"Most uroradiologists perform CT urography using multidetector-row CT aline (79%) and use a 3-phase technique (52%) using a single injection (76%) of contrast media at 3 ml/sec (52%) without a compression devise (81%) and with the patient in the supine position (90%)."
Current Use of Computed Tomographic Urography: Survey of the Society of Uroradiology
Townsend BA et al.
J Comput Assist Tomogr 2009; 33:96-100
- CT Urography: Indications per Society of Uroradiology
- Painless gross and microscopic hematuria
- Suspected transitional cell carcinoma
- Followup of transitional cell carcinoma
- Recurrent UTI’s
- Congenital anomalies
- Renal trauma "Most uroradiologists use CT Urography in their practice today; some no longer perform IV urography. Variability in multidetector-row CT technique suggests that more research is needed to determine the optimal protocol."
Current Use of Computed Tomographic Urography: Survey of the Society of Uroradiology
Townsend BA et al.
J Comput Assist Tomogr 2009; 33: 96-100
"CT Urography is essentially defined as a CT examination of the urinary tract before and after the administration of intravenous contrast material that includes excretory phase images."
What is the Current Role of CT Urography and MR Urography in the Evaluation of the Urinary Tract
Silverman SS, Leyendecker JR, Amis Jr ES
Radiology 2009; 250:309-323
- Split Bolus Technique for CT Urography (Maheshwari E et al.)
- Scan without contrast from top of kidneys thru the base of the bladder
- Inject 50 ml of iodixanol at 3 cc/sec
- Wait 5 minutes
- Inject 80 ml of iodixanol at 3 cc/sec
- Wait 100 seconds and then scan the patient from the top of the kidneys thru the pelvis (combined nephrographic and excretory phase) " In conclusion, in patients with hematuria, split bolus MDCT urography and oral hydration provide complete opacification of the majority of upper urinary tract segments and are accurate for the diagnosis of upper tract urothelial tumors."
Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients with Hematuria
Maheshwari E et al.
AJR 2010; 194:453-458
"We believe that oral hydration is a simple method of aiding urinary tract opacification while maintaining an effective workflow, as has been advocated previously by Kawamoto et al."
Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients with Hematuria
Maheshwari E et al.
AJR 2010; 194:453-458
"The negative predictive value of MDCT urography for upper tract tumors was 99.5% and 100% for two reviewers and 100% for the prospective interpretations."
Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients with Hematuria
Maheshwari E et al.
AJR 2010; 194:453-458
"Split-bolus MDCT urography provided at least 50% opacification of the majority of upper urinary tract segments and had high sensitivity, specificity, and accuracy for the detection of upper urinary tract tumors"
Split-Bolus MDCT Urography: Upper Tract Opacification and Performance for Upper Tract Tumors in Patients with Hematuria
Maheshwari E et al.
AJR 2010; 194:453-458
- Split Bolus Technique for the Kidneys (Zamboni GA et al.)
- Inject 50 ml of IV contrast
- Wait 3 minutes
- Inject 100 ml of contrast at 4-6 ml/sec
- Begin acquisition 5 seconds after trigger point of 200 HU is reached
- Obtain a single acquisition - Excretory Phase (4-8 minutes): Optimal Phase For Detection of-
- Transitional cell carcinoma
- Collecting system obstruction
- Pyelonephritis
- Changes in perfusion
- Measure lesion de-enhancement - Nephrographic Phase (60-140 sec): Optimal Phase For Detection of-
- Renal lesion detection
- Pyelonephritis
- Tumor invasion (renal vein/IVC)
- Characterize lesion density
- Perfusion changes
- Renal vein or IVC thrombus - Corticomedullary Phase (25-50sec) : Optimal Phase For Detection of-
- Evaluate arterial strutures
- Preoperative planning for nephron sparing surgery
- Define tumor vascularity
- Changes in perfusion
- Tumor detection - Unenhanced CT of the Kidney: Optimal Phase For Detection of-
- Calculus
- Cyst vs mass (HDRC vs solid tumor)
- High density renal cyst
- Identify location of the kidneys to define coverage
"The regions of altered perfusion on nephrographic or excretory contrast enhanced acquisitions would actually appear as regions of hyperattenuation if the kidney was imaged 3-6 hours after the initial CT, owing to a decreased rate of contrast transit through the tubules."
Optimizing Detectability of Renal Pathology with MDCT: Protocols, Pearls and Pitfalls
Johnson PT, Horton KM, Fishman EK
AJR 2010; 194:1001-1012
"Underdistension or inadequate opacification of the ureter may prevent identification of a small transitional cell carcinoma."
Optimizing Detectability of Renal Pathology with MDCT: Protocols, Pearls and Pitfalls
Johnson PT, Horton KM, Fishman EK
AJR 2010; 194:1001-1012
"With the goal of refining interpretive performance, this pictorial essay shows the patterns of conspicuity unique to each genitourinary pathologic abnormality, presents experience-based recommendations to improve detection and characterization using multiphasic MDCT, and describes pitfalls to avoid."
Optimizing Detectability of Renal Pathology with MDCT: Protocols, Pearls and Pitfalls
Johnson PT, Horton KM, Fishman EK
AJR 2010; 194:1001-1012
Optimizing Detectability of Renal Pathology With MDCT: Protocols, Pearls, and Pitfalls
Pamela T. Johnson, Karen M. Horton and Elliot K. Fishman
OBJECTIVE. The purpose of this article is to review MDCT acquisition protocol parameters and interpretative practices for evaluating genitourinary lesions other than classic renal cell carcinoma, to optimize lesion detectability and accurately characterize pathologic abnormalities.
CONCLUSION. With the goal of refining interpretative performance, this pictorial essay shows the patterns of conspicuity unique to each genitourinary pathologic abnormality, presents experience-based recommendations to improve detection and characterization using multiphasic MDCT, and describes pitfalls to be avoided.
How Not to Miss or Mischaracterize a Renal Cell Carcinoma: Protocols, Pearls, and Pitfalls
Pamela T. Johnson, Karen M. Horton and Elliot K. Fishman
OBJECTIVE. MDCT protocol optimization for renal cell carcinoma requires attention to several data acquisition, reconstruction, and display parameters. Specifically, multiple acquisitions with varying coverage, careful timing of each contrast-enhanced phase, and use of 2D and 3D multiplanar displays are required. This article reviews these parameters, supplemented by experience-based pearls and pitfalls.
CONCLUSION. Proper data acquisition and utilization of postprocessing tools are essential to avoid missed diagnoses or misinterpretation when imaging renal cell carcinoma.
"MDCT protocol optimization for renal cell carcinoma requires attention to several data acquisition, reconstruction, and display parameters. Specifically multiple acquisitions with varying coverage, careful timing of each contrast enhanced phase, and use of 2D and 3D multiplanar displays are required."
How Not to Miss or Mischaracterize a Renal Cell Carcinoma: Protocols, Pearls and Pitfalls
Johnson PT, Horton KM, Fishman EK
AJR 2010; 194: W307-315
"Although this study was designed to evaluate urinary system opacification and image quality by using a triple bolus technique, our sample size did not allow assignment of its diagnostic performance. A larger test group is needed to assign diagnostic abilities of this protocol."
Kidney and Urinary Tract Imaging: Triple Bolus Multidetector CT Urography as a One-Stop Shop-Protocol Design, Opacification, and Image Quality Analysis
Kekelidze M et al.
Radiology 2010; 255:508-516
"Multidetector CT Urography with a timed triple bolus scanning technique reduces effective radiation dose to about half of that caused by single bolus three phase multidetector CT urographic protocols without comprimising image quality of the kidneys and the urinary tract."
Kidney and Urinary Tract Imaging: Triple Bolus Multidetector CT Urography as a One-Stop Shop-Protocol Design, Opacification, and Image Quality Analysis
Kekelidze M et al.
Radiology 2010; 255:508-516
"Triple bolus multidetector CT urography is a dose efficient protocol acquiring corticomedullary-nephrographic-excretory and vascular enhancement phases in a single acquisition and provides sufficient opacification and distention of the upper urinary tract. Simultaneously adequate image quality of renal parenchyma and vascular anatomy is achieved."
Kidney and Urinary Tract Imaging: Triple Bolus Multidetector CT Urography as a One-Stop Shop-Protocol Design, Opacification, and Image Quality Analysis
Kekelidze M et al.
Radiology 2010; 255:508-516
- "The average time to generate simple MIPs at the console was 3.4 minutes (range 1.7-4.4 minutes), and 22.3 minutes (range 15-30 minutes) to create images at the 3D workstation."
Semiautomated MIP Images Created Directly on 16 Section Multidtector CT Console for Evaluation of Living Renal Donors
Singh AK et al.
Radiology 2007; 244:583-590
