Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour

Cowan, Nigel C.; Turney, Ben; Taylor, Nick; McCarthy, Catherine; Crew, Jeremy

doi:10.1111/j.1464-410x.2007.06766.x

Cited by 170 publications

(86 citation statements)

References 31 publications

(40 reference statements)

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“…Some guidelines suggest CTU for visible haematuria and not for non-visible haematuria unless there is high suspicion from baseline investigations [14], and this may be an appropriate economic practice. However, there will be a small number of urothelial lesions missed by this approach, given that CTU has a diagnostic superiority to the alternative investigations for haematuria [1,2]. Our diagnostic yield of urological malignancy was similar to that of previous studies [15,16], although these used intravenous urography and not CT.…”

Section: Discussionsupporting

confidence: 68%

“…It is difficult, however, to quantify the cost of the early identification of a treatable asymptomatic condition such as an aneurysm or adrenal malignancy. The cost incurred per patient is also relatively low when compared with the CT urogram itself and it is unlikely that the use of CTU will decrease owing to its superiority over IVU in detecting upper tract urothelial pathology [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…Previously, intravenous urography (IVU) was the primary imaging modality for the upper urinary tract. However, CTU has been shown to be more accurate at identifying upper tract urothelial pathology [1][2][3]. It also has the advantage of providing accurate staging for newly diagnosed tumours of the urinary tract and, in particular, may provide valuable staging information prior to an endoscopic resection in bladder cancer.…”

mentioning

confidence: 99%

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The economic implications of unsuspected findings from CT urography performed for haematuria

Bromage

Liew²,

Moore³

et al. 2012

BJR

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Objectives: We set out to determine the prevalence of unsuspected findings from CT urography (CTU) performed for haematuria and to evaluate the economic implications associated with the subsequent management of these findings. Methods: We analysed the results of 778 consecutive CTU scans performed in a haematuria clinic between 2008 and 2010. We excluded cases where diagnosis of an abnormality had been made prior to CTU. Costs incurred during the follow-up of unsuspected findings were calculated following guidance set out in the NHS Costing Manual 2009/10. Results: 778 CTU scans were performed for patients attending a haematuria clinic from 2008 to 2010. 455 men and 323 women underwent CTU scan; they had a median age of 62 years. 56% of scans were found to have unexpected extra-urinary findings (587 abnormalities in 439 scans). Common findings included diverticular disease (138, 17.7%), adrenal masses [85, 10.9%; 40 (5.1%) of which were indeterminate], lung abnormalities (67, 8.6%), gall bladders containing calculi (44, 5.7%), adnexal cysts (25, 7.7% of women) and aortic aneurysms (18, 2.3%). These findings led to a total of 136 outpatient appointments, 88 radiological investigations and 11 procedures (4 of which were major). The overall cost incurred was £47 366, or £60 per patient. Conclusion: CTU is associated with a high rate of unsuspected findings. There is an economic implication to performing CT scanning in this setting, in which further unanticipated investigation and treatment cost is approximately £60 per patient.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The economic implications of unsuspected findings from CT urography performed for haematuria

Bromage

Liew²,

Moore³

et al. 2012

BJR

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“…Urine cytology has a sensitivity of 21.1% for detecting bladder TCC [2]. Abdominal CT has a sensitivity of 80% for upper urinary tract tumor and a sensitivity of 60% for bladder tumors [3,4]. Cystoscopy has a sensitivity of 62-84% in white light cystoscopy [5].…”

Section: Discussionmentioning

confidence: 99%

Biopsy-Proven Transitional Cell Carcinoma of a Lung Mass Without an Urothelial Origin - A Rare Case Report

Liao¹,

Huang²

2017

J Clin Case Rep

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A 77-year-old man with smoking history visited Thoracic Surgery department with a complaint of dry cough and dyspnea for months. Chest CT showed a mass over left upper lobe, mediastinal lymph node enlargement and bilateral lung nodules. CT-guide biopsy of the left upper lung mass revealed transitional cell carcinoma. Nevertheless, no primary origin was discovered after a thorough evaluation of genitourinary tract, including abdominal CT, FDG-PET, cystoscopy and retrograde pyelography. We will discuss the possible reasons for the unknown primary origin of transitional cell carcinoma in a lung mass.

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“…Recently, even these indications have come under threat with the emergence of the CT urogram, which can provide exquisite demonstration of the renal parenchyma and urothelium at the expense of a high-radiation dose [6]. These techniques have largely replaced the IVU in healthcare settings, to the point where Amis [7] wrote a review in 1999 entitled ''Epitaph for the urogram'' predicting its demise.…”

mentioning

confidence: 99%

Digital tomosynthesis—a new lease of life for the intravenous urogram?

Wells

Raju²,

Rowberry³

et al. 2011

BJR

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Objectives: Digital tomosynthesis is a new digital technique based on conventional Xray tomography. It acquires multiple low-dose projections during a single sweep of the X-ray tube, which are reassembled to provide high-resolution slices at different depths. Suggested uses include visualisation of pulmonary nodules, mammography, angiography, dental imaging and delineation of fractures. This study aims to evaluate its potential role as part of an intravenous urogram (IVU) by assessing the diagnostic quality in imaging the kidneys in clinical practice. Methods: 100 renal units from consecutive traditional IVU studies were retrospectively compared with 101 renal units imaged using digital tomosynthesis. These were scored for visualisation of the renal outline and collecting system, presence of a renal cyst or mass and overall diagnostic quality. Radiation doses were calculated. Results: 46.5% of traditional IVUs were found to be of diagnostic quality. The IVUs with digital tomosynthesis were of diagnostic quality in 95.5%. This represents a highly statistically significant difference (p,0.0001). There was also a statistically significant dose reduction, with a mean reduction of 56%, for the samples studied. Conclusion: Digital tomosynthesis offers a significant increase in the percentage of diagnostic quality tests for assessing renal pathology, compared with traditional IVU, and significantly reduces radiation. It also offers considerable advantages in ease and speed of imaging. For these reasons, in any situation where IVU is still being used to assess the kidneys, digital tomosynthesis is likely to be of considerable benefit in improving diagnostic quality.

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Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour

Cited by 170 publications

References 31 publications

The economic implications of unsuspected findings from CT urography performed for haematuria

The economic implications of unsuspected findings from CT urography performed for haematuria

Biopsy-Proven Transitional Cell Carcinoma of a Lung Mass Without an Urothelial Origin - A Rare Case Report

Digital tomosynthesis—a new lease of life for the intravenous urogram?

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