Abstract
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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References
Nolte-Ernsting C, Cowan NC (2006) Understanding multislice CT urography techniques: many roads lead to Rome. Eur Radiol 16:2670–2686
Morcos SK (2007) CT Urography: technique, indications and limitations. Curr Opin Urology 17:56–64
Kawashima A, Vrtiska TJ, LeRoy AJ, Hartman RP, McCollough CH, King BF Jr (2004) CT urography. Radiographics 24(Suppl 1):S35–S58
Sudakoff GS, Guralnick M, Langenstroer P et al (2005) CT urography of urinary diversions with enhanced CT digital radiography: preliminary experience. AJR Am J Roentgenol 184:131–138
Grossfeld GD, Litwin MS, Wolf JS Jr et al (2001) Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy, part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology 57:604–610
Cohen RA, Brown RS (2003) Clinical practice: microscopic hematuria. N Engl J Med 348:2330–2338
Oosterlinck W, Solsona E, van der Meijden APM et al (2004) EAU Guidelines on diagnosis and treatment of upper urinary tract transitional cell carcinoma. Eur Urol 46:147–154
Gray Sears CL, Ward JF, Sears ST, Puckett MF, Kane CJ, Amling CL (2002) Prospective comparison of computerized tomography and excretory urography in the initial evaluation of asymptomatic microhematuria. J Urol 168:2457–2460
Lang EK, Macchia RJ, Thomas R et al (2002) Computerized tomography tailored for the assessment of microscopic hematuria. J Urol 167:547–554
Lang EK, Macchia RJ, Thomas R et al (2003) Improved detection of renal pathologic features on multiphasic helical CT compared with IVU in patients presenting with microscopic hematuria. Urology 61:528–532
Lang EK, Thomas R, Davis R et al (2004) Multiphasic helical computerized tomography for the assessment of microscopic hematuria: a prospective study. J Urol 171:237–243
Albani JM, Ciaschini MW, Streem SB, Herts BR, Angermeier MW (2007) The role of computerized tomographic urography in the initial evaluation of hematuria. J Urol 177:644–648
Tsili AC, Efremedis SC, Kalef-Ezra J et al (2007) Multidetector-row CT urography on a 16-row CT scanner in the evaluation of urothelial tumors. Eur Radiol 17:1046–1054
Caoili EM, Cohan RH, Inampudi P et al (2005) MDCT urography for upper tract urothelial neoplasms. AJR Am J Roentgenol 184:1873–1881
Fritz GA, Schoelnast H, Deutschmann H et al (2006) Multiphasic multidetector row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract. Eur Radiol 16:1244–1252
Cowan NC, Turney BW, Taylor NJ, McCarthy CL, Crew JP (2007) Multidetector CT urography for diagnosing upper urinary tract urothelial tumour. BJU Int 99:1363–1370
Planz B, George R, Adam G, Jakse G, Planz K (1995) Computed tomography for detection and staging of transitional cell carcinoma of the upper urinary tract. Eur Urol 27:146–150
Turney BW, Willatt JMC, Nixon D, Crew JP, Cowan NC (2006) Computed tomography for diagnosing bladder cancer. BJU Int 98:345–348
Thiruchelvam N, Mostafid H, Ubhayar G (2005) Planning percutaneous nephrolithotomy using multidetector computed tomography urography, multiplanar reconstruction and three-dimensional reformatting. BJU Int 95:1280–1284
Lang EK, Macchia RJ, Thomas R et al (2003) Detection of medullary and papillary necrosis at an early stage by multiphasic helical computed tomography. J Urol 170:94–98
Liu W, Mortele KJ, Silverman SG (2005) Incidental extraurinary findings at MDCT urography in patients with hematuria: prevalence and impact on imaging costs. AJR Am J Roentgenol 185:1051–1056
Kawamoto S, Horton KM, Fishman EK (2006) Opacification of the collecting system and ureters on excretory-phase CT using oral water as contrast medium. AJR Am J Roentgenol 186:136–140
Silverman SG, Akbar SA, Mortele KJ, Tuncali K, Bhagwat JG, Seifter JL (2006) Multidetector-row CT urography: comparison of furosemide and saline as adjuncts to contrast medium for depicting the normal urinary collecting system. Radiology 240:749–755
McNicholas MMJ, Raptopoulos VD, Schwartz RK et al (1998) Excretory phase CT urography for opacification of the urinary collecting system. AJR Am J Roentgenol 170:1261–1267
McTavish JD, Jinzaki M, Zou KH et al (2002) Multi-detector row CT urography: comparison of strategies for depicting the normal urinary collecting system. Radiology 225:83–790
Sanyal R, Deshmukh A, Sheorain VS, Taori K (2007) CT urography: a comparison of strategies of upper urinary tract opacification. Eur Radiol 17:1262–1266
Ichikawa T, Erturk SM, Araki T (2006) Multiphasic contrast-enhanced multidetector-row CT of the liver: contrast-enhancement theory and practical scan protocol with a combination of fixed injection duration and patients’ body-weight-tailored dose of contrast material. Eur J Radiol 58:165–176
Caoili EM, Cohan RH, Korobkin M et al (2002) Urinary tract abnormalities: initial experience with multi-detector row CT urography. Radiology 222:353–360
Caoili EM, Cohan RH, Korobkin M et al (2001) Effectiveness of abdominal compression during helical renal CT. Acad Radiol 8:1100–1106
Caoili EM, Inampudi P, Cohan RH et al (2005) Optimization of multi-detector row CT urography: effect of compression, saline administration, and prolongation of acquisition delay. Radiology 235:116–123
Nolte-Ernsting C, Wildberger JE, Borchers H, Schmitz-Rode T, Günther RW (2001) Multislice CT urography after diuretic injection: inital results. RoFo 173:176–180
Nolte-Ernsting C, Staatz G, Wildberger JE, Adam G (2003) [MR-urography and CT-urography: principles, examination techniques, applications]. RoFo 175:211–222
Kemper J, Adam G, Nolte-Ernsting C (2005) [Multislice CT urography: aspects for technical management and clinical indications]. Radiologe 45:905–914
Kemper J, Regier M, Begemann PGC, Stork A, Adam G, Nolte-Ernsting C (2005) Multislice computed tomography urography: intraindividual comparison of different preparation techniques for optimized depiction of the upper urinary tract in an animal model. Invest Radiol 40:126–133
Kemper J, Regier M, Stork A, Adam G, Nolte-Ernsting C (2006) [Multislice CT urography (MSCTU): evaluation of a modified scan protocol for optimized opacification of the collecting system]. RoFo 178:531–537
Kemper J, Regier M, Stork A, Adam G, Nolte-Ernsting C (2006) Improved visualization of the urinary tract in multidetector CT urography (MDCTU): analysis of individual acquisition delay and opacification using furosemide and low-dose test images. J Comput Assist Tomogr 30:751–757
Meindl T, Coppenrath EM, Khalil R, Mueller-Lisse UL, Reiser MF, Mueller-Lisse UG (2006) MDCT urography: retrospective determination of optimal delay time after intravenous contrast administration. Eur Radiol 16:1667–1674
Cohan RH, Caoili EM (2006) CT urography techniques. In: Silverman SG, Cohan RH (eds) CT urography: an atlas. Lippincott, Williams & Wilkins, Philadelphia, pp 11–21
Chow LC, Sommer FG (2001) Multidetector CT urography with abdominal compression and three-dimensional reconstruction. AJR Am J Roentgenol 177:849–855
Chai RY, Jhaveri K, Saini S, Hahn PF, Nicols S, Mueller PR (2001) Comprehensive evaluation of patients with hematuria on a multislice computed tomography scanner: protocol design and preliminary observations. Australas Radiol 45:536–538
Maher MM, Kalra MK, Rizzo S, Mueller PR, Saini S (2004) Multidetector CT urography in imaging of the urinary tract in patients with hematuria. Korean J Radiol 5:1–10
Chow LC, Kwan SW, Olcott EW, Sommer FG (2007) Split bolus MDCT urography with synchronous nephrographic and excretory phase enhancement. AJR Am J Roentgenol 189:314–322
Jinzaki M, Tanimoto A, Shinmoto H et al (2007) Detection of bladder tumors with dynamic contrast-enhanced MDCT. AJR Am J Roentgenol 188:913–918
Heneghan JP, Kim DH, Leder RA, DeLong D, Nelson RC (2001) Compression CT urography: a comparison with IVU in the opacification of the collecting system and ureters. J Comput Assist Tomogr 25:343–347
Sudakoff GS, Dunn DP, Hellman RS et al (2006) Opacification of the genitourinary collecting system during MDCT Urography with enhanced CT digital radiography: nonsaline versus saline bolus. AJR Am J Roentgenol 186:122–129
Huang J, Kim YH, Shankar S et al (2006) Multidetector CT urography: comparison of two different scanning protocols for improved visualization of the urinary tract. J Comput Assist Tomogr 30:33–36
Nolte-Ernsting C, Staatz G, Tacke J, Günther RW (2003) MR urography today. Abdom Imaging 28:191–209
Bellin MF, Renard-Penna R, Conort P et al (2004) Helical CT evaluation of the chemical composition of urinary tract calculi with a discriminant analysis of CT-attenuation values and density. Eur Radiol 14:2134–2140
Thomsen HS (2006) Reducing the risk of contrast media induced nephrotoxicity. In: Thomsen HS (ed) Contrast media: safety issues and ESUR guidelines. Springer, Berlin Heidelberg New York, pp 35–45
Coppenrath E, Meindl T, Herzog P et al (2006) Dose reduction in multidetector CT of the urinary tract: studies in a phantom model. Eur Radiol 16:1982–1989
Joffe SA, Servaes S, Okon S, Horowitz M (2003) Multi-detector row CT urography in the evaluation of hematuria. Radiographics 23:1441–1455
Noroozian M, Cohan RH, Caoili EM, Cowan NC, Ellis JH (2004) Multislice CT urography: state of the art. Br J Radiol 77 (Spec No 1):S74–S86
van der Molen AJ, Geleijns J (2007) Overranging in multislice CT: quantification and relative contribution to dose: a comparison of four 16-slice CT scanners. Radiology 247:208–216
Prokop M, Galanski M, van der Molen AJ, Schaefer-Prokop CM (2003) Spiral and multislice CT of the body. Thieme, Stuttgart
Sandrasegaran K, Rydberg J, Tann M, Hawes DR, Kopecky KK, Maglinte DD (2007) Benefits of routine use of coronal and sagittal reformations in multi-slice CT examination of the abdomen and pelvis. Clin Radiol 62:340–347
Zangos S, Steenburg SD, Phillips KD et al (2007) Acute abdomen: added diagnostic value of coronal reformations with 64-slice multidetector row computed tomography. Acad Radiol 14:19–27
Prokop M (2005) New challenges in MDCT. Eur Radiol 15 (Suppl 5):E35–E45
Jaffe TA, Nelson RC, Johnson GA et al (2006) Optimization of multiplanar reformations from isotropic datasets acquired with 16-detector row helical CT scanner. Radiology 238:292–299
Sandrasegaran K, Rydberg J, Akisik F, Hameed TA, Dunkle JW (2006) Isotropic CT examination of abdomen and pelvis: diagnostic quality of reformat. Acad Radiol 13:1338–1343
Kalra MK, Maher MM, Toth TL et al (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233:649–657
Nawfel RD, Judy PF, Schleipman AR, Silverman SG (2004) Patient radiation dose at CT Urography and conventional urography. Radiology 232:126–132
Meindl T, Coppenrath EM, Degenhardt C, Mueller-Lisse UL, Reiser M, Mueller-Lisse UG (2007) MDCT urography: experience with a biphasic excretory phase examination protocol. Eur Radiol 17 (in press, DOI 10.1007/s00330-007-0600-7)
Kemper J, Regier M, Bansmann PM et al (2007) Multidetector CT urography: experimental analysis of radiation dose reduction in an animal model. Eur Radiol 17:2318–2324
Liu W, Esler SJ, Kenny BJ, Goh RH, Rainbow AJ, Stevenson GW (2000) Low-dose nonenhanced helical CT of renal colic: assessment of ureteric stone detection and measurement of effective dose equivalent. Radiology 215:51–54
Spielmann AL, Heneghan JP, Lee LJ, Yoshizumi T, Nelson RC (2002) Decreasing the radiation dose for renal stone CT: a feasibility study of single- and multidetector CT. AJR Am J Roentgenol 178:1058–1062
Heneghan JP, McGuire KA, Leder RA, DeLong DM, Yoshizumi T, Nelson RC (2003) Helical CT for nephrolithiasis and ureterolithiasis: comparison of conventional and reduced radiation-dose techniques. Radiology 229:575–580
Tack D, Sourtzis S, Delpierre I, de Maertelaer V, Gevenois PA (2003) Low-dose unenhanced multidetector CT of patients with suspected renal colic. AJR Am J Roentgenol 180:305–311
Kluner C, Hein PA, Gralla O et al (2006) Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi? J Comput Assist Tomogr 30:44–50
Puig S, Felder-Puig R (2006) [Evidence-based radiology: a new approach to evaluate the clinical practice of radiology]. RoFo 178:671–679
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Van Der Molen, A.J., Cowan, N.C., Mueller-Lisse, U.G. et al. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol 18, 4–17 (2008). https://doi.org/10.1007/s00330-007-0792-x
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DOI: https://doi.org/10.1007/s00330-007-0792-x