ROLE OF SPLIT-BOLUS PORTAL VENOUS PHASE CT UROGRAPHY FOR KIDNEY AND URINARY TRACT DISEASES

Abstract

Background: The conventional CT Urography technique involves a single bolus of injection with three acquisitions leading to multiple exposures. Split bolus CT Urography involves acquisition of parenchymal and excretory phases in a single scan thus reducing the number of scans and radiation dose. We propose to introduce novel split-bolus portal venous phase protocol that allowed to provide synchronous visualization of the renal corticomedullary, nephrographic, and excretory phases with good tumor and vascular enhancement in a single acquisition. Materials And Methods: Hospital based observational study carried out in the department of Radiodiagnosis, together with the help of department of urology, department of pediatrics and pediatrics surgery, SMS medical college, Jaipur on 100 patients including both pediatric and adult population . Results: Out of total 100 cases, maximum 33 cases were of bosniak cysts. Amongst them 28 were bosniak type I , 3 of bosniak type II and one case each of bosniak type III and type IV. Bosniak cysts were followed by 15 cases of ureteric strictures, with 12 amongst them were post-op cases and remaining having tubercular etiology. Next maximum number of cases were of PUJ Obstruction and CT urography was done to rule out vascular crossings as a cause of PUJO. Four out of the 9 cases were associated with vascular crossing causing PUJ obstruction. Single phase Conclusion: split bolus CTU protocol used in our study provides excellent renal parenchymal enhancement and adequate opacication of the collecting system for evaluation of kidney and urinary tract in children and adults in most of the cases with good diagnostic accuracy and minimal radiation exposure. It is also helpful in accurately diagnosing complications such as infections and renal strictures in these patients. It can be used as an alternate diagnostic tool in resource limited settings where MRI is not available.