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Multidetector-row computed tomography (MDCT) in patients with a history of previous urothelial cancer or painless macroscopic haematuria

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Abstract

The sensitivity and specificity of MDCT for depiction and localization of urothelial carcinoma (UC) was determined retrospectively. Axial and coronal four-row MDCT of the urinary tract (unenhanced, contrast-enhanced nephrographic, CT urography) was independently reviewed for UC by a radiologist (R1) and a urologist (R2), without other patient information, in 27 patients (22 male, five female; age, 72 ± 11 years) with previous UC and/or painless macroscopic haematuria. Urinary tract segments included bladder, right and left upper, middle, and lower caliceal groups, renal pelvis, uretero-pelvic junction, upper, middle, and lower ureter. MDCT findings were corroborated by surgery, other invasive procedures, and 1-year follow-up, including MDCT, intravenous urography, and cystoscopy. Receiver-operating characteristic analysis was undertaken and the the area under the curve (AUC) calculated. Eighteen of 27 patients had evidence of UC (pTa, n = 3; pT1-pT3, n = 15; TNM 2002). Tumor was correctly located by both R1 and R2 in 17 patients (sensitivity, 94%; 95% confidence interval, 84–100%) and ruled out in seven (specificity, 78%; 95% confidence interval, 51–100%), with complete agreement. Each detected ten of 11 upper urinary tracts affected by UC. For 35 urinary tract segments with UC and 308 without, the AUC was 0.910 ± 0.035 (R1) and 0.74 ± 0.055 (R2), z = 2.4772, Bonferroni-corrected P = 0.022. MDCT depicts urinary tracts affected by UC with high sensitivity and substantial agreement between readers with different training.

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References

  1. American Cancer Society (2004) Cancer Facts & Figures 2004. American Cancer Society, Atlanta, GA, USA, pp 30329–34251

  2. Messing EM (2002) Urothelial tumors, renal pelvis and ureter. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ (eds) Campbell’s urology, 8th edn. Saunders, pp 2732–2784

    Google Scholar 

  3. Fraley EE (1978) Cancer of the renal pelvis. In: Skinner DG, de Kernion JB (eds) Genitourinary cancer. Saunders, Philadelphia

    Google Scholar 

  4. Huben RP, Mounzer AM, Murphy GP (1988) Tumor grade and stage as prognostic variables in upper tract urothelial tumors. Cancer 62:2016–2020

    Article  PubMed  CAS  Google Scholar 

  5. Hardeman SW, Perry A, Soloway MS (1988) Transitional cell carcinoma of the prostate following intravesical therapy for transitional cell carcinoma of the bladder. J Urol 140:289–292

    PubMed  CAS  Google Scholar 

  6. Babaian RJ, Johnson DE (1980) Primary carcinoma of the ureter. J Urol 123:357–359

    PubMed  CAS  Google Scholar 

  7. Murphy DM, Zincke H, Furlow WL (1981) Management of high grade transitional cell cancer of the upper urinary tract. J Urol 135:25–29

    Google Scholar 

  8. Shinka T, Uekado Y, Aoshi H, Hirano A, Ohkawa T (1988) Occurrence of uroepithelial tumors of the upper urinary tract after the initial diagnosis of bladder cancer. J Urol 140:745–748

    PubMed  CAS  Google Scholar 

  9. Oldbring J, Glifberg I, Mikulowski P, Hellsten S (1989) Carcinoma of the renal pelvis and ureter following bladder carcinoma: risk factors and clinicopathological findings. J Urol 141:1311–1313

    PubMed  CAS  Google Scholar 

  10. Herr HW, Cookson MW, Soloway SM (1996) Upper tract tumors in patients with primary bladder cancer followed for 15 years. J Urol 156:1286–1287

    Article  PubMed  CAS  Google Scholar 

  11. Solsona E, Iborra I, Ricos JV, Monros JL, Dumont R, Almenar S (1996) Extravesical involvement in patients with bladder carcinoma in situ: biological and therapy implications. J Urol 155:895–900

    Article  PubMed  CAS  Google Scholar 

  12. Solsona E, Iborra T, Ricos JV, Dumont R, Casanova JL, Calabuig C (1997) Upper tract involvement in patients with bladder carcinoma in situ (Tis): its impact on management. Urology 49:347–352

    Article  PubMed  CAS  Google Scholar 

  13. Solsona E, Iborra I, Ricos JV, Monros L, Rubio J, Almenar S (2002) Clinical panurothelial disease in patients with superficial bladder tumors: therapeutic implications. J Urol 167:2007–2011

    Article  PubMed  CAS  Google Scholar 

  14. Grossfeld GD, Litwin MS, Wolf JS Jr, Hricak H, Shuler CL, Agerter DC, Carroll PR (2001) 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 57:604–610

    Article  PubMed  CAS  Google Scholar 

  15. Lang EK, Macchia RJ, Thomas R, Watson RA, Marberger M, Lechner G, Gayle B, Richter F (2003) Improved detection of renal pathologic features on multiphasic helical CT compared with IVU in patients presenting with microscopic hematuria. Urology 61:528–532

    Article  PubMed  Google Scholar 

  16. O’Malley ME, Hahn PF, Yoder IC, Gazelle GS, McGovern FJ, Mueller PR (2003) Comparison of excretory phase, helical computed tomography with intravenous urography in patients with painless haematuria. Clin Radiol 58:294–300

    Article  PubMed  CAS  Google Scholar 

  17. McCoy JG, Honda H, Reznicek M, Williams RD (1991) Computerized tomography for detection and staging of localized and pathologically defined upper tract urothelial tumors. J Urol 46:1500–1503

    Google Scholar 

  18. Planz B, George R, Adam G, Jakse G, Planz K (1995) Computed tomography for detection and staging of transitional cell carcinoma of the upper urinary tract. Eur Urol 27:146–150

    PubMed  CAS  Google Scholar 

  19. Scolieri MJ, Paik ML, Brown SL, Resnick MI (2000) Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinoma. Urology 56:930–934

    Article  PubMed  CAS  Google Scholar 

  20. Cholankeril JV, Freundlich R, Ketyer S, Spirito AL, Napolitano J (1986) Computed tomography in urothelial tumors of renal pelvis and related filling defects. J Comput Tomogr 10:263–272

    Article  PubMed  CAS  Google Scholar 

  21. Garufi A, Priolo GD, Coppolino F, Giammusso B, Materazzo S (1993) Computed tomography evaluation of urothelial carcinoma of the upper urinary tract. Radiol Med (Torino) 86:489–495

    CAS  Google Scholar 

  22. Valignat C, Marechal JM, Rouviere O, Gelet A, Martin X, Castagnola C, Lyonnet D, Dubernard JM (1997) Contribution of computed tomography in the staging of upper urinary tract urothelial tumors. Importance of the tumor diameter measurement. Prog Urol 7:217–224

    PubMed  CAS  Google Scholar 

  23. Ohnesorge B, Flohr T, Schaller S, Klingenbeck-Regn K, Becker C, Schopf UJ, Bruning R, Reiser MF (1999) Principles and applications of multi-slice CT. Radiologe 39:923–931

    Article  PubMed  CAS  Google Scholar 

  24. Caoili EM, Cohan RH, Korobkin M, Platt JF, Francis IR, Faerber GJ, Montie JE, Ellis JH (2002) Urinary tract abnormalities: initial experience with multidetector-row CT urography. Radiology 222:353–360

    Article  PubMed  Google Scholar 

  25. Rimondini A, Morra A, Bertolotto M, Locatelli M, Pozzi Mucelli R (2001) Spiral-CT with multiplanar reconstruction (MPRS) in the evaluation of ureteral neoplasms: preliminary results. Radiol Med (Torino) 101:459–465

    CAS  Google Scholar 

  26. Caoili EM, Cohan RH, Inampudi P, Ellis JH, Shah RB, Faerber GJ, Montie JE (2005) MDCT urography of upper tract urothelial neoplasms. AJR Am J Roentgenol 184:1873–1881

    PubMed  Google Scholar 

  27. Glantz SA (1997) Primer of biostatistics, 4th edn. McGraw-Hill, New York, pp 184–212

    Google Scholar 

  28. Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36

    PubMed  CAS  Google Scholar 

  29. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843

    PubMed  CAS  Google Scholar 

  30. Browne RF, Meehan CP, Colville J, Power R, Torreggiani WC (2005) Transitional cell carcinoma of the upper urinary tract: spectrum of imaging findings. Radiographics 25:1609–1627

    Article  PubMed  Google Scholar 

  31. Fritz GA, Schoellnast H, Deutschmann HA, Quehenberger F, Tillich M (2006) Multiphasic multidetector-row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract. Eur Radiol 16:1244–1252

    Article  PubMed  Google Scholar 

  32. Raptopoulos V, McNamara A (2005) Improved pelvicalyceal visualization with multidetector computed tomography urography; comparison with helical computed tomography. Eur Radiol 15:1834–1840

    Article  PubMed  CAS  Google Scholar 

  33. Kemper J, Regier M, Stork A, Adam G, Nolte-Ernsting C (2006) 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 30:751–757

    Article  PubMed  Google Scholar 

  34. Silverman SG, Akbar SA, Mortele KJ, Tuncali K, Bhagwat JG, Seifter JL (2006) Multi-detector row CT urography of normal urinary collecting system: furosemide versus saline as adjunct to contrast medium. Radiology 240:749–755

    Article  PubMed  Google Scholar 

  35. Meindl T, Coppenrath E, Kahlil R, Muller-Lisse UL, Reiser MF, Muller-Lisse UG (2006) MDCT urography: retrospective determination of optimal delay time after intravenous contrast administration. Eur Radiol 16:1667–1674

    Article  PubMed  Google Scholar 

  36. Caoili EM, Inampudi P, Cohan RH, Ellis JH (2005) Optimization of multi-detector row CT urography: effect of compression, saline administration, and prolongation of acquisition delay. Radiology 235:116–123

    Article  PubMed  Google Scholar 

  37. Gupta KB, Silverman SG, McTavish JD, O’Leary M, Bernazzani J (2001) The impact on diagnostic yield, practice patterns, and cost of using CT urography rather than intravenous urography in the evaluation of hematuria. Radiology 221(P):501

    Google Scholar 

  38. Coppenrath E, Meindl T, Herzog P, Khalil R, Mueller-Lisse U, Krenn L, Reiser M, Mueller-Lisse UG (2006) Dose reduction in multidetector CT of the urinary tract. Studies in a phantom model. Eur Radiol 16:1982–1989

    Article  PubMed  CAS  Google Scholar 

  39. Galanski M, Nagel HD, Stamm G (2001) CT radiation exposure risk in Germany. Rofo 173:R1–R66

    PubMed  CAS  Google Scholar 

  40. Brix G, Nagel HD, Stamm G, Veit R, Lechel U, Griebel J, Galanski M (2003) Radiation exposure in multi-slice versus single-slice spiral CT: results of a nationwide survey. Eur Radiol 13:1979–1991

    Article  PubMed  CAS  Google Scholar 

  41. Hidajat N, Vogl T, Schroder RJ, Felix R (1996) Calculated organ doses and effective dosage for computerized tomography examination of the thorax and abdomen: are these doses realistic? Rofo 164:382–387

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Radiology, University of Munich, Ziemssenstrasse 1, 80336, Muenchen, Germany

    Ullrich G. Mueller-Lisse, Josef Hinterberger, Thomas Meindl & Maximilian F. Reiser

  2. Department of Urology, University of Munich, Munich, Germany

    Ulrike L. Mueller-Lisse & Peter Schneede

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  1. Ullrich G. Mueller-Lisse
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  3. Josef Hinterberger
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Correspondence to Ullrich G. Mueller-Lisse.

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Estimation of radiation dose (long version) (DOC 31 kb)

Table A

Estimation of radiation dose in MD CT of the urinary tract (estimates for Siemens Volume Zoom four-row CT scanner) (min minimum, max maximum) (DOC 30 kb)

Appendix

Appendix

Estimation of radiation dose

Effective dose (E, measured in mSv) in CT of the abdomen and pelvis is influenced by several factors, some of which are estimated based on available measurements and technical considerations rather than being actually measured [39, 40]. For the four-row CT scanner applied here, V was 120 KVp, CTDIw,eff was 9.0 mGy per 100 mAs per slice at 1 mm collimation, and 7.6 mGy per 100 mAs per slice at 2.5 mm collimation (CT scanner software), PB was 0.49 [39], kCT was 1.0 [39], and fmean was 0.0072 for male patients and 0.0100 for female patients [41]. Estimated ranges of E in this study were 2.18–3.35 mSv (males) and 3.02–4.65 mSv (females) for unenhanced MDCT of the kidneys, 7.74–11.90 mSv (males) and 9.55–14.69 mSv (females) for MDCT from the diaphragm to the symphysis pubis in the nephrographic phase, and 4.91–9.26 mSv (males) and 5.84–11.02 mSv (females) for MDCT from the upper poles of the kidneys to the distal ureter in the excretory phase, respectively.

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Mueller-Lisse, U.G., Mueller-Lisse, U.L., Hinterberger, J. et al. Multidetector-row computed tomography (MDCT) in patients with a history of previous urothelial cancer or painless macroscopic haematuria. Eur Radiol 17, 2794–2803 (2007). https://doi.org/10.1007/s00330-007-0609-y

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