TY - JOUR

T1 - Upper urinary tract tumors

T2 - how does the contrast enhancement measured in a split-bolus CTU correlate to histological staging?

AU - Gandrup, Karen L

AU - Nordling, Jørgen

AU - Balslev, Ingegerd

AU - Thomsen, Henrik S

N1 - © The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

PY - 2014/7

Y1 - 2014/7

N2 - BACKGROUND: Computed tomography urography (CTU) is used widely in the work-up of patients with symptoms of urinary tract lesions. Preoperative knowledge of whether a tumor is invasive or non-invasive is important for the choice of surgery. So far there are no studies about the distinction of invasive and non-invasive tumors in ureter and renal pelvis based on the enhancement measured with Hounsfield Units.PURPOSE: To examine the value of CTU using split-bolus technique to distinguish non-invasive from invasive urothelial carcinomas in the upper urinary tract.MATERIAL AND METHODS: Patients who underwent nephroureterectomy between 2006 and 2011 and who had split-bolus CTU prior to surgery were included. The images were available electronically. The attenuation values before and after administration of iodine-based contrast media were measured. The radiology, patient, and pathology records were reviewed.RESULTS: Of the 158 patients who underwent unilateral nephroureterectomy 69 fulfilled the inclusion criteria. Histopathological examination revealed 31 patients with non-invasive and 38 with invasive urothelial carcinoma. Neither absolute attenuation nor change in attenuation values obtained at CTU could distinguish between invasive and non-invasive lesions. No patients had a CTU within the last year before the examination that resulted in surgery.CONCLUSION: A split-bolus CTU cannot distinguish between invasive and non-invasive urothelial tumors in the upper urinary tract, but the examination is useful to diagnose a tumor in the renal pelvis and the ureter.

AB - BACKGROUND: Computed tomography urography (CTU) is used widely in the work-up of patients with symptoms of urinary tract lesions. Preoperative knowledge of whether a tumor is invasive or non-invasive is important for the choice of surgery. So far there are no studies about the distinction of invasive and non-invasive tumors in ureter and renal pelvis based on the enhancement measured with Hounsfield Units.PURPOSE: To examine the value of CTU using split-bolus technique to distinguish non-invasive from invasive urothelial carcinomas in the upper urinary tract.MATERIAL AND METHODS: Patients who underwent nephroureterectomy between 2006 and 2011 and who had split-bolus CTU prior to surgery were included. The images were available electronically. The attenuation values before and after administration of iodine-based contrast media were measured. The radiology, patient, and pathology records were reviewed.RESULTS: Of the 158 patients who underwent unilateral nephroureterectomy 69 fulfilled the inclusion criteria. Histopathological examination revealed 31 patients with non-invasive and 38 with invasive urothelial carcinoma. Neither absolute attenuation nor change in attenuation values obtained at CTU could distinguish between invasive and non-invasive lesions. No patients had a CTU within the last year before the examination that resulted in surgery.CONCLUSION: A split-bolus CTU cannot distinguish between invasive and non-invasive urothelial tumors in the upper urinary tract, but the examination is useful to diagnose a tumor in the renal pelvis and the ureter.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Contrast Media

KW - Diagnosis, Differential

KW - Female

KW - Humans

KW - Image Processing, Computer-Assisted

KW - Iopamidol

KW - Kidney Pelvis

KW - Male

KW - Middle Aged

KW - Neoplasm Grading

KW - Neoplasm Staging

KW - Observer Variation

KW - Radiographic Image Enhancement

KW - Reproducibility of Results

KW - Tomography, X-Ray Computed

KW - Ureter

KW - Ureteral Neoplasms

KW - Urologic Neoplasms

U2 - 10.1177/0284185113505278

DO - 10.1177/0284185113505278

M3 - Journal article

C2 - 24056890

VL - 55

SP - 761

EP - 768

JO - Acta Radiologica - Series Diagnosis

JF - Acta Radiologica - Series Diagnosis

SN - 0365-5954

IS - 6

ER -