2014 CAN CT (COMPUTED TOMOGRAPHY) VIRTUAL CYSTOSCOPY WITH INTRA VESICAL DILUTE CONTRAST MEDIA REPLACE SURVEILLANCE CYSTOSCOPY?

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology (I)1 Apr 20132014 CAN CT (COMPUTED TOMOGRAPHY) VIRTUAL CYSTOSCOPY WITH INTRA VESICAL DILUTE CONTRAST MEDIA REPLACE SURVEILLANCE CYSTOSCOPY? Uttam Mete, abizer kapadia, anupam lal, niranjan khandelwal, Nandita Kakkar, and Arupkumar Mandal Uttam MeteUttam Mete Chandigarh, India More articles by this author , abizer kapadiaabizer kapadia Chandigarh, India More articles by this author , anupam lalanupam lal Chandigarh, India More articles by this author , niranjan khandelwalniranjan khandelwal Chandigarh, India More articles by this author , Nandita KakkarNandita Kakkar Chandigarh, India More articles by this author , and Arupkumar MandalArupkumar Mandal Chandigarh, India More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2433AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the value of Computed tomography (CT) Virtual Cystoscopy by intravesical instillation of dilute contrast medium, for the detection of bladder tumour in patients undergoing conventional cystoscopy for Transitional Cell Carcinoma (TCC) of the Urinary Bladder. METHODS In this prospective study a total of twenty (20) patients, comprising of 18 males and two females, with carcinoma of the urinary bladder were enrolled. After performing non-enhanced scan, 250 to 300 ml of dilute contrast(10 ml of 76% urogaffin contrast in 500 ml of normal saline, 2% solution) was instilled into the bladder. Helical volume scanning of the contrast medium filled baldder was done in both supine and prone positions. Three-dimensional images were reconstructed with visualization gray scale software to study the axial images. Data was downloaded into a work station equipped with navigation software. Bladder mucosal surface was delineated using contrast medium and by adjusting the threshold HU manually using standard visualization software. The lumen was displayed without any pixel defects by optimizing the threshold at 300 to 450 HU based on smoothing pixel defects visually. The number, size, location and morphological features of the lesions were noted on transverse and virtual images. Each lesion was characterized as polypoidal, sessile, focal septae or irregular wall thickening. Data acquired by virtual CT Cystoscopy and conventional cystoscopy were compared. RESULTS The conventional cystoscopy had detected 17 lesions in 14 patients (70 %). CT virtual cystoscopy detected fifteen lesions in 12patients (60%) and fifteen out of 17 lesions (88.24%). Seven lesions (58.3 %) were papillary and 5 (41.6 %) were sessile. (25 %) patients had multiple lesion and (75 %) had a single lesion. The mean lesion size was 2.8 cm. ( smallest 0.9 cm & largest 5.5cm). Two lesion with <1cm. were missed. The probable reason of not achieving 100 % sensitivity was the lesion size. The specificity, positive predictive value, negative predictive value and accuracy of CT cystoscopy were 100%, 100%, 75% & 90% respectively. CONCLUSIONS Detection rate of bladder lesion with vitual CT cystoscopy approaches conventional cystoscopy . It obviates operation theatre visit, physical & psychological trauma and might detect enlarged pelvic lymph nodes. In situations where conventional cystoscopy cannot be applied CT virtual cystoscopy can be of clinical benefit. CT machine with proper approved software for navigation and an experienced radiologist are the prerequisite for CT cystoscopy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e827 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Uttam Mete Chandigarh, India More articles by this author abizer kapadia Chandigarh, India More articles by this author anupam lal Chandigarh, India More articles by this author niranjan khandelwal Chandigarh, India More articles by this author Nandita Kakkar Chandigarh, India More articles by this author Arupkumar Mandal Chandigarh, India More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...