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

Karen L Gandrup; Jørgen Nordling; Ingegerd Balslev; Henrik S Thomsen

doi:10.1177/0284185113505278

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

Karen L Gandrup, Jørgen Nordling, Ingegerd Balslev, Henrik S Thomsen

Department of Clinical Medicine

17 Citations (Scopus)

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.

Original language	English
Journal	Acta Radiologica
Volume	55
Issue number	6
Pages (from-to)	761-768
Number of pages	8
ISSN	0284-1851
DOIs	https://doi.org/10.1177/0284185113505278
Publication status	Published - Jul 2014

Keywords

Adult
Aged
Aged, 80 and over
Contrast Media
Diagnosis, Differential
Female
Humans
Image Processing, Computer-Assisted
Iopamidol
Kidney Pelvis
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Observer Variation
Radiographic Image Enhancement
Reproducibility of Results
Tomography, X-Ray Computed
Ureter
Ureteral Neoplasms
Urologic Neoplasms

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10.1177/0284185113505278

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title = "Upper urinary tract tumors: how does the contrast enhancement measured in a split-bolus CTU correlate to histological staging?",

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.",

keywords = "Adult, Aged, Aged, 80 and over, Contrast Media, Diagnosis, Differential, Female, Humans, Image Processing, Computer-Assisted, Iopamidol, Kidney Pelvis, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Observer Variation, Radiographic Image Enhancement, Reproducibility of Results, Tomography, X-Ray Computed, Ureter, Ureteral Neoplasms, Urologic Neoplasms",

author = "Gandrup, {Karen L} and J{\o}rgen Nordling and Ingegerd Balslev and Thomsen, {Henrik S}",

note = "{\textcopyright} The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.",

year = "2014",

month = jul,

doi = "10.1177/0284185113505278",

language = "English",

volume = "55",

pages = "761--768",

journal = "Acta Radiologica - Series Diagnosis",

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publisher = "SAGE Publications",

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TY - JOUR

T1 - Upper urinary tract tumors

T2 - how does the contrast enhancement measured in a split-bolus CTU correlate to histological staging?

AU - Gandrup, Karen L

AU - Nordling, Jørgen

AU - Balslev, Ingegerd

AU - Thomsen, Henrik S

N1 - © The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

PY - 2014/7

Y1 - 2014/7

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Contrast Media

KW - Diagnosis, Differential

KW - Female

KW - Humans

KW - Image Processing, Computer-Assisted

KW - Iopamidol

KW - Kidney Pelvis

KW - Male

KW - Middle Aged

KW - Neoplasm Grading

KW - Neoplasm Staging

KW - Observer Variation

KW - Radiographic Image Enhancement

KW - Reproducibility of Results

KW - Tomography, X-Ray Computed

KW - Ureter

KW - Ureteral Neoplasms

KW - Urologic Neoplasms

U2 - 10.1177/0284185113505278

DO - 10.1177/0284185113505278

M3 - Journal article

C2 - 24056890

SN - 0365-5954

VL - 55

SP - 761

EP - 768

JO - Acta Radiologica - Series Diagnosis

JF - Acta Radiologica - Series Diagnosis

IS - 6

ER -

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

Abstract

Keywords

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