Multislice computed tomography urography in the diagnosis of urinary tract diseases

Abstract

Background/Aim. Multislice computed tomography (MSCT) has triggered considerable changes in uroradiological imaging. The aim of this study was to establish the place of MSCT urography (MSCTU) in comparison with intravenous urography (IVU) and to determine the sensitivity and specificity of MSCT in the evaluation of urothelial abnormalities. Methods. This prospective study included 120 patients with a high clinical suspicion of urinary tract diseases divided into two groups. The group I consisted of 60 patients with macroscopic hematuria, bladder carcinoma and malignant pelvic tumors after radiotherapy or operation. They underwent both IVU and MSCTU. The group II included 60 patients (? 40 years old) with retroperitoneal and malignant pelvic tumors, complicated pyelonephritis, microscopic hematuria, acute urinary tract obstruction (without visible calculi on unenhanced scans), and they were submitted to computed tomography with additional scan phase enabling MSCTU. Results. Compared with IVU, MSCTU is more sensitive for the detection of urinary tract diseases (parenchymal changes, renal tumors, urolithiasis, fibrosis) and extraurinary processes. MSCTU is more specific than IVU for renal parenchymal abnormalities, tumors of the excretory system, urolithiasis, bladder tumors, fibrosis and extraurinary diseases. MSCTU is equally sensitive, but more specific for hydronephrosis compared to MSCT. The diagnosis made by the use of MSCTU in patients with macroscopic and microscopic hematuria and with obstruction not caused by stones, perfectly comply with operative findings and histological diagnosis. Conclusion. The obtained results support MSCTU to be the modality of choice in the diagnostic algorithm of patients with macroscopic hematuria and in the evaluation of microscopic hematuria and unexplained obstruction of the urinary tract. The only remaining role for IVU in our institution is imaging of the upper urinary tract in patients with hematuria under the age of 40.Uvod/Cilj. Uvodjenje viseslojne kompjuterizovane tomografije (multislice computed tomography - MSCT) dovelo je do znacajnih promena u uroradioloskom snimanju. Cilj ove studije bio je da se utvrdi mesto MSCT urografije (MSCTU) u odnosu na intravensku urografiju (IVU), kao i da se odredi senzitivnost i specificnost MSCTU za odredjivanje patoloskih promena urotela. Metode. U ovo prospektivno istrazivanje bilo je ukljuceno 120 bolesnika sa visokom sumnjom na oboljenje urinarnog trakta. Bolesnici su bili podeljeni u dve grupe. U grupi I bilo je 60 bolesnika sa makroskopskom hematurijom, karcinomom mokracne besike i malignim tumorima u karlici nakon zracenja ili operacije i svima su uradjeni IVU i MSCTU. U grupi II bilo je 60 bolesnika zivotnog doba ? 40 godina sa retroperitonealnim i malignim tumorima u karlici, komplikovanim pijelonefritisom, mikroskopskom hematurijom, akutnom opstrukcijom urinarnog trakta (bez prisustva konkrementa na nekontrastnim skenovima), a svima je uradjen pregled kompjuterizovanom tomografijom i dodatna faza koja omogucava MSCTU. Rezultati. U odnosu na IVU, MSCTU je senzitivnija u detekciji oboljenja urinarnog trakta (parenhimske promene, tumori bubrega, urolitijaza, fibroza) i ekstra-urinarnih procesa. Tehnika MSCTU je specificnija od IVU za parenhimske promene bubrega, tumore ekskretornog sistema, urolitijazu, tumore mokracne besike, fibrozu i ekstra-urinarna oboljenja. Tehnika MSCTU podjednako je senzitvna, ali specificnija za hidronefrozu u odnosu na MSCT. Dijagnoze postavljene pomocu MSCTU kod bolesnika sa makroskopskom i mikroskopskom hematurijom, kao i opstrukcijom koja nije izazvana konkrementom, u visokoj su saglasnosti sa operativnim i patohistoloskim nalazom. Zakljucak. Dobijeni rezultati ukazuju na to da je MSCTU metoda izbora u dijagnostickom algoritmu kod bolesnika sa makroskopskom i mikroskopskom hematurijom, ali i za analizu bolesnika sa nerazjasnjenom opstrukcijom urinarnog trakta. Jedina preostala primena za IVU u nasoj ustanovi je vizualizacija gornjeg urinarnog trakta kod bolesnika sa hematurijom mladjih od 40 godina.