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Renard-Penna R, Rocher L, Roy C, André M, Bellin MF, Boulay I, Eiss D, Girouin N, Grenier N, Hélénon O, Lapray JF, Lefèvre A, Matillon X, Ménager JM, Millet I, Ronze S, Sanzalone T, Tourniaire J, Brunelle S, Rouvière O. Imaging protocols for CT urography: results of a consensus conference from the French Society of Genitourinary Imaging. Eur Radiol 2019; 30:1387-1396. [PMID: 31848742 DOI: 10.1007/s00330-019-06529-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/17/2019] [Accepted: 10/18/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To develop technical guidelines for computed tomography urography. METHODS The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Consensus was strictly defined using a priori criteria. RESULTS Forty-two expert uro-radiologists completed both survey rounds with no attrition between the rounds. Ninety-six (70%) of the initial 138 statements of the questionnaire achieved final consensus. An intravenous injection of 20 mg of furosemide before iodinated contrast medium injection was judged mandatory. Improving the quality of excretory phase imaging through oral or intravenous hydration of the patient or through the use of an abdominal compression device was not deemed necessary. The patient should be imaged in the supine position and placed in the prone position only at the radiologist's request. The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. Repeated single-slice test acquisitions should not be performed to decide of the timing of excretory phase imaging; instead, excretory phase imaging should be performed 7 min after the injection of the contrast medium. The optimal combination of unenhanced, corticomedullary phase and nephrographic phase imaging depends on the context; suggestions of protocols are provided for eight different clinical situations. CONCLUSION This expert-based consensus conference provides recommendations to standardise the imaging protocol for computed tomography urography. KEY POINTS • To improve excretory phase imaging, an intravenous injection of furosemide should be performed before the injection of iodinated contrast medium. • Systematic oral or intravenous hydration is not necessary to improve excretory phase imaging. • The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation.
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Affiliation(s)
- Raphaële Renard-Penna
- Academic Department of Radiology, Hôpital Pitié-Salpêtrière and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Sorbonne Universités, GRC no 5, ONCOTYPE-URO, Paris, France.
| | - Laurence Rocher
- Department of Diagnostic and Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Paris Sud, Le Kremlin Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- IR4M, UMR 8081, Service hospitalier Joliot Curie, Orsay, France
| | - Catherine Roy
- Department of Radiology B, CHU de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Marc André
- Department of Radiology, Hôpital Européen, Marseille, France
| | - Marie-France Bellin
- Department of Diagnostic and Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Paris Sud, Le Kremlin Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- IR4M, UMR 8081, Service hospitalier Joliot Curie, Orsay, France
| | - Isabelle Boulay
- Department of Radiology, Fondation Hôpital Saint Joseph, Paris, France
| | - David Eiss
- Department of Adult Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - Nicolas Grenier
- Department of Diagnostic and Interventional Adult Imaging, CHU de Bordeaux, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Olivier Hélénon
- Department of Adult Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - Arnaud Lefèvre
- Centre d'Imagerie Médicale Tourville, Paris, France
- Department of Radiology, American Hospital of Paris, Neuilly, France
| | - Xavier Matillon
- Department of Urology and Transplantation, Hospices Civils de Lyon, Lyon, France
- Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France
- CarMeN Laboratory, INSERM U1060, Lyon, France
| | | | - Ingrid Millet
- Department of Radiology, Hôpital Lapeyronie, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Sébastien Ronze
- Imagerie médicale Val d'Ouest Charcot (IMVOC), Ecully, France
| | - Thomas Sanzalone
- Department of Radiology, Centre Hospitalier de Valence, Valence, France
| | - Jean Tourniaire
- Department of Radiology, Clinique Rhône Durance, Avignon, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, Marseille, France
| | - Olivier Rouvière
- Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69 347, Lyon, France
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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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Bombiński P, Brzewski M, Warchol S, Biejat A, Banasiuk M, Gołębiowski M. Influence of diuretic (furosemide) on contrast medium distribution in computed tomography urography of high-grade hydronephrosis in children. Cent European J Urol 2019; 71:476-480. [PMID: 30680245 PMCID: PMC6338812 DOI: 10.5173/ceju.2018.1742] [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: 06/26/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction Diuretics improve visualization of the urinary tract in computed tomography urography in adults, as well as in magnetic resonance urography in adults and children. Also, diuretics can help to diagnose upper urinary tract obstruction in intravenous urography, ultrasonography or dynamic scintigraphy. However, there are still missing data on evaluation of furosemide usefulness in computed tomography urography examinations in children with suspected congenital anomalies of the urinary tracts. The aim of this study was to compare the homogeneity of contrast medium distribution in high-grade hydronephrosis in pediatric computed tomography urographies performed with and without use of diuretic (furosemide). Materials and method We have restrospectively analyzed computed tomography urography image series performed in the Department of Pediatric Radiology, in children with suspected congenital anomalies of the kidney and the urinary tract. Kidney units with high-grade hydronephrosis were divided in two groups: non-furosemide (n = 25) and furosemide (n = 28) group, where diuretic in dose 1 mg/kg, with maximum 20 mg, was administered intravenously 3–5 min before contrast medium administration. Subjective image quality and diagnostic confidence were evaluated by two independent radiologists and compared between study groups. Results There were no significant differences in subjective image quality and diagnostic confidence between furosemide and non-furosemide groups. Conclusions Addition of furosemide to computed tomography urography does not improve homogeneity of contrast medium distribution in hydronephrotic kidneys in children.
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Affiliation(s)
| | - Michał Brzewski
- Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Stanislaw Warchol
- Department of Pediatric Surgery and Urology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Biejat
- Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Banasiuk
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Marek Gołębiowski
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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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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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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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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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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MDCT evaluation of ureteral tumors: advantages of 3D reconstruction and volume visualization. AJR Am J Roentgenol 2014; 201:1239-47. [PMID: 24261362 DOI: 10.2214/ajr.13.10880] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This article reviews the use of CT urography in diagnosing ureteral transitional cell carcinomas, different CT urography protocols, CT findings suggestive of ureteral malignancy, and the importance of 3D reconstructions. CONCLUSION The ureters can be problematic to evaluate on CT, partly because of difficulties in obtaining adequate ureteral distention and opacification. Proper diagnosis hinges not only on appropriate interpretation of the axial images but also on the utilization of a 3D technique (volume rendering or maximum intensity projection) as an ancillary tool.
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BRIARD R, CUTHBERT F, RICHENBERG J. Haematuria. IMAGING 2013. [DOI: 10.1259/imaging.20110060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tzeng WS, Wu RH, Huang SKH, Mak CW, Liao ACH, Lin VCH. A comparison of pyelography and various reconstructions of multidetector helical computed tomography urography images for diagnosing urinary obstruction. Clin Imaging 2012; 36:773-9. [PMID: 23154009 DOI: 10.1016/j.clinimag.2011.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/15/2011] [Indexed: 11/20/2022]
Abstract
Radiologists and urologists require practical and helpful image reconstructions for diagnosing urinary obstruction. We performed different types of imaging and reconstruction, then used a self-designed urinary obstruction-specific questionnaire to evaluate the diagnostic outcome of them. Our results suggested that two-dimensional (2D) axial computed tomography (CT) is clinically superior to retrograde pyelography or antegrade pyelography, and to other modes of image reconstruction that are often used for diagnosing urinary obstruction.
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Affiliation(s)
- Wen-Sheng Tzeng
- Department of Medical Imaging, Chi-Mei Medical Center, Yung Kang Campus, 901, Chung Hwa Rd, Yung Kang City, Tainan County, Taiwan.
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MDCT urography with high-volume low-concentration i.v. contrast material, peroral hydration, i.v. furosemide, and i.v. saline: qualitative and quantitative assessment in 100 consecutive patients. AJR Am J Roentgenol 2012; 199:111-7. [PMID: 22733901 DOI: 10.2214/ajr.11.7754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to qualitatively and quantitatively assess MDCT urography performed with a high volume of low-concentration (240 mg I/mL) i.v. contrast agent supplemented with peroral hydration, i.v. furosemide, and i.v. saline. MATERIALS AND METHODS This retrospective evaluation of 100 consecutive normal MDCT urograms was performed for clinical indication of hematuria; patients (76 men and 24 women) were 27-90 years old (mean [± SD] age, 60 ± 15 years). Three radiologists evaluated the degree of opacification across six urinary tract segments (for a total of 1200 measurements per radiologist) on a 4-point scale (0-3). One radiologist measured the maximum short-axis diameter of the proximal, mid, and distal ureters in each patient. Mean opacification scores were calculated for each segment. Radiologist agreement was assessed by kappa coefficient and Spearman rank correlation. Ureteral diameter was correlated to degree of opacification using the Jonckheere-Terpstra trend test. A comparison with published studies using similar scoring methods was undertaken. RESULTS Of 1200 measured ureteral segments, a total of 24 among the three radiologists were reported as nonopacified. The mean opacification scores ranged from 2.63 ± 0.8 to 3.00 ± 0.8. Calculated kappa coefficients are indicative of substantial agreement (> 0.61). The mean maximal ureteral diameters were 5.44 ± 1.10, 6.32 ± 1.54, and 5.32 ± 1.55 mm for the proximal, mid, and distal ureters, respectively. For all three radiologists, the mean opacification scores increased as distention increased. The Spearman correlation and corresponding p value (p < 0.001) for the association between the distention with the opacification scores show significant correlation. The opacification scores and ureteral distention exceeded published results. CONCLUSION An MDCT urography technique using high-volume low-concentration i.v. contrast, oral and i.v. hydration, and i.v. diuretic reliably optimizes urinary tract opacification and distention. A positive correlation was found between ureteral distention and opacification.
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Split-bolus CT-urography using dual-energy CT: feasibility, image quality and dose reduction. Eur J Radiol 2012; 81:3160-5. [PMID: 22647423 DOI: 10.1016/j.ejrad.2012.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 04/18/2012] [Accepted: 05/04/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To prospectively evaluate the feasibility of dual-energy (DE) split-bolus CT-urography (CTU) and the quality of virtual non-enhanced images (VNEI) and DE combined nephrographic-excretory phase images (CNEPI), and to estimate radiation dose reduction if true non-enhanced images (TNEI) could be omitted. PATIENTS AND METHODS Between August and September 2011, 30 consecutive patients with confirmed or suspected urothelial cancer or with hematuria underwent DE CT. Single-energy TNEI and DE CNEPI were obtained. VNEI was reconstructed from CNEPI. Image quality of CNEPI and VNEI was evaluated using a 5-point scale. The attenuation of urine in the bladder on TNEI and VNEI was measured. The CT dose index volume (CTDI (vol)) of the two scans was recorded. RESULTS The mean image quality score of CNEPI and VNEI was 4.7 and 3.3, respectively. The mean differences in urine attenuation between VNEI and TNEI were 14±15 [SD] and -16±29 in the anterior and posterior parts of the bladder, respectively. The mean CTDI (vol) for TNEI and CNEPI was 11.8 and 10.9 mGy, respectively. Omission of TNEI could reduce the total radiation dose by 52%. CONCLUSION DE split-bolus CTU is technically feasible and can reduce radiation exposure; however, an additional TNEI scan is necessary when the VNEI quality is poor or quantitative evaluation of urine attenuation is required.
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Optimization of 64-MDCT Urography: Effect of Dual-Phase Imaging With Furosemide on Collecting System Opacification and Radiation Dose. AJR Am J Roentgenol 2011; 197:W882-6. [DOI: 10.2214/ajr.11.6965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Multi-detector CT urography: effect of oral hydration and contrast medium volume on renal parenchymal enhancement and urinary tract opacification—a quantitative and qualitative analysis. Eur Radiol 2010; 20:2146-52. [DOI: 10.1007/s00330-010-1785-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 01/25/2010] [Accepted: 02/28/2010] [Indexed: 10/19/2022]
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Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients With Hematuria. AJR Am J Roentgenol 2010; 194:453-8. [DOI: 10.2214/ajr.09.3228] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Multidetector row CT urography: does supine or prone positioning produce better pelvecalyceal and ureteral opacification? Clin Imaging 2009; 33:369-73. [DOI: 10.1016/j.clinimag.2009.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 12/20/2007] [Indexed: 11/22/2022]
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Washburn ZW, Dillman JR, Cohan RH, Caoili EM, Ellis JH. Computed Tomographic Urography Update: An Evolving Urinary Tract Imaging Modality. Semin Ultrasound CT MR 2009; 30:233-45. [DOI: 10.1053/j.sult.2009.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Current use of computed tomographic urography: survey of the society of uroradiology. J Comput Assist Tomogr 2009; 33:96-100. [PMID: 19188794 DOI: 10.1097/rct.0b013e318168f71e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine uroradiologists' opinions and practices regarding computed tomographic (CT) urography. METHODS A Web-based survey was sent via e-mail to all 259 members of the Society of Uroradiology. Of the 229 successfully delivered e-mails, 90 (39%) members responded. RESULTS Of 90 uroradiologists, 87% perform CT urography. Compared with intravenous (IV) urography, 69% of uroradiologists use CT urography more than 75% of the time urinary tract imaging is requested; 27% stated that CT urography has completely replaced IV urography. Most uroradiologists perform CT urography using multidetector-row CT alone (79%) and use a 3-phase technique (52%) using a single injection (76%) of contrast material at 3 mL/s (52%) without a compression device (81%) and with the patient in supine position (80%). CONCLUSIONS Most uroradiologists use CT urography in their practice today; some no longer perform IV urography. Variability in multidetector-row CT technique suggests that more research is needed to determine the optimal protocol.
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Silverman SG, Leyendecker JR, Amis ES. What Is the Current Role of CT Urography and MR Urography in the Evaluation of the Urinary Tract? Radiology 2009; 250:309-23. [DOI: 10.1148/radiol.2502080534] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Stacul F, Rossi A, Cova MA. CT urography: The end of IVU? Radiol Med 2008; 113:658-69. [DOI: 10.1007/s11547-008-0281-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 09/06/2007] [Indexed: 12/17/2022]
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Kim S, Wang LL, Heiken JP, Siegel CL, Hildebolt CF, Bae KT. Opacification of Urinary Bladder and Ureter at CT Urography: Effect of a Log-rolling Procedure and Postvoiding Residual Bladder Urine Volume. Radiology 2008; 247:747-53. [DOI: 10.1148/radiol.2473070965] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Hematuria may have a number of causes, of which the more common are urinary tract calculi, urinary tract infection, urinary tract neoplasms (including renal cell carcinoma and urothelial tumors), trauma to the urinary tract, and renal parenchymal disease. This article discusses the current status of imaging of patients suspected of having urologic causes of hematuria. The role of all modalities, including plain radiography, intravenous urography or excretory urography, retrograde pyelography, ultrasonography, and multidetector computed tomography (MDCT) in evaluation of these patients is discussed. The article highlights the current status of MDCT urography in imaging of patients with hematuria, and discusses various-often controversial-issues, such as optimal protocol design, accuracy of the technique in imaging of the urothelium, and the significant issue of radiation dose associated with MDCT urography.
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Affiliation(s)
- Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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Sudakoff GS, Dunn DP, Guralnick ML, Hellman RS, Eastwood D, See WA. Multidetector computerized tomography urography as the primary imaging modality for detecting urinary tract neoplasms in patients with asymptomatic hematuria. J Urol 2008; 179:862-7; discussion 867. [PMID: 18221955 DOI: 10.1016/j.juro.2007.10.061] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE We determined whether multidetector computerized tomography urography is sensitive and specific for detecting urinary tract neoplasms when used as the primary imaging modality for evaluating patients with hematuria. MATERIALS AND METHODS A retrospective review was performed of the radiological, urological and pathological records of 468 patients without a history of urinary neoplasms who presented with hematuria. All patients underwent multidetector computerized tomography urography and complete urological evaluation, including cystoscopy. Laboratory urinalysis and cytology were done in 350 and 318 of the 468 patients, respectively. Multivariate logistic regression analysis was performed using the variables multidetector computerized tomography urography diagnosis, worst urine cytology, number of red blood cells per high power field, gross hematuria, age and gender to predict urinary tract neoplasm. RESULTS A total of 50 urinary neoplasms were diagnosed in 468 patients. Multidetector computerized tomography urography detected 32 of 50 neoplasms for a sensitivity of 64%, specificity of 98%, positive predictive value of 76% and negative predictive value of 96%. There were 10 false-positive and 18 false-negative multidetector computerized tomography urography studies. Multivariate logistic regression showed that abnormal multidetector computerized tomography urography findings, ie neoplasm (p <0.0001), and suspicious or positive urine cytology (p = 0.0009) were significant. Patients with an abnormal multidetector computerized tomography urography diagnosis and suspicious or positive urine cytology had 44 and 47 times greater odds, respectively, of having urinary neoplasms compared to the odds in those with normal examinations. CONCLUSIONS Multidetector computerized tomography urography is relatively sensitive and highly specific for detecting urinary neoplasms. It may serve as the primary imaging modality to evaluate patients with hematuria. Multidetector computerized tomography urography does not eliminate the role of cystoscopy in the evaluation of hematuria.
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Affiliation(s)
- Gary S Sudakoff
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Dillman JR, Caoili EM, Cohan RH. Multi-detector CT urography: a one-stop renal and urinary tract imaging modality. ACTA ACUST UNITED AC 2008; 32:519-29. [PMID: 17597338 DOI: 10.1007/s00261-007-9185-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multi-detector computed tomography urography (CTU) is a robust imaging modality for evaluation of the kidneys and urinary tract. When compared to excretory urography (EU), CTU's superior contrast resolution appears to more effectively detect and characterize numerous benign and malignant conditions involving the kidneys, upper urinary tracts, and urinary bladder. While the concept of CTU has been utilized for nearly a decade, there is still no universally accepted technique. In fact, numerous articles evaluating various CTU techniques and associated ancillary maneuvers have been recently described in the literature. This review will discuss various indications, specific techniques, image reconstruction/reformatting, detection of pathology, and pitfalls related to CTU.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, University of Michigan Medical Center, B1-132 Taubman Center, 0302, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0302, USA
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Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CCA, Takahashi S, Cohan RH. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol 2007; 18:4-17. [DOI: 10.1007/s00330-007-0792-x] [Citation(s) in RCA: 255] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 09/08/2007] [Accepted: 09/14/2007] [Indexed: 12/14/2022]
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Dillman JR, Caoili EM, Cohan RH, Ellis JH, Francis IR, Nan B, Zhang Y. Comparison of Urinary Tract Distension and Opacification Using Single-Bolus 3-Phase vs Split-Bolus 2-Phase Multidetector Row CT Urography. J Comput Assist Tomogr 2007; 31:750-7. [PMID: 17895787 DOI: 10.1097/rct.0b013e318033df36] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare urinary tract distension and opacification obtained with single-bolus 3-phase and split-bolus 2-phase multidetector row computed tomographic urography (CTU) techniques. METHODS Twenty-six single-bolus 3-phase CTU examinations were retrospectively compared with 26 split-bolus 2-phase examinations. Two readers reviewed excretory-phase imaging to record quantitative measurements of urinary tract distension and qualitative measurements of urinary tract opacification. RESULTS Single-bolus 3-phase CTU technique provided better overall urinary tract distension than did split-bolus 2-phase technique (P = 0.05). Single-bolus CTU images demonstrated superior lower pole and interpolar region intrarenal collecting system distension when compared with split-bolus CTU images (P < or = 0.04). Qualitative opacification scores for the lower urinary tract were significantly higher, using single-bolus technique for only 1 of 2 reviewers. No significant differences between techniques in intrarenal collecting system opacification, ureteral distension, or ureteral opacification were identified. CONCLUSIONS Improved urinary tract distension is obtained with single-bolus 3-phase CTU technique.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI 48109-0302, USA
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Roy C, Jeantroux J, Irani FG, Sauer B, Lang H, Saussine C. Accuracy of intermediate dose of furosemide injection to improve multidetector row CT urography. Eur J Radiol 2007; 66:253-61. [PMID: 17646072 DOI: 10.1016/j.ejrad.2007.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 05/09/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Evaluate the usefulness of intermediate dose furosemide to improve visualization of the intrarenal collecting system and ureter using MDCTU. MATERIALS AND METHODS Two groups of 100 patients without urinary tract disease or major abdominal pathology underwent MDCTU. Group I (various abdominal indications) was performed without any additional preparation and Group II (suspicion of urinary tract disease) 10 min after injection of furosemide (20mg). MIP images of the excretory phase were post-processed. Maximal short-axis diameter of the pelvis and ureter were measured on axial images for all phases. Visualization of the collecting system wall and the identification of the whole ureter were assessed. RESULTS Mean pelvic diameter before contrast was (7.4mm, S.D.+/-2.7; 13.4mm, S.D.+/-4.1), on cortico-medullary phase (8.4mm, S.D.+/-4.2; 14.3mm, S.D.+/-4), on nephrographic phase (8.1mm, S.D.+/-2.5; 14.8mm, S.D.+/-4) and on excretory phase (9.7 mm, S.D.+/-3.4; 14.9 mm, S.D.+/-4.5), respectively, for Groups I and II. Intrarenal collecting system wall was clearly identified on both corticomedullary and nephrographic phases in 91% of Group II against 20% of Group I. Opacification of the entire ureter was excellent on excretory phase in 96% of Group II against 13% of Group I. The difference between the mean values for the two groups was statistically significant for all phases (p<10(-9)). CONCLUSION Intermediate-dose furosemide (20mg) before MDCTU is a very simple add-on for accurate depiction of pelvicalyceal details and collecting system wall without artefacts. The procedure is associated with a constant and complete visualisation of the entire urete.
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Affiliation(s)
- Catherine Roy
- Department of Radiology B, Universitary Hospital of Strasbourg-Civil Hospital, 1, Place de l'Hopital BP 426, 67091 Strasbourg Cedex, France.
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Meindl T, Coppenrath E, Degenhart C, Müller-Lisse UL, Reiser MF, Müller-Lisse UG. MDCT urography: experience with a bi-phasic excretory phase examination protocol. Eur Radiol 2007; 17:2512-8. [PMID: 17429641 DOI: 10.1007/s00330-007-0600-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Revised: 01/04/2007] [Accepted: 01/22/2007] [Indexed: 10/23/2022]
Abstract
The benefit of multidetector computed tomographic urography (MDCTU) for visualising early and late excretory phase (EP) upper urinary tract (UUT) opacification has been studied. UUT opacification was retrospectively evaluated in 45 bi-phasic four-row MDCTU examinations. The UUT was divided into intrarenal collecting system (IRCS), proximal, middle and distal ureter. Two independent readers rated opacification: 1, none; 2, partial; 3, complete. Numbers of segments and percentages of UUTs at each score were calculated for each EP and two EPs combined. Results of a single EP and of combined EPs were compared by Wilcoxon matched-pairs signed-ranks. IRCS and proximal ureter were at least partially opacified in each EP in >95%. The middle ureter was at least partially opacified in the early and late EP in 85% and 93%, respectively. The distal ureter was opacified in 65% (49/75) in the early EP and in 78% (59/75) in the late EP. Combining two EPs, non-opacified distal segments decreased to 9% (7/75). Significant improvement between a single EP and combining two EPs were found for the middle and distal ureter (P < 0.03). Bi-phasic MDCTU substantially improved opacification of the middle and distal ureter. IRCS and proximal ureter are reliably opacified with one EP.
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Affiliation(s)
- Thomas Meindl
- Department of Clinical Radiology, University Munich, Ziemssenstr 1, 80336, Munich, Germany.
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Abstract
Since the discovery of X-rays by Wilhelm Conrad R?entgen at the end of the 19th century, diagnostic imaging techniques have been continously improved by technological advances, bringing radiological diagnosis into the very center of modern medicine. Nowadays, it is hard to imagine therapy planning without previous radiological examination. Great advances in the field of computer technology have been accompanied by development of radiological techniques, and today they include not only morphological and anatomical, but also dynamic, functional and molecular imaging. This paper is an overview of new and improved radiological techniques and their implementation.
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Abstract
Bladder cancer is a heterogeneous and frequently multifocal disease with a variable clinical course. The management of bladder cancer is therefore challenging and complicated. CT and MR imaging have replaced the traditional excretory urography and are emerging as the imaging modalities of choice for work-up of patients who have bladder cancer. Imaging provides essential diagnostic information for detection, staging, and post-treatment follow-up of bladder cancer.
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Affiliation(s)
- Jingbo Zhang
- Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Kemper J, Regier M, Stork A, Adam G, Nolte-Ernsting C. Improved visualization of the urinary tract in multidetector CT urography (MDCTU): analysis of individual acquisition delay and opacification using furosemide and low-dose test images. J Comput Assist Tomogr 2006; 30:751-7. [PMID: 16954923 DOI: 10.1097/01.rct.0000224631.25198.ed] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To retrospectively analyze the reliability of opacification and image quality of a modified MDCTU examination protocol using furosemide and an individual acquisition delay by low-dose test images MATERIALS AND METHODS Excretory phase images obtained from 4-row and 16-row MSCTU examinations in 103 patients (69 men, 34 women) were independently reviewed by two radiologists. MDCTUs were performed by using a low-dose furosemide iv injection. No fixed delay for urographic image acquisition was applied. Urographic timing was individually adjusted by performing low-dose test images of the distal ureters to display their current opacification. Image analysis included grading of opacification and image quality of the segmented collecting system. Average urographic delay was calculated. Stratified comparisons of mean scores were assessed. Interobserver kappa values were calculated. RESULTS Calculated median scan delay for patients with normal creatine levels (n = 92) was 420 sec (mean 453 sec; SD, 121 sec). The median number of acquired test images was 2 (range 1-6 images). The analysis of opacification demonstrated that 97% of the ICS, 89% of the proximal, 86% of the middle, and 81% of the distal ureter segments showed opacification greater than 90%. 7.8% of the distal ureteral segments could not be visualized. Statistics did not show significant differences of opacification between proximal, middle, and distal ureteral segments (P > 0.05). Overall image quality of MSCTU showed to be high when latest test images indicated homogeneous bilateral contrasted ureters (Pearson correlation coefficient r= 0.81). Interobserver kappa values were 0.8 and 0.78. CONCLUSION Furosemide and scan delay timing by means of test images for MDCTU proved to be a reliable procedure to reach improved opacification of the upper urinary tract. It features the individual adaption of MDCTU to the excretory rate of the kidneys.
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Affiliation(s)
- Joern Kemper
- University Medical Center Hamburg-Eppendorf, Clinic of Diagnostic and Interventional Radiology, Hamburg, Germany.
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Nolte-Ernsting C, Cowan N. Understanding multislice CT urography techniques: many roads lead to Rome. Eur Radiol 2006; 16:2670-86. [PMID: 16953373 DOI: 10.1007/s00330-006-0386-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 05/10/2006] [Accepted: 06/27/2006] [Indexed: 11/30/2022]
Abstract
CT urography has emerged as a serious alternative to conventional urography by utilizing the advantages of modern multislice CT techniques for the visualization of the entire upper urinary tract. Several different examination techniques have been developed in multislice CT (MSCT) urography for improving the opacification and distension of the urinary tract. All efforts in performing MSCT urography have to compromise between the best possible image quality and a reasonably low radiation exposure. Initial low-dose examination protocols are already available. Operating modern MSCT urography properly is not difficult, but it presupposes basic knowledge on the variety of current MSCT urography techniques, including such issues as present-day indications, split-bolus injection, compression, saline infusion, low-dose diuretic administration, hybrid scanning, timing of the acquisition delay, examination protocols, postprocessing, image analysis, and radiation exposure. This article is not intended to provide guidelines of how to conduct MSCT urography, but everyone will be able to understand the functionality of several robust operating MSCT urography techniques, which helps making an individual selection for the clinical practice. In the near future, systematic studies are awaited evaluating the morphologic and diagnostic accuracy of MSCT urography regarding diverse urinary tract disorders.
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Affiliation(s)
- Claus Nolte-Ernsting
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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