Upper urinary tract tumors: how does the contrast enhancement measured in a split-bolus CTU correlate to histological staging?. (July 2014)

• Record Type: Journal Article
• Authors: Gandrup, Karen L; Nordling, Jørgen; Balslev, Ingegerd; Thomsen, Henrik S
• Is Part Of: Acta radiologica. Volume 55:Number 6(2014:Jul.)
• Page Start: 761
• Page End: 768
• Publication Date: 2014-07
• Subjects: Abdominal/GI -- CT -- ureters -- adults -- tissue characterization -- neoplasms – primary; Radiology, Medical -- Periodicals; Radiography, Medical -- Periodicals; Radiotherapy -- Periodicals; 616.0757
• DOI: 10.1177/0284185113505278
• Languages: English
• ISSNs: 0284-1851

Abstract

Background: Computed tomography urography (CTU) is used widely in the work-up of patients with symptoms of urinary tract lesions. Preoperative knowledge of whether a tumor is invasive or non-invasive is important for the choice of surgery. So far there are no studies about the distinction of invasive and non-invasive tumors in ureter and renal pelvis based on the enhancement measured with Hounsfield Units. Purpose: To examine the value of CTU using split-bolus technique to distinguish non-invasive from invasive urothelial carcinomas in the upper urinary tract. Material and Methods: Patients who underwent nephroureterectomy between 2006 and 2011 and who had split-bolus CTU prior to surgery were included. The images were available electronically. The attenuation values before and after administration of iodine-based contrast media were measured. The radiology, patient, and pathology records were reviewed. Results: Of the 158 patients who underwent unilateral nephroureterectomy 69 fulfilled the inclusion criteria. Histopathological examination revealed 31 patients with non-invasive and 38 with invasive urothelial carcinoma. Neither absolute attenuation nor change in attenuation values obtained at CTU could distinguish between invasive and non-invasive lesions. No patients had a CTU within the last year before the examination that resulted in surgery. Conclusion: A split-bolus CTU cannot distinguish between invasive and non-invasive urothelial tumors in the upper urinary tract, but the examination is useful to diagnose a tumor in the renal pelvis and the ureter.