CT Urography of Urinary Diversions with Enhanced CT Digital Radiography: Preliminary Experience

Sudakoff, Gary S.; Guralnick, Michael L.; Langenstroer, Peter; Foley, W D; Cihlar, Krista L; Shakespear, Jonathan S; See, William A.

doi:10.2214/ajr.184.1.01840131

Cited by 39 publications

(32 citation statements)

References 20 publications

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“…CTU may be useful in guiding percutaneous nephrolithotomy procedures [19], to depict abnormal postoperative findings in patients after urinary diversions [4], or to effectively diagnose medullary and papillary necrosis in an early stage when treatment can reverse the ischemic process [20]. Also, during CTU significant extraurinary findings may be found [8,21].…”

Section: Indicationsmentioning

confidence: 99%

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CT urography: definition, indications and techniques. A guideline for clinical practice

et al. 2007

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The aim was to develop clinical guidelines for multidetector computed tomography urography (CTU) by a group of experts from the European Society of Urogenital Radiology (ESUR). Peer-reviewed papers and reviews were systematically scrutinized. A summary document was produced and discussed at the ESUR 2006 and ECR 2007 meetings with the goal to reach consensus. True evidence-based guidelines could not be formulated, but expert guidelines on indications and CTU examination technique were produced. CTU is justified as a first-line test for patients with macroscopic haematuria, at high-risk for urothelial cancer. Otherwise, CTU may be used as a problem-solving examination. A differential approach using a one-, two- or three-phase protocol is proposed, whereby the clinical indication and the patient population will determine which CTU protocol is employed. Either a combined nephrographic-excretory phase following a split-bolus intravenous injection of contrast medium, or separate nephrographic and excretory phases following a single-bolus injection can be used. Lower dose (CTDIvol 5-6 mGy) is used for benign conditions and normal dose (CTDIvol 9-12 mGy) for potential malignant disease. A low-dose (CTDIvol 2-3 mGy) unenhanced series can be added on indication. The expert-based CTU guidelines provide recommendations to optimize techniques and to unify the radiologist's approach to CTU.

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Section: Indicationsmentioning

confidence: 99%

“…As MDCT has become more widely available, CTU has begun to replace other imaging techniques, especially intravenous urography (IVU). CTU is currently performed for a variety of indications using different protocols [1,2] for which purely CT-based techniques as well as hybrid CT-radiography techniques [3,4] have been utilised.…”

Section: Introductionmentioning

confidence: 99%

CT urography: definition, indications and techniques. A guideline for clinical practice

et al. 2007

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“…Postoperative imaging studies are established for the evaluation of postsurgical complications and follow-up [12][13][14][15] . Several imaging studies used computed tomography and static MRI to evaluate postoperative anatomy and functional aspects of the neobladder [9,[15][16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

Real-Time MRI of Continent and Stress Incontinent Male Patients after Orthotopic Ileal Neobladder

et al. 2011

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Introduction: The aim of this study was to correlate anatomic differences with continence status in male patients after cystoprostatectomy and ileal neobladder using real-time magnetic resonance imaging. Patients and Methods: Anatomic differences of 14 male patients (7 daytime continent and 7 stress incontinent) with ileal neobladder were determined by measuring the orthogonal distance of the bladder neck to the pubococcygeal line (PCL) to correlate anatomic differences with continence status. Results: The median distance of the bladder neck to PCL was +5.4 mm in continent patients before voiding whereas in incontinent patients it was +2 mm (p = 0.012). During the Valsalva maneuver, the median distance in continent patients was +4 and in incontinent patients –3 mm (p = 0.003). At the end of micturition, the median distance was +2.3 mm in continent patients and –12 mm in incontinent patients (p = 0.002). Conclusions: The bladder neck in incontinent patients showed more pronounced mobility in relation to the PCL during micturition and the Valsalva maneuver as compared to continent patients. In addition, the ileal neobladder was positioned significantly lower in the pelvis of incontinent patients. These preliminary results suggest that a stable bladder neck may be an important factor to reach full continence in patients with ileal neobladder.

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“…An elegant alternative injection technique, designated as "split-bolus", is also available for CT urography [3,6,[23][24][25][26][27][28]. Using the split bolus technique, one injects initially only 30 to 40 ml of contrast material.…”

Section: Techniques Of Contrast Materials Injectionmentioning

confidence: 99%

“…Caoili et al describe a four-phase protocol including unenhanced, nephrographic-phase, early excretory-phase, and late excretory-phase scans [7,19,20]. If a split bolus injection technique is preferred instead of a single bolus, CT urography can be performed using a two-phase protocol including an unenhanced phase and a nephro-pyelographic phase [6,23,[25][26][27][28].…”

Section: Number Of Ct Sans Per Ct Urographic Examinationmentioning

confidence: 99%

Understanding multislice CT urography techniques: many roads lead to Rome

2006

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CT urography has emerged as a serious alternative to conventional urography by utilizing the advantages of modern multislice CT techniques for the visualization of the entire upper urinary tract. Several different examination techniques have been developed in multislice CT (MSCT) urography for improving the opacification and distension of the urinary tract. All efforts in performing MSCT urography have to compromise between the best possible image quality and a reasonably low radiation exposure. Initial low-dose examination protocols are already available. Operating modern MSCT urography properly is not difficult, but it presupposes basic knowledge on the variety of current MSCT urography techniques, including such issues as present-day indications, split-bolus injection, compression, saline infusion, low-dose diuretic administration, hybrid scanning, timing of the acquisition delay, examination protocols, postprocessing, image analysis, and radiation exposure. This article is not intended to provide guidelines of how to conduct MSCT urography, but everyone will be able to understand the functionality of several robust operating MSCT urography techniques, which helps making an individual selection for the clinical practice. In the near future, systematic studies are awaited evaluating the morphologic and diagnostic accuracy of MSCT urography regarding diverse urinary tract disorders.

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CT Urography of Urinary Diversions with Enhanced CT Digital Radiography: Preliminary Experience

Abstract: CTU with 3D rendering can accurately depict both normal and abnormal postoperative findings in patients with urinary diversions. Adding enhanced CTDR can improve visualization of the urinary collecting system.

Cited by 39 publications

References 20 publications

CT urography: definition, indications and techniques. A guideline for clinical practice

CT urography: definition, indications and techniques. A guideline for clinical practice

Real-Time MRI of Continent and Stress Incontinent Male Patients after Orthotopic Ileal Neobladder

Understanding multislice CT urography techniques: many roads lead to Rome

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