CT urography: Definition, indications and techniques. A guideline for clinical practice

Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
European Radiology (Impact Factor: 4.01). 02/2008; 18(1):4-17. DOI: 10.1007/s00330-007-0792-x
Source: PubMed

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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    • "Many protocols for the evaluation of haematuria have used a combination of ultrasound and IVU with success for a comprehensive assessment of the upper urinary tract [51]. Recent guidelines from the European Society of Urogenital Radiology state that ultrasound may be used alone in low-risk patients to image the upper urinary tract but in high-risk patients CT urography is warranted [52]. "
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    ABSTRACT: This paper discusses the current status of imaging in the investigation of patients with haematuria. The physician must rationalize imaging so that serious causes such as malignancy are promptly diagnosed while at the same time not exposing patients to unnecessary investigations. There is currently no universal agreement about the optimal imaging work up of haematuria. The choice of modality to image the urinary tract will depend on individual patient factors such as age, the presence of risk factors for malignancy, renal function, a history of calculus disease and pregnancy, and other factors, such as local policy and practice, cost effectiveness and availability of resources. The role of all modalities, including conventional radiography, intravenous urography/excretory urography, ultrasonography, retrograde pyelography, multidetector computed tomography urography (MDCTU), and magnetic resonance urography, is discussed. This paper highlights the pivotal role of MDCTU in the imaging of the patient with haematuria and discusses issues specific to this modality including protocol design, imaging of the urothelium, and radiation dose. Examination protocols should be tailored to the patient while all the while optimizing radiation dose.
    Advances in Urology 07/2014; 2014:414125. DOI:10.1155/2014/414125
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    • "Kidneys excreted contrast and ureters and bladder were filled and then emptied through the tissue engineered bladder conduit. The use of 3D curved MPR was in accordance with CT urography guidelines used for high-definition visualization of an entire urinary tract albeit the use of angiographic equipment as primary imaging modality is not standard [15]. However, the Xper-CT algorithms give a high enough resolution to clearly provide an unambiguous image of the continuity of the open channel. "
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    ABSTRACT: Surgical intervention is sometimes needed to create a conduit from the abdominal wall to the bladder for self-catheterization. We developed a method for tissue engineering a conduit for bladder emptying without in vitro cell culturing as a one-step procedure. In a porcine animal model bladder, wall tissue was excised and the mucosa was minced to small particles. The particles were attached to a tube in a 1 : 3 expansion rate with fibrin glue and transplanted back by attaching the tube to the bladder and through the abdominal wall. Sham served as controls. After 4-5 weeks, conduits were assessed in respect to macroscopic and microscopic appearance in 6 pigs. Two pigs underwent radiology before termination. Gross examination revealed a patent conduit with an opening to the bladder. Histology and immunostaining showed a multilayered transitional uroepithelium in all cases. Up to 89% of the luminal surface area was neoepithelialized but with a loose attachment to the submucosa. No epithelium was found in control animals. CT imaging revealed a patent channel that could be used for filling and emptying the bladder. Animals that experienced surgical complications did not form conduits. Minced autologous bladder mucosa can be transplanted around a tubular mold to create a conduit to the urinary bladder without in vitro culturing.
    10/2013; 2013(4):212734. DOI:10.1155/2013/212734
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    • "In several cases, we successfully adopted the time- and dose-efficient triple-bolus MDCT-urography protocol described by Kekelidze et al., which includes preliminary unenhanced scans, an initial 30 ml CM bolus injected at 2 ml/s flow for urinary opacification, a 7-min delay, a second (50 ml at 1.5 ml/s) and third (65 ml at 3 ml/s) CM injection separated 20 s from each other to provide parenchymal and vascular visualisation respectively, followed by a single MDCT volumetric acquisition. Therefore, triple-bolus MDCT urography provides simultaneous renovascular, corticomedullary, nephrographic and excretory imaging with a reduced effective radiation dose compared to the usual multiphasic MDCT protocols [13, 14]. "
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    ABSTRACT: Robot-assisted laparoscopic radical prostatectomy (RALRP) is currently accepted as the preferred minimally invasive surgical treatment for localised prostate cancer, with optimal oncologic and functional results. Despite growing surgical experience, reduced postoperative morbidity and hospital stays, RALRP-related complications may occur, which are severe in 5-7 % of patients and sometimes require reoperation. Therefore, in hospitals with an active urologic surgery, urgent diagnostic imaging is increasingly requested to assess suspected early complications following RALRP surgery. Based upon our experience, this pictorial review discusses basic principles of the surgical technique, the optimal multidetector CT (MDCT) techniques to be used in the postoperative urologic setting, the normal postoperative anatomy and imaging appearances. Afterwards, we review and illustrate the varied spectrum of RALRP-related complications including haemorrhage, urinary leaks, anorectal injuries, peritoneal changes, surgical site infections, abscess collections and lymphoceles, venous thrombosis and port site hernias. Knowledge of surgical procedure details, appropriate MDCT acquisition techniques, and familiarity with normal postoperative imaging appearances and possible complications are needed to correctly perform and interpret early post-surgical imaging studies, particularly to identify those occurrences that require prolonged in-hospital treatment or surgical reintervention. • Robot-assisted laparoscopic radical prostatectomy allows minimally invasive surgery of localised cancer • Urologic surgeons may request urgent imaging to assess suspected postoperative complications • Main complications include haemorrhage, urine leaks, anorectal injuries, infections and lymphoceles • Correct multidetector CT techniques allow identifying haematomas, active bleeding and extravasated urine • Imaging postoperative complications is crucial to assess the need for surgical reoperation.
    Insights into Imaging 09/2013; 4(5). DOI:10.1007/s13244-013-0280-6
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