Purpose: To prospectively determine the accuracy of portal venous phase helical multi-detector row computed tomography (CT) for bladder lesion evaluation in patients with hematuria by using cystoscopy as the reference standard.
Materials and Methods: The study was approved by the institutional review board for human investigation, and informed consent was obtained from all patients. This study included 118 patients (91 male, 27 female; age range, 15-87 years; mean age ± standard deviation, 62 years ±14) who underwent portal venous phase multi-detector row CT (scanning delay, 70 seconds; section thickness, 2 mm) and conventional cystoscopy because of painless gross hematuria or recurrent microscopic hematuria. Two reviewers with different experience levels independently evaluated the bladder for lesions at CT in a prospective fashion. The K statistic was used to determine the per lesion and per patient agreement between the two reviewers and between the CT and cystoscopic findings. The sensitivity and specificity of multi- detector row CT for bladder lesion detection were analyzed for numbers of lesions and for numbers of patients.
Results:Multi-detector row CT showed excellent per lesion (K = 0.839) and per patient (K = 0.881) agreement between the two reviewers. Respective per lesion and per patient agreement between the CT and cystoscopic findings was also excellent in the first (K = 0.866 and K = 0.881) and second (K = 0.802 and K = 0.863) reviewers. The sensitivity and specificity of multi-detector row CT were 89%-92% and 88%-97%, respectively, in the per lesion analysis and 95% and 91%-93%, respectively, in the per patient analysis for both reviewers. All statistical parameters of diagnostic accuracy were similar between the two reviewers (P>. 05).
Conclusion: Portal venous phase multi-detector row CT can provide high accuracy and reader agreement for bladder lesion detection in patients with painless gross hematuria and recurrent microscopic hematuria; these results indicate that multi-detector row CT can be used as the initial bladder examination in such patients.