Detection of Urothelial Tumors: Comparison of Urothelial Phase with Excretory Phase CT Urography—A Prospective Study

Published Online:https://doi.org/10.1148/radiol.12111623

Urothelial phase CT urography after injection of a diuretic has a higher lesion detection rate than the excretory phase for both upper and lower urinary tract tumors, which suggests its possible use as a single-phase protocol for evaluating the entire urinary tract.

Purpose

To compare contrast material–enhanced computed tomographic (CT) urography 60 seconds after injection of contrast material (urothelial phase [UP]) after intravenous administration of a diuretic with the standard 5-minute delayed excretory phase (EP) in a high-risk population for upper tract tumors.

Materials and Methods

Institutional review board approval and informed consent were obtained. Eighty CT urographic examinations in 77 patients known to have or at high risk for urothelial malignancy were included. After intravenous administration of a diuretic, dual-phase CT urography was performed at 60 seconds (UP) and 5 minutes (EP) after intravenous administration of contrast material. Two experienced abdominal radiologists independently interpreted each phase more than 1 month apart to minimize recall bias. Urinary tract distention and location and size of all lesions suspected of being urothelial tumors were recorded. Standard of reference was obtained from prospective study interpretation and surgical histopathologic findings. Generalized estimating equations for logistic regression were used to compare performance measures and adjust for the correlation of repeated measures within patients.

Results

There were 23 upper and 61 lower urinary tract tumors confirmed in 15 and 32 patients, respectively. For detection of bladder tumors, there was higher sensitivity for the UP than the EP (89.3% [109 of 122] vs 70.5% [86 of 122], respectively; P < .0001). For detection of upper tract tumors, there was higher sensitivity for the UP than the EP (82.6% [38 of 46] vs 69.6% [32 of 46], respectively; P = .0194). Distention of all upper urinary tract segments was better during the EP than the UP (P < .0001).

Conclusion

UP CT urography after injection of a diuretic has a higher lesion detection rate than the EP for both upper and lower urinary tract tumors, which suggests its possible use as a single-phase protocol for evaluation of the entire urinary tract in patients at high risk for urothelial tumors.

© RSNA, 2012

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Article History

Received August 2, 2011; revision requested September 14; revision received December 12; accepted December 30; final version accepted January 6, 2012.
Published online: July 2012
Published in print: July 2012