- “ A thorough CT urography examination involves four key phases- unenhanced, arterial, nephrogenic, and excretory- to permit identification of features such as enhancement, excretion, and associated vasculature.”
Imaging of Urothelial Cancers: What the Urologist Needs to Know
Lee EK et al.
AJR 2011; 196:1249-1254 - “ CT urography was more accurate than excretory urography in the detection and localization of upper urinary tract urothelial carcinoma and should be considered as the initial examination for the evaluation of patients at high risk for upper urinary tract urothelial carcinoma.”
Comparison of CT Urography and Excretory Urography in the Detection and Localization of Urothelial carcinoma of the Upper Urinary Tract
Jinzaki M et al.
AJR 2011; 196:1102-1109 - Infiltrative TCCs May Simulate: Differential Dx
- Focal infection
- Renal cell carcinoma (papillary cell as hypovascular)
- Lymphoma
- Metastases
- XGP - Urothelial Cancers: findings
- Single or multiple sessile filling defects that compress the renal sinus fat
- Pelvicaliceal irregularities (stricture like)
- Focal or diffuse mural thickening
- Caliceal amputation
- Tumor filled distended calices - Urothelial Cancers: facts
- Make up 10-15% of all renal tumors
- 90% are transitional cell carcinomas, 9% are squammous cell carcinoma and 1% are mucinous adenocarcinoma
- Average age is 6-7th decade of life
- Male to female ratio is 3-1
- 40% of patients with upper tract TCC will develop metachronous TCC of the lower urinary tract "Familiarity with the unusual radiologic features of urothelial cancer of the renal pelvicaliceal system will facilitate making the correct diagnosis as well as developing adequate treatment options."
Urothelial Cancer of the Renal Pelvicaliceal System: Unusual Imaging Manifestations
Prando A et al.
RadioGraphics 2010; 30:1553-1566
"The positive predictive value of CT urography for upper tract urothelial cancer is moderate because benign findings mimic cancer. Positive findings on a CT urogram are more likely to indicate cancer in the setting of large masses or positive urine cytology."
Positive Predictive Value of CT Urography in the Evaluation of Upper Tract Urothelial Cancer
Sadow CA et al.
DOI:10.2214/AJR.09.4147
"When stratified by location, urothelial thickening was more predictive of tumor in the pelvicalyceal system than in the ureter. In contrast filling defects were more predictive in the ureter than the pelvicalyceal system."
Significance of Upper Urinary Tract Urothelial Thickening and Filling Defect Seen on MDCT Urography in Patients With a History of Urothelial Neoplasms
Xu AD et al.
AJR 2010; 195: 959-965
"Our data confirm that CT urography has utility in the surveillance of upper tract tumors. Urothelial thickening is an important radiologic sign of tumor, especially in the pelvicalyceal system."
Significance of Upper Urinary Tract Urothelial Thickening and Filling Defect Seen on MDCT Urography in Patients With a History of Urothelial Neoplasms
Xu AD et al.
AJR 2010; 195: 959-965
- Split Bolus Technique for CT Urography (Maheshwari E et al.)
- Scan without contrast from top of kidneys thru the base of the bladder
- Inject 50 ml of iodixanol at 3 cc/sec
- Wait 5 minutes
- Inject 80 ml of iodixanol at 3 cc/sec
- Wait 100 seconds and then scan the patient from the top of the kidneys thru the pelvis (combined nephrographic and excretory phase) " In conclusion, in patients with hematuria, split bolus MDCT urography and oral hydration provide complete opacification of the majority of upper urinary tract segments and are accurate for the diagnosis of upper tract urothelial tumors."
Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients with Hematuria
Maheshwari E et al.
AJR 2010; 194:453-458
"We believe that oral hydration is a simple method of aiding urinary tract opacification while maintaining an effective workflow, as has been advocated previously by Kawamoto et al."
Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients with Hematuria
Maheshwari E et al.
AJR 2010; 194:453-458
"The negative predictive value of MDCT urography for upper tract tumors was 99.5% and 100% for two reviewers and 100% for the prospective interpretations."
Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients with Hematuria
Maheshwari E et al.
AJR 2010; 194:453-458
"Split-bolus MDCT urography provided at least 50% opacification of the majority of upper urinary tract segments and had high sensitivity, specificity, and accuracy for the detection of upper urinary tract tumors"
Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients with Hematuria
Maheshwari E et al.
AJR 2010; 194:453-458
- Split Bolus Technique for the Kidneys (Zamboni GA et al.)
- Inject 50 ml of IV contrast
- Wait 3 minutes
- Inject 100 ml of contrast at 4-6 ml/sec
- Begin acquisition 5 seconds after trigger point of 200 HU is reached
- Obtain a single acquisition
Kidney: Transitional Cell Carcinoma of the Kidney: Facts
- Multiplicity common
- Distal ureter most common site in the ureter (73%)
- metastases common to renal vein, IVC and local nodes
- Tumors may occassionally have fine stippled calcifications
Kidney: Transitional Cell Carcinoma of the Kidney: Facts
- 15% of malignant renal tumors
- More common in men (2-1)
- Incidences peaks in 7th decade
- Upper tract TCC occurs in 2% of patient with lower tract disease, but 40% of patients with upper tract disease develop lower tract disease
"The hallmark of TCC is multiplicity and recurrence. Nearly 2-4% of patients with bladder cancer develop upper tract TCC, but 40% of patients with upper tract TCC develop bladder cancer."
Imaging and Staging of Transitional Cell Carcinoma: Part 2, Upper Urinary Tract
Vikram R et al
AJR 2009;192:1488-1493
