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Multidetector CT urography in imaging of the urinary tract in patients with hematuria.

Maher MM, Kalra MK, Rizzo S, Mueller PR, Saini S - Korean J Radiol (2004 Jan-Mar)

Bottom Line: This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

ABSTRACT
This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.

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Related in: MedlinePlus

A 42-year-old man underwent multidetector CT urography examination for hematuria. An eccentric filling defect (arrow) in the distal left ureter was reported as suspicious for urothelial neoplasm on axial post-contrast (A), coronal (B) and sagittal (C) maximum intensity projection images. Retrograde pyelography did not reveal any intraluminal abnormality. In retrospect, the "filling defect" was thought to be due to vascular impression.
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Figure 7: A 42-year-old man underwent multidetector CT urography examination for hematuria. An eccentric filling defect (arrow) in the distal left ureter was reported as suspicious for urothelial neoplasm on axial post-contrast (A), coronal (B) and sagittal (C) maximum intensity projection images. Retrograde pyelography did not reveal any intraluminal abnormality. In retrospect, the "filling defect" was thought to be due to vascular impression.

Mentions: Based on the accruing experience with MDCTU, it is now believed that adequate distension and opacification of the ureter and pelvicaliceal system are fundamental factors in the thorough evaluation of the urothelium (Fig. 7). Urothelial pathology can be difficult to appreciate even with optimal ureteric distension and opacification at standard soft tissue windows. Viewing the opacified ureters and pelvicaliceal system at wider window settings such as "bone windows" aids in identifying subtle filling defects in patients with hematuria and in distinguishing ureteral neoplasms from other filling defects. Coronal reconstructions of the ureters provide anatomic views of the urinary tract similar to those seen at excretory urography, with equivalent anatomic detail to excretory urograms. 3D reconstructions can also demonstrate the longitudinal extension of a lesion, and can evaluate for the presence of multicentric tumors. The urinary tract distal to an obstructing lesion is also well demonstrated, thus overcoming the limitations of excretory urography in a non-functioning kidney with obstructive disease (32). Other advantages of MDCTU over excretory urography include identification and characterization of the causes of ureteric obstruction including short segment malignant strictures with associated mural thickening, retroperitoneal masses and lymphadenopathy, retroperitoneal fibrosis, benign ureteric strictures and iatrogenic causes such as post hysterectomy and colectomy injuries (33, 34).


Multidetector CT urography in imaging of the urinary tract in patients with hematuria.

Maher MM, Kalra MK, Rizzo S, Mueller PR, Saini S - Korean J Radiol (2004 Jan-Mar)

A 42-year-old man underwent multidetector CT urography examination for hematuria. An eccentric filling defect (arrow) in the distal left ureter was reported as suspicious for urothelial neoplasm on axial post-contrast (A), coronal (B) and sagittal (C) maximum intensity projection images. Retrograde pyelography did not reveal any intraluminal abnormality. In retrospect, the "filling defect" was thought to be due to vascular impression.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698107&req=5

Figure 7: A 42-year-old man underwent multidetector CT urography examination for hematuria. An eccentric filling defect (arrow) in the distal left ureter was reported as suspicious for urothelial neoplasm on axial post-contrast (A), coronal (B) and sagittal (C) maximum intensity projection images. Retrograde pyelography did not reveal any intraluminal abnormality. In retrospect, the "filling defect" was thought to be due to vascular impression.
Mentions: Based on the accruing experience with MDCTU, it is now believed that adequate distension and opacification of the ureter and pelvicaliceal system are fundamental factors in the thorough evaluation of the urothelium (Fig. 7). Urothelial pathology can be difficult to appreciate even with optimal ureteric distension and opacification at standard soft tissue windows. Viewing the opacified ureters and pelvicaliceal system at wider window settings such as "bone windows" aids in identifying subtle filling defects in patients with hematuria and in distinguishing ureteral neoplasms from other filling defects. Coronal reconstructions of the ureters provide anatomic views of the urinary tract similar to those seen at excretory urography, with equivalent anatomic detail to excretory urograms. 3D reconstructions can also demonstrate the longitudinal extension of a lesion, and can evaluate for the presence of multicentric tumors. The urinary tract distal to an obstructing lesion is also well demonstrated, thus overcoming the limitations of excretory urography in a non-functioning kidney with obstructive disease (32). Other advantages of MDCTU over excretory urography include identification and characterization of the causes of ureteric obstruction including short segment malignant strictures with associated mural thickening, retroperitoneal masses and lymphadenopathy, retroperitoneal fibrosis, benign ureteric strictures and iatrogenic causes such as post hysterectomy and colectomy injuries (33, 34).

Bottom Line: This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

ABSTRACT
This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.

Show MeSH
Related in: MedlinePlus