Imagerie des tumeurs des voies excrétrices supérieures : état de l’art pour le rapport scientifique annuel de l’Association française d’urologie

Abstract

To propose a state of the art regarding imaging techniques for the diagnosis and work-up of upper tract urothelial carcinoma (UTUC). A systematic review of the scientific literature was performed in the Medline database (PubMed) until 2014 using different associations of the following keywords: urothelial carcinomas; upper urinary tract; ureter; renal pelvis; CT scan; MRI; ultrasound; urography. Imaging has a prominent role in the diagnosis, extension and follow-up assessment of upper tract urothelial cancers (UTUC). The couple ultrasound/intravenous urography made way for the multidetector computed tomography urography (MDCTU) and for the magnetic resonance imaging urography (MRU), which can also be combined in some cases. This review of the literature presents available techniques for the exploration of the upper urinary tract, the main protocols (in particular the interest of furosemide addition), details the interpretation techniques for searching UTUC on serial imaging, as well as the main differential diagnoses, and their accuracy. Finally, the role of imaging, according to patient's context is discussed. The combination or fusion of different modalities (CT, MR…) for the same objective is highlighted and presented as the likely evolution of UTUC imaging. MDCTU is nowadays the gold standard imaging modality for the diagnosis of UTUC.