Multi–detector CT Urography in the diagnosis of urinary tract abnormalities
Abstract
Introduction: Different imaging techniques are being used in the diagnosis of urinary tract abnormalities. IVU, magnetic resonance (MR) imaging, ultrasonography (US), computed tomography (CT), retrograde ureterography, pyelography, cystoscopy, and ureteroscopy are used to diagnose patients with urinary complaints. Non contrast MDCT is now routinely used to evaluate calculi, Renal masses, ureteral abnormalities and urinary bladder masses. Excretory-phase CT can now be used to evaluate the ureter. Preliminary results of excretory-phase CT demonstrate a high sensitivity (95%) in diagnosing upper urinary tract uroepithelial malignancy. CT usually demonstrates bladder disease, but flat tumours of the bladder are difficult to be identified with CT, and the cystoscopy remains the study of choice in evaluating for bladder malignany. Now with the help of MDCT protocol, comprehensive evaluation of renal disease can be performed.
Material and Methods: It is a retrospective study of 60 patients, From May 2013 to November 2014. 60 patients (41 male and 19 were females with mean age 44 yrs (age range 27 – 61 years) were selected in this study. All the patients underwent CT scan study with or without intravenous contrast medium. CT scan study was performed on a MDCT scanner (Siemens Medical Systems).
Result: Out of 60 patients, 42 (70 %) had urolithiasis. The unenhanced CT examination provides adequate information of all urinary calculi and associated hydronephrosis. 18 cases (30 %) demonstrated non urolithiasis abnormality. Out of 18 cases, 6 (10 %) cases demonstrated masse, 8 (13.33 %) cases demonstrated inflammatory changes. Congenital anomalieswas found in 4 patients (6.66%).
Conclusion: MDCT urography is the best modality with a combination of unenhanced, nephrographic-phase and excretory-phase in wide spectrum of urinary tract abnormalities. CT urography demonstrates both intrinsic and extrinsic abnormalities of ureter than IVU.
Downloads
References
2. McNicholas MM, Raptopoulos VD, Schwartz RK, Sheiman RG, Zormpala A, Prassopoulos PK, Ernst RD, Pearlman JD. Excretory phase CT urography for opacification of the urinary collecting system. AJR Am J Roentgenol. 1998 May;170(5):1261-7.
3. Grossfeld GD, Litwin MS, Wolf JS Jr, et al . Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practicepolicy- part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, andfollow-up. Urology. 2001 Apr;57(4):604-10.
4. Sheth S, Scatarige JC, Horton KM, Corl FM, Fishman EK. Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics. 2001 Oct;21 Spec No:S237-54. [PubMed]
5. Caoili EM, Cohan RH, Korobkin M, et al. Urinary tract abnormalities: initial experience with multi detector row CT urography. Radiology 2002 Feb;222(2):353-60. [PubMed]
6. Lang EK, Macchia RJ, Thomas R, et al. Computerized tomography tailored for the assessment of microscopic hematuria. J Urol 2002 Feb;167(2 Pt 1):547-54. [PubMed]
7. Kopka L, Fischer U, Zoeller G, Schmidt C, Ringert RH, Grabbe E. Dual-phase helical CT of the kidney: value of the corticomedullary and nephrographic phase for evaluation ofrenal lesions and preoperative staging of renal cell carcinoma. AJR Am J Roentgenol. 1997 Dec;169(6):1573-8. [PubMed]
8. Urban BA. The small renal mass: what is the role of multiphasic helical scanning? Radiology. 1997 Jan;202(1):22-3. [PubMed]
9. Fielding JR, Silverman SG, Rubin GD. Helical CT of the urinary tract. AJR Am J Roentgenol. 1999 May;172(5):1199-206. [PubMed]
10. Chow LC, Olcott EW, Sommer FG. Multi-detector row CT urography (CTU) with synchronous nephrographic and excretory phase enhancement (abstr). AJR Am J Roentgenol 2003; 180(suppl):71.
11. Sierakowski R, Finlayson B, Landes RR, Finlayson CD, Sierakowski N. The frequency of urolithiasis in hospital discharge diagnoses in the United States. Invest Urol. 1978 May;15(6):438-41.
12. Sommer FG1, Jeffrey RB Jr, Rubin GD, Napel S, Rimmer SA, Benford J, Harter PM. Detection of ureteral calculi in patients with suspected renal colic: value of reformatted noncontrast helical CT. AJR Am J Roentgenol. 1995 Sep;165(3):509-13.
13. Fielding JR, Silverman SG, Samuel S, Zou KH, Loughlin KR. Unenhanced helical CT of ureteral stones: a replacement for excretory urography in planning treatment. AJR Am J Roentgenol. 1998 Oct;171(4):1051-3. [PubMed]
14. Smith RC, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, Lange RC. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology. 1995 Mar;194(3):789-94. [PubMed]
15. Middleton WD, Dodds WJ, Lawson TL, Foley WD. Renal calculi: sensitivity for detection with US. Radiology. 1988 Apr;167(1):239-44. [PubMed]
16. Haddad MC, Sharif HS, Shahed MS, Mutaiery MA, Samihan AM, Sammak BM, Southcombe LA, Crawford AD. Renal colic: diagnosis and outcome. Radiology. 1992 Jul;184(1):83-8. [PubMed]
17. Bosniak MA. The current radiological approach to renal cysts. Radiology. 1986 Jan;158(1):1-10. [PubMed]
18. Bosniak MA. Diagnosis and management of patients with complicated cystic lesions of the kidney. AJR Am J Roentgenol. 1997 Sep;169(3):819-21. [PubMed]
19. Maki DD, Birnbaum BA, Chakraborty DP, Jacobs JE, Carvalho BM, Herman GT. Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. Radiology. 1999 Nov;213(2):468-72. [PubMed]
20. Cohan RH, Sherman LS, Korobkin M, Bass JC, Francis IR. Renal masses: assessment of corticomedullary-phase and nephrographic-phase CT scans. Radiology. 1995 Aug;196(2):445-51.
21. Vrtiska TJ, King BF, LeRoy AJ, et al. CT urography: description of a novel technique using a uniquely modified multidetector-row CT scanner (abstr). Radiology 2010; 217(P):225.
OAI - Open Archives Initiative
