2015 REPEAT IMAGING IS UNNECESSARY WHEN URETERS ARE INCOMPLETELY OPACIFIED ON COMPUTED TOMOGRAPHY UROGRAPHY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology (I)1 Apr 20132015 REPEAT IMAGING IS UNNECESSARY WHEN URETERS ARE INCOMPLETELY OPACIFIED ON COMPUTED TOMOGRAPHY UROGRAPHY Jason Woo, Lejla Aganovic, Fiona Cassidy-Hughes, Christian Welch, and A. Karim Kader Jason WooJason Woo San Diego, CA More articles by this author , Lejla AganovicLejla Aganovic San Diego, CA More articles by this author , Fiona Cassidy-HughesFiona Cassidy-Hughes San Diego, CA More articles by this author , Christian WelchChristian Welch San Diego, CA More articles by this author , and A. Karim KaderA. Karim Kader San Diego, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2434AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Computed tomography urography (CTU) has become the preferred imaging modality for hematuria evaluation and for surveillance of the upper urinary tract for urothelial malignancies. Ureteral segments are frequently nonopacified because of ureteral peristalsis, anatomical variations, and differences in contrast excretion. Incompletely evaluated ureters are concerning for missed urothelial malignancies. There are no reports of the clinical significance of nonopacified ureteral segments nor recommendations about how to deal with this increasingly common clinical scenario. We investigate the clinical significance of incompletely opacified ureters on CTU and whether repeat imaging offers increased diagnostic yield. METHODS 1000 consecutive CTUs performed at the San Diego VA hospital from 2006 to 2010 were reviewed. If a nonopacified segment was seen, a repeat scan through that ureteral segment was performed during the same CT study. All CTUs were reviewed by two attending radiologists. Presence of mass, hydroureter or ureteral wall thickening was recorded. Follow up urinary tract imaging and urologic evaluations were reviewed for development of new upper tract malignancies. RESULTS The primary indications were gross hematuria, microscopic hematuria or upper tract evaluation in patients with known urothelial malignancies. 536 of 1000 (53.6%) CTUs had at least one nonopacified segment of ureter after initial scan. 231 patients (23.1%) had complete opacification after repeat scan. 305 (30.5%) had at least one segment that was never completely opacified. On repeat scans, there were no cases of newly discovered ureteral tumors in a previously nonopacified segment of ureter. In the nonopacified group, all cases of pathologically confirmed ureteral tumors (15/15) had associated findings of hydroureter, ureteral wall thickening or an obvious mass. No patients with nonopacified ureteral segments and otherwise normal CTU developed upper tract malignancies in the 2-6 year period of follow up. CONCLUSIONS In this analysis, in the absence of hydroureter, ureteral wall thickening or mass, nonopacified segments of ureter on CTU were not clinically significant. We found no cases when repeating CTU to further opacify segments altered the clinical course or demonstrated new significant findings. Repeat imaging may be unnecessary in these cases, and may result in excess cost and radiation exposure. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e827-e828 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Woo San Diego, CA More articles by this author Lejla Aganovic San Diego, CA More articles by this author Fiona Cassidy-Hughes San Diego, CA More articles by this author Christian Welch San Diego, CA More articles by this author A. Karim Kader San Diego, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...