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


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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    • "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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    • "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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