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CT Urography and applications in uroephithelial tumors Orith Portnoy Dept. of Diagnostic Radiology Sheba Medical Center, Sakler School of Med. Tel-Aviv.

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Presentation on theme: "CT Urography and applications in uroephithelial tumors Orith Portnoy Dept. of Diagnostic Radiology Sheba Medical Center, Sakler School of Med. Tel-Aviv."— Presentation transcript:

1 CT Urography and applications in uroephithelial tumors Orith Portnoy Dept. of Diagnostic Radiology Sheba Medical Center, Sakler School of Med. Tel-Aviv University, Israel

2 IVP (intravenous pyelography)  Initial modality for upper tract imaging in hematuria, flank pain & others for 7 decades.  Less sensitive than CT for:  Renal masses (21% for 2 cm mass)  Urinary tract stones  Renal inflammation  Renal trauma

3 CT Urography (CTU)  Single detector  MDCT volumetric acquisition  high resolution reconstructions  Both renal parenchyma and urothelium shown in a single examination  Shortening schedule for diagnostic evaluation (hematuria)

4 CTU at Sheba  Since 6/2004  ~ 500 studies  GE MDCT 16/64 slice, Philips MDCT BR 40/64 slice

5 Protocol CTU  Monitored by a radiologist  Non contrast phase (low dose)  Nephrographic phase (100s delay)  saline IV  Excretory phase ( slices) tailored  Reconstructions on a 4.1 or 4.2 GE workstation

6 Normal CTU – Axial images

7 MPR MIP MPR MIP

8 3D volume rendering

9 CTU – Rec. bladder TCC 80 Y.O. man Macrohematuria S/P 17 operations for bladder TCC

10 Staging - Lymphadenopathy

11 CTU – virtual cystoscopy

12 56 Y.O. man macrohematuria Rec. bladder TCC seen at cystoscopy Posterior view

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14 CTU and US 46 Y.O. women 1 event of macrohematuria

15 CTU and IVP  68 Y.O. man  Left flank pain  US (stone)  lithothripsy  hematuria post 3w  IVP  cystoscopy (susp. tumor)

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19 61 Y.O. man Recurrent macrohematuria 6 mo. before – US, IVP, cystoscopy

20 Bladder TCC and CLL Retrograde pyelography – narrowed ureter CTU and PET CT

21 Sensitivity  Detection of upper tract urothelial tumors by CTU – 91-94% in relation to biopsy ( Dillman Abd Imaging 2008 )  Detection of bladder tumors: microhematuria – 40% vs. cystoscopy, macrohematuria high risk – 93% sens., 99% spec. (Albani J Urol 2007, Turney BJU 2006)  High risk: >40y, macrohematuria, smoking, GU tumor P/H, occupational exposure

22 Types of Urinary Diversion after Cystectomy  Incontinent diversion (ileal, colonic)  Continent cutaneous catheterizable reservoir  Orthotopic neobladder

23 Imaging after bladder reconstruction  Complications  Recurrence  Understanding the reconstruction anatomy helps diagnose complications  US, IVP, cystography/lupography antegrade/retrograde pyelography, CT, nuclear medicine  CT-UROGRAPHY

24 Bladder reconstructin FU

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26  68 Y.O. man  6 years post bladder replacement d/t TCC  6 months intermittent macrohematuria

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28 Posterior view

29 CT 18 mo. before

30 Nawfel et al Radiology 2004 CTU - Disadvantages  Radiation dose  Mean effective dose: mSv  CTU 1.5 more than standard IVP  Time consuming processing, reviewing  Lack large scale research on cost-effectiveness

31 CTU - summary  Useful diagnostic examination that allows comprehensive evaluation of urinary tracts  Problem solving tool with other modalities  Becoming the primary imaging study for the work-up of patients with hematuria and other genitourinary conditions  Shorter diagnostic evaluation, decrease need for ureteroscopies  Tailored examination can save radiation  Referrals should be limited (urologists)

32 THANK YOU!

33 66 Y.O. man 1 year post partial nephrectomy for RCC. New hydronephrosis on CT, suspect rec. obstructing tumor. CTU and “regular” CT POST.VIEW


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