See Hyung Kim, Abstract Co-Author: Nothing to Disclose

Yujin Yeo, Presenter: Nothing to Disclose

We prospectively compare nephrographic phase (NP) MDCT urography using oral hydration and a diuretic with the standard pyelographic phase (PP) for detecting recurrence after transurethral resection (TUR).

We included 140 MDCT urography examinations in 121 patients (87 men and 34 women; range, 46–88 years) who had a risk for recurrence of urinary tract. MDCT urography after contrast injection was performed at 60 seconds NP and 420 seconds PP. Two radiologists independently recorded recurred lesion for each phase. Standard of reference was obtained from histology and prospective clinical decision. Distention and opacification were compared for each radiologist in each segment in each phase by kappa and Spearman rank coefficients. Generalized estimating equations for logistic regression were used to compare performance in each radiologist and phase, and adjusted for possibility within patient correlation.

Urinary tract distention was rated significantly better at the PP for all segments (P < 0 .001). The degree of pacification provided by each radiologist for the same segment showed high correlation. There were 59 bladder and 19 upper tract recurrences in 38 and 13 patients. For recurrence detection in bladder, the overall accuracy was significantly higher the NP than the PP [91.9% (354/386) vs. 83.2% (321/386), P = 0.038]. For recurrence detection in upper tract, the overall accuracy was significantly higher the NP than the PP [86.7% (260/300) vs. 80.2%(240/300), P = 0.028].

NP MDCT urography has higher detection in recurrence than the PP, which suggests indispensable use for evaluating the urinary tract after TUR.

It is impractical to perform follow-up cystoscopy or ureteroscopy on all the patients after TUR. NP with sufficient distention perhaps could be of help to use invasive modality properly and to reduce the number of studies needed to diagnose recurrence.

Kim, S, Yeo, Y, MDCT Urography in Detecting Recurrence after Transurethral Resection of Bladder Cancer: Comparison of Nephrographic Phase with Pyelographic Phase.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000269.html