CT urography for diagnosis of upper urinary tract urothelial carcinoma: Are both nephrographic and excretory phases necessary?

Mitsuru Takeuchi, Aaron J. Konrad, Akira Kawashima, Stephen A. Boorjian, Naoki Takahashi

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVE. The objective of our study was to compare the diagnostic performance of nephrographic phase only, excretory phase only, and both nephrographic and excretory phases of CT urography (CTU) for the detection of upper tract urothelial carcinoma. MATERIALS AND METHODS. Forty-nine consecutive patients with pathologically proven upper tract urothelial carcinoma who underwent a single-bolus CTU examination were evaluated. Forty-nine control patients with normal findings on two CTU examinations performed at a 1-year interval were included. Two radiologists independently reviewed the 98 CTU examinations at three different sessions (nephrographic phase only, excretory phase only, and both nephrographic and excretory phases simultaneously) and rated the likelihood of the presence of a urothelial carcinoma in each segment of the renal collecting system and ureter using a 5-point scale. Sensitivity, specificity, and AUC of ROC curve were calculated per segment and per patient. RESULTS. A total of 314 segments, 56 of which contained tumors, were evaluated. In the per-segment analysis for reviewers 1 and 2, the sensitivity, specificity, and AUC, respectively, were as follows: 88%, 98%, and 0.95 and 84%, 97%, and 0.94 for the nephrographic phase; 79%, 98%, and 0.91 and 89%, 98%, and 0.95 for the excretory phase; and 88%, 99%, and 0.95 and 89%, 99%, and 0.96 for the combined nephrographic and excretory phases. The AUC of the combined nephrographic and excretory phases was significantly higher than that of the nephrographic phase (per-patient analysis, reviewer 2) and that of excretory phase (persegment analysis, reviewer 1) but was not significantly different in any other comparisons. CONCLUSION. The nephrographic and excretory phases are complementary for the detection of upper tract urothelial carcinoma.

Original languageEnglish (US)
Pages (from-to)W320-W327
JournalAmerican Journal of Roentgenology
Volume205
Issue number3
DOIs
StatePublished - Sep 1 2015

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Urography
Urinary Tract
Area Under Curve
Carcinoma
Sensitivity and Specificity
Ureter
ROC Curve
Kidney
Neoplasms

Keywords

  • CT urography
  • Diagnostic performance
  • Excretory phase
  • Nephrographic phase
  • Upper urinary tract urothelial carcinoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

CT urography for diagnosis of upper urinary tract urothelial carcinoma : Are both nephrographic and excretory phases necessary? / Takeuchi, Mitsuru; Konrad, Aaron J.; Kawashima, Akira; Boorjian, Stephen A.; Takahashi, Naoki.

In: American Journal of Roentgenology, Vol. 205, No. 3, 01.09.2015, p. W320-W327.

Research output: Contribution to journalArticle

Takeuchi, Mitsuru ; Konrad, Aaron J. ; Kawashima, Akira ; Boorjian, Stephen A. ; Takahashi, Naoki. / CT urography for diagnosis of upper urinary tract urothelial carcinoma : Are both nephrographic and excretory phases necessary?. In: American Journal of Roentgenology. 2015 ; Vol. 205, No. 3. pp. W320-W327.
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title = "CT urography for diagnosis of upper urinary tract urothelial carcinoma: Are both nephrographic and excretory phases necessary?",
abstract = "OBJECTIVE. The objective of our study was to compare the diagnostic performance of nephrographic phase only, excretory phase only, and both nephrographic and excretory phases of CT urography (CTU) for the detection of upper tract urothelial carcinoma. MATERIALS AND METHODS. Forty-nine consecutive patients with pathologically proven upper tract urothelial carcinoma who underwent a single-bolus CTU examination were evaluated. Forty-nine control patients with normal findings on two CTU examinations performed at a 1-year interval were included. Two radiologists independently reviewed the 98 CTU examinations at three different sessions (nephrographic phase only, excretory phase only, and both nephrographic and excretory phases simultaneously) and rated the likelihood of the presence of a urothelial carcinoma in each segment of the renal collecting system and ureter using a 5-point scale. Sensitivity, specificity, and AUC of ROC curve were calculated per segment and per patient. RESULTS. A total of 314 segments, 56 of which contained tumors, were evaluated. In the per-segment analysis for reviewers 1 and 2, the sensitivity, specificity, and AUC, respectively, were as follows: 88{\%}, 98{\%}, and 0.95 and 84{\%}, 97{\%}, and 0.94 for the nephrographic phase; 79{\%}, 98{\%}, and 0.91 and 89{\%}, 98{\%}, and 0.95 for the excretory phase; and 88{\%}, 99{\%}, and 0.95 and 89{\%}, 99{\%}, and 0.96 for the combined nephrographic and excretory phases. The AUC of the combined nephrographic and excretory phases was significantly higher than that of the nephrographic phase (per-patient analysis, reviewer 2) and that of excretory phase (persegment analysis, reviewer 1) but was not significantly different in any other comparisons. CONCLUSION. The nephrographic and excretory phases are complementary for the detection of upper tract urothelial carcinoma.",
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AU - Konrad, Aaron J.

AU - Kawashima, Akira

AU - Boorjian, Stephen A.

AU - Takahashi, Naoki

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N2 - OBJECTIVE. The objective of our study was to compare the diagnostic performance of nephrographic phase only, excretory phase only, and both nephrographic and excretory phases of CT urography (CTU) for the detection of upper tract urothelial carcinoma. MATERIALS AND METHODS. Forty-nine consecutive patients with pathologically proven upper tract urothelial carcinoma who underwent a single-bolus CTU examination were evaluated. Forty-nine control patients with normal findings on two CTU examinations performed at a 1-year interval were included. Two radiologists independently reviewed the 98 CTU examinations at three different sessions (nephrographic phase only, excretory phase only, and both nephrographic and excretory phases simultaneously) and rated the likelihood of the presence of a urothelial carcinoma in each segment of the renal collecting system and ureter using a 5-point scale. Sensitivity, specificity, and AUC of ROC curve were calculated per segment and per patient. RESULTS. A total of 314 segments, 56 of which contained tumors, were evaluated. In the per-segment analysis for reviewers 1 and 2, the sensitivity, specificity, and AUC, respectively, were as follows: 88%, 98%, and 0.95 and 84%, 97%, and 0.94 for the nephrographic phase; 79%, 98%, and 0.91 and 89%, 98%, and 0.95 for the excretory phase; and 88%, 99%, and 0.95 and 89%, 99%, and 0.96 for the combined nephrographic and excretory phases. The AUC of the combined nephrographic and excretory phases was significantly higher than that of the nephrographic phase (per-patient analysis, reviewer 2) and that of excretory phase (persegment analysis, reviewer 1) but was not significantly different in any other comparisons. CONCLUSION. The nephrographic and excretory phases are complementary for the detection of upper tract urothelial carcinoma.

AB - OBJECTIVE. The objective of our study was to compare the diagnostic performance of nephrographic phase only, excretory phase only, and both nephrographic and excretory phases of CT urography (CTU) for the detection of upper tract urothelial carcinoma. MATERIALS AND METHODS. Forty-nine consecutive patients with pathologically proven upper tract urothelial carcinoma who underwent a single-bolus CTU examination were evaluated. Forty-nine control patients with normal findings on two CTU examinations performed at a 1-year interval were included. Two radiologists independently reviewed the 98 CTU examinations at three different sessions (nephrographic phase only, excretory phase only, and both nephrographic and excretory phases simultaneously) and rated the likelihood of the presence of a urothelial carcinoma in each segment of the renal collecting system and ureter using a 5-point scale. Sensitivity, specificity, and AUC of ROC curve were calculated per segment and per patient. RESULTS. A total of 314 segments, 56 of which contained tumors, were evaluated. In the per-segment analysis for reviewers 1 and 2, the sensitivity, specificity, and AUC, respectively, were as follows: 88%, 98%, and 0.95 and 84%, 97%, and 0.94 for the nephrographic phase; 79%, 98%, and 0.91 and 89%, 98%, and 0.95 for the excretory phase; and 88%, 99%, and 0.95 and 89%, 99%, and 0.96 for the combined nephrographic and excretory phases. The AUC of the combined nephrographic and excretory phases was significantly higher than that of the nephrographic phase (per-patient analysis, reviewer 2) and that of excretory phase (persegment analysis, reviewer 1) but was not significantly different in any other comparisons. CONCLUSION. The nephrographic and excretory phases are complementary for the detection of upper tract urothelial carcinoma.

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KW - Diagnostic performance

KW - Excretory phase

KW - Nephrographic phase

KW - Upper urinary tract urothelial carcinoma

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