 26803434 DOI: 10.1016/j.urolonc.2015.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the changes in use of the different imaging modalities for diagnosing upper tract urothelial carcinoma (UTUC) and assess how these changes have affected tumor stage at the time of surgery. MATERIALS AND METHODS We assessed the Surveillance, Epidemiology, and End Results (SEER) cancer registry and linked Medicare claims data (1992-2009) for 5377 patients who underwent surgery for UTUC. We utilized International Classification of Disease-Oncology 3 codes to identify UTUC. International Classification of Disease, ninth Revision, Clinical Modification and Current Procedure Terminology codes identified surgical treatment and imaging modalities. We assessed for use of intravenous pyelography, retrograde pyelography (RGP), computed tomography urography (CTU), magnetic resonance urography (MRU), and endoscopy. For each modality, patients were categorized as having received the modality at least once or not at all. Patient characteristics were compared using chi-squared tests. Usage of imaging modalities and tumor stage was trended using Cochran-Armitage tests. We stratified our data into 2 multivariate logistic regression models to determine the effect of imaging modalities on tumor stage: 1992 to 1999 with all modalities except MRU, and 2000 to 2009 with all modalities. RESULTS Our patient population was predominantly White males of more than 70 years old. Intravenous pyelography and RGP declined in use (62% and 72% in 1992 vs. 6% and 58% in 2009, respectively) while computed tomography urography, MRU, and endoscopy increased in use (2%, 0%, and 37% in 1992 vs. 44%, 6%, and 66% in 2009, respectively). In both regression analyses, endoscopy was associated with lower-stage tumors. In the 2000 to 2009 model, RGP was associated with lower-stage tumors, and MRU was associated with higher-stage tumors. Finally, our data showed an increasing number of modalities utilized for each patient (1% receiving 4 modalities in 1992 vs. 20% in 2009). CONCLUSIONS We found trends toward the utilization of newer imaging modalities to diagnose UTUC and more modalities per patient. Endoscopy and RGP were associated with smaller tumors, whereas MRU was associated with larger tumors. Further studies are needed to evaluate the utility of the different modalities in diagnosing UTUC.
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Affiliation(s)
- Anand Mohapatra
- Division of Urologic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO.
| | | | - Sam Bhayani
- Division of Urologic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Jack Baty
- Division of Biostatistics, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Joel Vetter
- Division of Urologic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Seth A Strope
- Division of Urologic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
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Jinzaki M, Kikuchi E, Akita H, Sugiura H, Shinmoto H, Oya M. Role of computed tomography urography in the clinical evaluation of upper tract urothelial carcinoma. Int J Urol 2016; 23:284-98. [DOI: 10.1111/iju.13032] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/15/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Eiji Kikuchi
- Department of Urology; Keio University School of Medicine; Tokyo Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Hiroaki Sugiura
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Hiroshi Shinmoto
- Department of Radiology; National Defense Medical College; Tokorozawa Saitama Japan
| | - Mototsugu Oya
- Department of Urology; Keio University School of Medicine; Tokyo Japan
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Moosavi B, Fasih N, Virmani V, Kielar A. Beyond ureterolithiasis: gamut of abnormalities affecting the ureter. Clin Imaging 2016; 40:678-90. [PMID: 27317212 DOI: 10.1016/j.clinimag.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 12/08/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022]
Abstract
Nephrolithiasis is the most common condition involving the ureters. However, various other entities can affect the ureters, albeit less frequently. Imaging plays a crucial role in diagnosis, management, and follow-up of ureteral pathology. In the past decade, computed tomography urography has replaced traditional methods of ureteral imaging due to its high spatial resolution, multiplanar imaging, and rapid acquisition time. More recently, magnetic resonance urography has also been explored in evaluating ureteral abnormalities. In this review, we briefly discuss current imaging techniques used in assessment of the ureters and present a diverse group of diseases affecting the ureters. We begin with primary and secondary ureteral malignancies, followed by uncommon infectious/inflammatory diseases that can involve the ureters including tuberculosis, xanthogranulomatous pyelonephritis, and graft-versus-host disease. We then discuss the imaging characteristics of endometriosis and retroperitoneal fibrosis as two important examples of pelvic and retroperitoneal processes that occasionally obstruct the ureters and present with clinical symptoms similar to that of renal stones. We end with a brief discussion of miscellaneous conditions that affect the ureters, including ureteral hemorrhage, ureteral intussusception, ureteral pseudodiverticulosis, Malacoplakia, and ureteritis cystica. Knowledge of these entities and their characteristic imaging manifestations along with patient's clinical presentation allows accurate diagnosis and timely patient management.
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Affiliation(s)
- Bardia Moosavi
- The Ottawa hospital, Department of Radiology Civic Campus, 1053 Carling Avenue, Room C120, Ottawa, ON, K1T4E9.
| | - Najla Fasih
- The Ottawa hospital, Department of Radiology, 501 Smyth Road, Ottawa, ON, K1H 8L6.
| | - Vivek Virmani
- The Ottawa hospital, Department of Radiology, 501 Smyth Road, Ottawa, ON, K1H 8L6.
| | - Ania Kielar
- The Ottawa hospital, Department of Radiology, 501 Smyth Road, Ottawa, ON, K1H 8L6.
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CT Urography for Diagnosis of Upper Urinary Tract Urothelial Carcinoma: Are Both Nephrographic and Excretory Phases Necessary? AJR Am J Roentgenol 2015; 205:W320-7. [PMID: 26295668 DOI: 10.2214/ajr.14.14075] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of our study was to compare the diagnostic performance of nephrographic phase only, excretory phase only, and both nephrographic and excretory phases of CT urography (CTU) for the detection of upper tract urothelial carcinoma. MATERIALS AND METHODS Forty-nine consecutive patients with pathologically proven upper tract urothelial carcinoma who underwent a single-bolus CTU examination were evaluated. Forty-nine control patients with normal findings on two CTU examinations performed at a 1-year interval were included. Two radiologists independently reviewed the 98 CTU examinations at three different sessions (nephrographic phase only, excretory phase only, and both nephrographic and excretory phases simultaneously) and rated the likelihood of the presence of a urothelial carcinoma in each segment of the renal collecting system and ureter using a 5-point scale. Sensitivity, specificity, and AUC of ROC curve were calculated per segment and per patient. RESULTS A total of 314 segments, 56 of which contained tumors, were evaluated. In the per-segment analysis for reviewers 1 and 2, the sensitivity, specificity, and AUC, respectively, were as follows: 88%, 98%, and 0.95 and 84%, 97%, and 0.94 for the nephrographic phase; 79%, 98%, and 0.91 and 89%, 98%, and 0.95 for the excretory phase; and 88%, 99%, and 0.95 and 89%, 99%, and 0.96 for the combined nephrographic and excretory phases. The AUC of the combined nephrographic and excretory phases was significantly higher than that of the nephrographic phase (per-patient analysis, reviewer 2) and that of excretory phase (per-segment analysis, reviewer 1) but was not significantly different in any other comparisons. CONCLUSION The nephrographic and excretory phases are complementary for the detection of upper tract urothelial carcinoma.
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Abstract
Hematuria is the main symptom of many urological and nephrological diseases. In the differential diagnostics a distinction is made between painful and pain-free and between macrohematuria which is visible to the naked eye and microhematuria which is not visible. The reasons for hematuria are basically renal (glomerular) and non-renal (non-glomerular) causes. In order not to overlook early symptoms of malignant and relevant benign diseases and also to avoid excessive diagnostic tests, a differentiated approach is necessary.
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Affiliation(s)
- M Horstmann
- Klinik und Poliklinik für Urologie, Universität Jena, Lessingstr. 1, 07743, Jena, Deutschland,
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Rausch S, Gakis G, Bedke J, Stenzl A. [Elective organ and function preservation in ureter and renal pelvis tumors]. Urologe A 2015; 53:1284-94. [PMID: 25148912 DOI: 10.1007/s00120-014-3557-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With the technical innovations of smaller, flexible ureteroscopes, color-filtered imaging, and endoscopic laser technology, organ-preserving treatment for upper urinary tract transitional cell carcinoma has become feasible. While in the past, radical nephroureterectomy was the sole gold standard approach for the treatment of upper urinary tract tumors, the endoscopic approach is no longer restricted to only patients with the imperative indication of kidney preservation. Initial clinical results have demonstrated oncologic efficacy of endoscopic management or segmental ureteral resection. However, careful preoperative risk-assessment and close endoscopic follow-up are mandatory.
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Affiliation(s)
- S Rausch
- Klinik für Urologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
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