The Experts below are selected from a list of 4428 Experts worldwide ranked by ideXlab platform
Stuart G Silverman - One of the best experts on this subject based on the ideXlab platform.
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diagnostic yield of ct Urography in the evaluation of young adults with hematuria
American Journal of Roentgenology, 2012Co-Authors: Peter R Lokken, Cheryl A Sadow, Stuart G SilvermanAbstract:OBJECTIVE. CT Urography is increasingly used as the initial imaging test in patients with hematuria. The aim of our study was to determine the yield of CT Urography in young adults with hematuria to see whether single phase unenhanced CT would have been sufficient. MATERIALS AND METHODS. We reviewed medical records of consecutive patients undergoing CT Urography between March 2000 and July 2009 at our tertiary medical center. Of 5400 CT urograms performed, 375 (6.9%) in 359 patients aged 40 years or younger with hematuria were included in the study. Urographic findings were tabulated according to their clinical significance. CT images were reviewed to see whether contrast-enhanced images were necessary for diagnosis. RESULTS. A clinically significant source was found in 83 of 375 examinations (22.1%), including 42 of 142 (29.6%) for gross hematuria, 29 of 181 (16.0%) for microscopic hematuria, and 12 of 52 (23.1%) for hematuria of unspecified subtype. The most common clinically significant findings were r...
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comparison of ct Urography and excretory Urography in the detection and localization of urothelial carcinoma of the upper urinary tract
American Journal of Roentgenology, 2011Co-Authors: Masahiro Jinzaki, Kazuhiro Matsumoto, Eiji Kikuchi, Kazuki Sato, Yutaka Horiguchi, Yuji Nishiwaki, Stuart G SilvermanAbstract:OBJECTIVE. The purpose of this study was to compare the accuracy of CT Urography and excretory Urography for the detection and localization of upper urinary tract urothelial carcinoma.MATERIALS AND METHODS. Of 128 patients at high risk for upper tract urothelial carcinoma who were examined with both CT Urography and excretory Urography between 2002 and 2007, 24 were undiagnosed and excluded. CT Urography and excretory Urography results of the remaining 104 patients and 552 urinary tract segments were compared with histopathologic examination or follow-up imaging at 1 year. Two readers independently scored the confidence levels for the presence or absence of upper urinary tract urothelial carcinoma in each of six upper urinary tract segments on both CT Urography and excretory Urography; differences were resolved by consensus.RESULTS. Upper urinary tract urothelial carcinoma was diagnosed in 77 (14%) segments of 46 (44%) patients. Per-patient sensitivity, specificity, overall accuracy, and area under the re...
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what is the current role of ct Urography and mr Urography in the evaluation of the urinary tract
Radiology, 2009Co-Authors: Stuart G Silverman, John R Leyendecker, Stephen E AmisAbstract:Technologic advances in both computed tomography (CT) and magnetic resonance (MR) imaging have resulted in the ability to image the urinary tract in ways that surpass the prior mainstay of urinary tract imaging, the intravenous urogram. In adults, for most, if not all, historical indications for intravenous Urography, CT Urography or MR Urography is now the preferred examination. Although a variety of techniques for both examinations have been described, each test provides more diagnostic information than does intravenous Urography. With the introduction of multidetector technology, CT Urography, to date, has emerged as the initial heir apparent to intravenous Urography; many years of experience have now clearly demonstrated that CT is the test of choice for many urologic problems, including urolithiasis, renal masses, urinary tract infection, trauma, and obstructive uropathy. CT Urography provides a detailed anatomic depiction of each of the major portions of the urinary tract--the kidneys, intrarenal collecting systems, ureters, and bladder--and thus allows patients with hematuria to be evaluated comprehensively. MR Urography can be used also to evaluate the urinary tract and has the advantage of not using ionizing radiation and the potential to provide more functional information than CT. However, MR Urography is less established and less reliably results in diagnostic image quality relative to CT Urography. Although both tests can be used to evaluate the urinary tract, several issues remain and include reaching a consensus on the optimal protocols and appropriate utilization in an era of cost containment and heightened concerns about radiation exposure.
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multi detector row ct Urography comparison of strategies for depicting the normal urinary collecting system
Radiology, 2002Co-Authors: Jeffrey D Mctavish, Masahiro Jinzaki, Kelly H Zou, Richard D Nawfel, Stuart G SilvermanAbstract:PURPOSE: To evaluate several protocols for depiction of the urinary collecting system with multi–detector row computed tomographic (CT) Urography. MATERIALS AND METHODS: Fifty-one patients with hematuria or a suspicious renal mass underwent CT Urography, during which thinly collimated (1-mm) pyelographic phase scanning was performed 8–10 minutes after contrast medium administration. Patients were examined while prone only (n = 17) and while both prone and supine (n = 17) after a 250-mL infusion of normal saline. Each collecting system and ureter was divided into six segments that were assigned opacification scores. All acquisition techniques were compared, and the highest-scoring technique was compared with that in 17 patients who underwent conventional intravenous Urography (IVU). Three reconstruction techniques (transverse, coronal, and maximal intensity projection) were also compared. Stratified analysis was performed with the paired two-tailed Student t test to compare opacification scores for both th...
M Alaopas - One of the best experts on this subject based on the ideXlab platform.
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mr Urography in evaluation of acute flank pain
American Journal of Roentgenology, 2012Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE. The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain.SUBJECTS AND METHODS. Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference.RESULTS. Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the det...
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patients with acute flank pain comparison of mr Urography with unenhanced helical ct
Radiology, 2002Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Sakari Kainulainen, Auli Malinen, M AlaopasAbstract:PURPOSE: To compare unenhanced helical computed tomography (CT) and magnetic resonance (MR) Urography, by using T2-weighted and contrast material–enhanced T1-weighted imaging to examine patients with acute flank pain, with reference to excretory Urography and final clinical diagnosis. MATERIALS AND METHODS: Forty-nine patients underwent CT, MR Urography (with T2-weighted and gadopentetate dimeglumine–enhanced T1-weighted sequences), and excretory Urography. CT and MR urographic findings were evaluated separately and independently by two radiologists each (CT, observers A and B; MR Urography, observers C and D) for the presence, cause, level, and degree of obstruction. The final conclusive diagnosis was based on the combination of excretory urographic, clinical, and interventional results. RESULTS: At final diagnosis, 32 (65%) patients were found to have ureteral stones causing unilateral obstruction. In ureteral stone detection, the sensitivity and specificity of CT were 90.6% (29 of 32 patients) and 100....
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mr Urography in evaluation of acute flank pain t2 weighted sequences and gadolinium enhanced three dimensional flash compared with Urography
American Journal of Roentgenology, 2001Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain. SUBJECTS AND METHODS Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference. RESULTS Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the detection of stones 3D FLASH was superior, with a sensitivity of 96.2% and 100% and specificity of 100% and 100% for observers A and B, respectively, compared with a sensitivity of 57.7% and 53.8% and a specificity of 100% and 100%, respectively, for T2-weighted sequences. The best degree of obstruction was seen with 3D FLASH, and the interobserver agreement was excellent for stone detection (kappa = 0.97). CONCLUSION T2-weighted sequences alone are not sufficient for examining patients with acute flank pain. However, the combined use of both T2-weighted and 3D FLASH sequences will ensure better confidence in the evaluation of acute suspected renal colic. MR Urography can replace conventional excretory Urography when the latter is contraindicated or undesirable.
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mr Urography in evaluation of acute flank pain t2 weighted sequences and gadolinium enhanced three dimensional flash compared with Urography fast low angle shot
American Journal of Roentgenology, 2001Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE. The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain.SUBJECTS AND METHODS. Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference.RESULTS. Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the det...
M Sudah - One of the best experts on this subject based on the ideXlab platform.
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Magnetic Resonance (MR) and Computed Tomography (CT) Urography Imaging protocols.
2016Co-Authors: M Sudah, Sakari Kainulainen, Amro Masarwah, Marja Pitkänen, Hanna Matikka, Vaiva Dabravolskaite, Sirpa Aaltomaa, Ritva VanninenAbstract:Magnetic Resonance (MR) and Computed Tomography (CT) Urography Imaging protocols.
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mr Urography in evaluation of acute flank pain
American Journal of Roentgenology, 2012Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE. The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain.SUBJECTS AND METHODS. Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference.RESULTS. Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the det...
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patients with acute flank pain comparison of mr Urography with unenhanced helical ct
Radiology, 2002Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Sakari Kainulainen, Auli Malinen, M AlaopasAbstract:PURPOSE: To compare unenhanced helical computed tomography (CT) and magnetic resonance (MR) Urography, by using T2-weighted and contrast material–enhanced T1-weighted imaging to examine patients with acute flank pain, with reference to excretory Urography and final clinical diagnosis. MATERIALS AND METHODS: Forty-nine patients underwent CT, MR Urography (with T2-weighted and gadopentetate dimeglumine–enhanced T1-weighted sequences), and excretory Urography. CT and MR urographic findings were evaluated separately and independently by two radiologists each (CT, observers A and B; MR Urography, observers C and D) for the presence, cause, level, and degree of obstruction. The final conclusive diagnosis was based on the combination of excretory urographic, clinical, and interventional results. RESULTS: At final diagnosis, 32 (65%) patients were found to have ureteral stones causing unilateral obstruction. In ureteral stone detection, the sensitivity and specificity of CT were 90.6% (29 of 32 patients) and 100....
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mr Urography in evaluation of acute flank pain t2 weighted sequences and gadolinium enhanced three dimensional flash compared with Urography
American Journal of Roentgenology, 2001Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain. SUBJECTS AND METHODS Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference. RESULTS Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the detection of stones 3D FLASH was superior, with a sensitivity of 96.2% and 100% and specificity of 100% and 100% for observers A and B, respectively, compared with a sensitivity of 57.7% and 53.8% and a specificity of 100% and 100%, respectively, for T2-weighted sequences. The best degree of obstruction was seen with 3D FLASH, and the interobserver agreement was excellent for stone detection (kappa = 0.97). CONCLUSION T2-weighted sequences alone are not sufficient for examining patients with acute flank pain. However, the combined use of both T2-weighted and 3D FLASH sequences will ensure better confidence in the evaluation of acute suspected renal colic. MR Urography can replace conventional excretory Urography when the latter is contraindicated or undesirable.
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mr Urography in evaluation of acute flank pain t2 weighted sequences and gadolinium enhanced three dimensional flash compared with Urography fast low angle shot
American Journal of Roentgenology, 2001Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE. The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain.SUBJECTS AND METHODS. Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference.RESULTS. Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the det...
Ritva Vanninen - One of the best experts on this subject based on the ideXlab platform.
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Magnetic Resonance (MR) and Computed Tomography (CT) Urography Imaging protocols.
2016Co-Authors: M Sudah, Sakari Kainulainen, Amro Masarwah, Marja Pitkänen, Hanna Matikka, Vaiva Dabravolskaite, Sirpa Aaltomaa, Ritva VanninenAbstract:Magnetic Resonance (MR) and Computed Tomography (CT) Urography Imaging protocols.
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mr Urography in evaluation of acute flank pain
American Journal of Roentgenology, 2012Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE. The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain.SUBJECTS AND METHODS. Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference.RESULTS. Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the det...
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patients with acute flank pain comparison of mr Urography with unenhanced helical ct
Radiology, 2002Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Sakari Kainulainen, Auli Malinen, M AlaopasAbstract:PURPOSE: To compare unenhanced helical computed tomography (CT) and magnetic resonance (MR) Urography, by using T2-weighted and contrast material–enhanced T1-weighted imaging to examine patients with acute flank pain, with reference to excretory Urography and final clinical diagnosis. MATERIALS AND METHODS: Forty-nine patients underwent CT, MR Urography (with T2-weighted and gadopentetate dimeglumine–enhanced T1-weighted sequences), and excretory Urography. CT and MR urographic findings were evaluated separately and independently by two radiologists each (CT, observers A and B; MR Urography, observers C and D) for the presence, cause, level, and degree of obstruction. The final conclusive diagnosis was based on the combination of excretory urographic, clinical, and interventional results. RESULTS: At final diagnosis, 32 (65%) patients were found to have ureteral stones causing unilateral obstruction. In ureteral stone detection, the sensitivity and specificity of CT were 90.6% (29 of 32 patients) and 100....
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mr Urography in evaluation of acute flank pain t2 weighted sequences and gadolinium enhanced three dimensional flash compared with Urography
American Journal of Roentgenology, 2001Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain. SUBJECTS AND METHODS Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference. RESULTS Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the detection of stones 3D FLASH was superior, with a sensitivity of 96.2% and 100% and specificity of 100% and 100% for observers A and B, respectively, compared with a sensitivity of 57.7% and 53.8% and a specificity of 100% and 100%, respectively, for T2-weighted sequences. The best degree of obstruction was seen with 3D FLASH, and the interobserver agreement was excellent for stone detection (kappa = 0.97). CONCLUSION T2-weighted sequences alone are not sufficient for examining patients with acute flank pain. However, the combined use of both T2-weighted and 3D FLASH sequences will ensure better confidence in the evaluation of acute suspected renal colic. MR Urography can replace conventional excretory Urography when the latter is contraindicated or undesirable.
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mr Urography in evaluation of acute flank pain t2 weighted sequences and gadolinium enhanced three dimensional flash compared with Urography fast low angle shot
American Journal of Roentgenology, 2001Co-Authors: M Sudah, Ritva Vanninen, Kaarina Partanen, A Heino, Petri Vainio, M AlaopasAbstract:OBJECTIVE. The aim of this study was to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced three-dimensional fast low-angle shot (3D FLASH) MR Urography in the evaluation of patients with acute flank pain.SUBJECTS AND METHODS. Forty consecutive patients with symptoms of acute flank pain underwent MR Urography followed immediately by excretory Urography. Heavily T2-weighted (combined thin-slice half-Fourier acquisition single-shot turbo spin-echo [HASTE] and thick-slab single-shot turbo spin-echo) and 3D FLASH sequences were evaluated separately and independently by two experienced radiologists for the presence, cause, level, and degree of obstruction. Interobserver agreement was calculated using the kappa statistic. Excretory Urography and the final clinical diagnosis were used as reference.RESULTS. Twenty-six patients were found to have unilateral obstruction caused by ureteral stones. Both MR Urography methods were excellent for detecting obstruction. In the det...
Nigel C Cowan - One of the best experts on this subject based on the ideXlab platform.
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evaluation of diagnostic strategies for bladder cancer using computed tomography ct Urography flexible cystoscopy and voided urine cytology results for 778 patients from a hospital haematuria clinic
BJUI, 2012Co-Authors: Christopher Blick, S Nazir, Susan Mallett, Benjamin W Turney, Natasha Onwu, Ian S D Roberts, Jeremy Crew, Nigel C CowanAbstract:Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Haematuria clinics with same day imaging and flexible cystoscopy are an efficient way for investigating patients with haematuria. The principal role of haematuria clinics with reference to bladder cancer is to determine which patients are ‘normal’ and may be discharged, and which patients are abnormal and should undergo rigid cystoscopy. It is well recognised that CT Urography offers a thorough evaluation of the upper urinary tract for stones, renal masses and urothelial neoplasms but the role of CT Urography for diagnosing bladder cancer is less certain. The aim of the present study was to evaluate the diagnostic accuracy of CT Urography in patients with visible haematuria aged >40 years and to determine if CT Urography has a role for diagnosing bladder cancer. This study shows that the optimum diagnostic strategy for investigating patients with visible haematuria aged >40 years with infection excluded is a combined strategy using CT Urography and flexible cystoscopy. Patients positive for bladder cancer on CT Urography should be referred directly for rigid cystoscopy and so avoid flexible cystoscopy. The number of flexible cystoscopies required therefore may be reduced by 17%. The present study also shows that the diagnostic accuracy of voided urine cytology is too low to justify its continuing use in a haematuria clinic using CT Urography and flexible cystoscopy. OBJECTIVES • To evaluate and compare the diagnostic accuracy of computed tomography (CT) Urography with flexible cystoscopy and voided urine cytology for diagnosing bladder cancer. • To evaluate diagnostic strategies using CT Urography as: (i) an additional test or (ii) a replacement test or (iii) a triage test for diagnosing bladder cancer in patients referred to a hospital haematuria rapid diagnosis clinic. PATIENTS AND METHODS • The clinical cohort consisted of a consecutive series of 778 patients referred to a hospital haematuria rapid diagnosis clinic from 1 March 2004 to 17 December 2007. Criteria for referral were at least one episode of macroscopic haematuria, age >40 years and urinary tract infection excluded. Of the 778 patients, there were 747 with technically adequate CT Urography and flexible cystoscopy examinations for analysis. • On the same day, patients underwent examination by a clinical nurse specialist followed by voided urine cytology, CT Urography and flexible cystoscopy. Voided urine cytology was scored using a 5-point system. CT Urography was reported immediately by a uroradiologist and flexible cystoscopy performed by a urologist. Both examinations were scored using a 3-point system: 1, normal; 2, equivocal; and 3, positive for bladder cancer. • The reference standard consisted of review of the hospital imaging and histopathology databases in December 2009 for all patients and reports from the medical notes for those referred for rigid cystoscopy. Follow-up was for 21–66 months. RESULTS • The prevalence of bladder cancer in the clinical cohort was 20% (156/778). For the diagnostic strategy using CT Urography as an additional test for diagnosing bladder cancer, when scores of 1 were classified as negative and scores of 2 and 3 as positive, sensitivity was 1.0 (95% confidence interval [CI] 0.98–1.00), specificity was 0.94 (95% CI 0.91–0.95), the positive predictive value (PPV) was 0.80 (95% CI 0.73–0.85) and the negative predictive value (NPV) was 1.0 (95% CI 0.99–1.00). • For the diagnostic strategy using CT Urography as a replacement test for flexible cystoscopy for diagnosing bladder cancer, when scores of 1 were classified as negative and scores of 2 and 3 as positive, sensitivity was 0.95 (95% CI 0.90–0.97), specificity was 0.83 (95% CI 0.80–0.86), the PPV was 0.58 (95% CI 0.52–0.64), and the NPV was 0.98 (95% CI 0.97–0.99). Similarly using flexible cystoscopy for diagnosing bladder cancer, if scores of 1 were classified as negative and scores of 2 and 3 as positive, sensitivity was 0.98 (95% CI 0.94– 0.99), specificity was 0.94 (95% CI 0.92–0.96), the PPV was 0.80 (95% CI 0.73–0.85) and the NPV was 0.99 (95% CI 0.99–1.0). • For the diagnostic strategy using CT Urography and flexible cystoscopy as a triage test for rigid cystoscopy and follow-up (option 1), patients with a positive CT Urography score are referred directly for rigid cystoscopy, and patients with an equivocal or normal score were referred for flexible cystoscopy. Sensitivity was 1.0 (95% CI 0.98–1.0), specificity was 0.94 (95% CI 0.91–0.95), the PPV was 0.80 (95% CI 0.73–0.85), and the NPV was 1.0 (95% CI 0.99–1.0). • For the diagnostic strategy using CT Urography and flexible cystoscopy as a triage test for rigid cystoscopy and follow-up (option 2), patients with a positive CT Urography score are referred directly for rigid cystoscopy, patients with an equivocal score are referred for flexible cystoscopy and patients with a normal score undergo clinical follow-up. Sensitivity was 0.95 (95% CI 0.90–0.97), specificity was 0.98 (95% CI 0.97–0.99), the PPV was 0.93 (95% CI 0.87–0.96), and the NPV was 0.99 (95% CI 0.97–0.99). • For voided urine cytology, if scores of 0–3 were classified as negative and 4–5 as positive for bladder cancer, sensitivity was 0.38 (95% CI 0.31–0.45), specificity was 0.98 (95% CI 0.97–0.99), the PPV was 0.82 (95% CI 0.72–0.88) and the NPV was 0.84 (95% CI 0.81–0.87). CONCLUSIONS • There is a clear advantage for the diagnostic strategy using CT Urography and flexible cystoscopy as a triage test for rigid cystoscopy and follow-up (option 1), in which patients with a positive CT Urography score for bladder cancer are directly referred for rigid cystoscopy, but all other patients undergo flexible cystoscopy. • Diagnostic accuracy is the same as for the additional test strategy with the advantage of a 17% reduction of the number of flexible cystoscopies performed. • The sensitivity of voided urine cytology is too low to justify its continuing use in a hospital haematuria rapid diagnosis clinic using CT Urography and flexible cystoscopy.
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ct Urography for hematuria
Nature Reviews Urology, 2012Co-Authors: Nigel C CowanAbstract: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.
