CT Urography for Hematuria

Overview

Journal Nat Rev Urol

Specialty Urology

Date 2012 Mar 14

PMID 22410682

Citations 36

Authors

Nigel C Cowan

Affiliations

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Abstract

Hematuria can signify serious disease such as bladder cancer, upper urinary tract urothelial cell carcinoma (UUT-UCC), renal cell cancer or urinary tract stones. CT urography is a rapidly evolving technique made possible by recent advances in CT technology. CT urography is defined as CT examination of the kidneys, ureters and bladder with at least one series of images acquired during the excretory phase after intravenous contrast administration. The reasoning for using CT urography to investigate hematuria is based on its high diagnostic accuracy for urothelial cell carcinoma (UCC) and favorable comparison with other imaging techniques. The optimum diagnostic imaging strategy for patients with hematuria at high-risk for UCC involves the use of CT urography as a replacement for other imaging tests (ultrasonography, intravenous urography, or retrograde ureteropyelography) and as a triage test for cystoscopy, resulting in earlier diagnosis and improved prognosis of bladder cancer, UUT-UCC, renal cell cancer and stones. Current problems with CT urography for investigating hematuria might be solved with a formative educational program simulating clinical reporting to reduce reader error, and a new technique for image-guided biopsy of UUT-UCC detected by CT urography for histopathological confirmation of diagnosis and elimination of false-positive results. CT urography is recommended as the initial imaging test for hematuria in patients at high-risk for UCC.

Citing Articles

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References

Wang L, Wong Y, Huang C, Wu C, Hung S, Chen H . Multidetector computerized tomography urography is more accurate than excretory urography for diagnosing transitional cell carcinoma of the upper urinary tract in adults with hematuria. J Urol. 2009; 183(1):48-55. DOI: 10.1016/j.juro.2009.08.144. View

Chow L, Kwan S, Olcott E, Sommer G . Split-bolus MDCT urography with synchronous nephrographic and excretory phase enhancement. AJR Am J Roentgenol. 2007; 189(2):314-22. DOI: 10.2214/AJR.07.2288. View

Maheshwari E, OMalley M, Ghai S, Staunton M, Massey C . Split-bolus MDCT urography: Upper tract opacification and performance for upper tract tumors in patients with hematuria. AJR Am J Roentgenol. 2010; 194(2):453-8. DOI: 10.2214/AJR.09.3228. View

Anderson E, Murphy R, Rennie A, Cowan N . Multidetector computed tomography urography (MDCTU) for diagnosing urothelial malignancy. Clin Radiol. 2007; 62(4):324-32. DOI: 10.1016/j.crad.2006.10.008. View

Roupret M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R . European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol. 2011; 59(4):584-94. DOI: 10.1016/j.eururo.2010.12.042. View

Chow L, Sommer F . Multidetector CT urography with abdominal compression and three-dimensional reconstruction. AJR Am J Roentgenol. 2001; 177(4):849-55. DOI: 10.2214/ajr.177.4.1770849. View

van der Molen A, Cowan N, Mueller-Lisse U, Nolte-Ernsting C, Takahashi S, Cohan R . CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol. 2007; 18(1):4-17. DOI: 10.1007/s00330-007-0792-x. View

Webb J . Imaging in haematuria. Clin Radiol. 1997; 52(3):167-71. DOI: 10.1016/s0009-9260(97)80269-3. View

Knox M, Rivers-Bowerman M, Bardgett H, Cowan N . Multidetector computed tomography with triple-bolus contrast medium administration protocol for preoperative anatomical and functional assessment of potential living renal donors. Eur Radiol. 2010; 20(11):2590-9. DOI: 10.1007/s00330-010-1855-y. View

10.

Stacul F, van der Molen A, Reimer P, Webb J, Thomsen H, Morcos S . Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011; 21(12):2527-41. DOI: 10.1007/s00330-011-2225-0. View

11.

Silverman S, Lee B, Seltzer S, Bloom D, Corless C, Adams D . Small (< or = 3 cm) renal masses: correlation of spiral CT features and pathologic findings. AJR Am J Roentgenol. 1994; 163(3):597-605. DOI: 10.2214/ajr.163.3.8079852. View

12.

Kekelidze M, Dwarkasing R, Dijkshoorn M, Sikorska K, Verhagen P, Krestin G . Kidney and urinary tract imaging: triple-bolus multidetector CT urography as a one-stop shop--protocol design, opacification, and image quality analysis. Radiology. 2010; 255(2):508-16. DOI: 10.1148/radiol.09082074. View

13.

Cowan N, Turney B, Taylor N, McCarthy C, Crew J . Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour. BJU Int. 2007; 99(6):1363-70. DOI: 10.1111/j.1464-410X.2007.06766.x. View

14.

Tomson C, Porter T . Asymptomatic microscopic or dipstick haematuria in adults: which investigations for which patients? A review of the evidence. BJU Int. 2002; 90(3):185-98. DOI: 10.1046/j.1464-410x.2002.02841.x. View

15.

Grossfeld G, Litwin M, Wolf Jr J, Hricak H, Shuler C, Agerter D . Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy--part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology. 2001; 57(4):604-10. DOI: 10.1016/s0090-4295(01)00920-7. View

16.

Jinzaki M, Matsumoto K, Kikuchi E, Sato K, Horiguchi Y, Nishiwaki Y . Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract. AJR Am J Roentgenol. 2011; 196(5):1102-9. DOI: 10.2214/AJR.10.5249. View

17.

Dillman J, Caoili E, Cohan R . Multi-detector CT urography: a one-stop renal and urinary tract imaging modality. Abdom Imaging. 2007; 32(4):519-29. DOI: 10.1007/s00261-007-9185-5. View

18.

Caoili E, Cohan R, Korobkin M, Platt J, Francis I, Faerber G . Urinary tract abnormalities: initial experience with multi-detector row CT urography. Radiology. 2002; 222(2):353-60. DOI: 10.1148/radiol.2222010667. View

19.

Nolte-Ernsting C, Staatz G, Tacke J, Gunther R . MR urography today. Abdom Imaging. 2003; 28(2):191-209. DOI: 10.1007/s00261-001-0187-4. View

20.

Smith R, Verga M, McCarthy S, Rosenfield A . Diagnosis of acute flank pain: value of unenhanced helical CT. AJR Am J Roentgenol. 1996; 166(1):97-101. DOI: 10.2214/ajr.166.1.8571915. View