AJR:194, February 2010
Ekta Maheshwari, Martin E. O'Malley,Sangeet Ghai, Marie Staunton,Christine Massey
OBJECTIVE. Our purpose was to assess upper urinary tract opacification and the perfor¬mance of split-bolus MDCT urography for upper tract tumors in patients with hematuria.
MATERIALS AND METHODS. Between January 2004 and December 2006, we identi¬fied 200 patients (119 men, 81 women; median age, 58 years, age range, 18-89 years) who under¬went MDCT urography for hematuria. MDCT urography included unenhanced and combined nephrographic and excretory phase imaging of the urinary tract. Images were independently re¬viewed by two radiologists blinded to the final diagnosis. The degree of upper urinary tract opaci¬fication and the diagnosis were recorded. Prospective interpretations were also reviewed. The stan¬dard of reference included all available clinical, imaging, and laboratory data for up to 12 months after MDCT urography. Sensitivity, specificity, accuracy, and positive and negative predictive val¬ues were calculated for upper tract tumors for prospective and retrospective interpretations.
RESULTS. For reviewers 1 and 2, 85.1% and 84.5% of segments were at least 50% opaci¬fied, respectively. Final diagnoses for hematuria were no cause, 123 (61.5%); urothelial can¬cer, 27 (13.5%); nonmalignant, 46 (23%) and indeterminate, four patients (2%). There were nine upper tract cancers. Sensitivity, specificity, and accuracy for upper tract cancers for pro¬spective interpretation, reviewer 1 and reviewer 2, were 100%, 99%, 99%; 100%, 99.5%, 99.5%; and 88.9%, 99.0%, 98.5%, respectively.
CONCLUSION. Split-bolus MDCT urography provided at least 50% opacification of the majority of upper urinary tract segments and had high sensitivity, specificity, and accu¬racy for the detection of upper urinary tract tumors.