The importance of computerized tomographic urography in evaluation of the patients with hematuria

Year 2018, Volume: 10 Issue: 4, 483 - 491, 01.12.2018

Mustafa Özdemir , Aysel Türkvatan Cansever Fatma Ayça Edis Özdemir Muharrem Tola , Onur Tutar

https://doi.org/10.21601/ortadogutipdergisi.373455

Abstract

ObjObjective: The aim of this study is
to evaluate the results of computerized tomographic (CT) urography in cases
with hematuria complaints and to investigate the efficacy of CT urography in
detecting the cause of hematuria.

Material and Method: We retrospectively
screened 59 patients (27 female, 32 male) aged between 20 and 90 (mean 50.5)
who had macroscopic or microscopic hematuria between January 2007 and May 2008
and underwent CT urography in our clinic. All of the cases were examined using
the same examination protocol (pre-contrast, nephrographic phase, pyelographic
phase) with a 16-detector multislice CT device. Two-and three-dimensional
images were generated using basal images from multiplanar reformat, maximum
intensity projection and volume rendering techniques.

Findings: In 6 out of 59 patients
(10.2%) with hematuria, no findings were found with CT urography. Causes of
hematuria detected by CT urography in the remaining 53 cases; renal cell
carcinoma (n = 3), Bosniak category 4 renal cyst (n = 1), renal papillary
necrosis (n = 1), ureteropelvic junction obstruction (n = 2), pelvicaliceal
multiple renal cysts (n = 8), multiple intrarenal lymphadenopathy (n = 1),
ureteral tumor (n = 1) and bladder abnormalities (n = 11) causing pneumatic and
dilatation of the pelvicalyceal structures. In addition, 41 of 52 (79%) cases
had extraurinar findings.

Conclusion: CT urography allows
comprehensive evaluation of hematuria in a single examination. For this reason,
CT urography can be used as an initial examination if there is no contraindication
in any of these patients.

Keywords

Hematuria, computerized tomograpy, urography

Hematürili hastaların değerlendirilmesinde bilgisayarlı tomografik ürografinin yeri

Abstract

AmaAmaç: Bu çalışmanın amacı hematüri
yakınması ile gelen olgularda bilgisayarlı tomografik (BT) ürografi
sonuçlarının değerlendirilmesi ve hematürinin nedeninin saptanmasında BT ürografinin etkinliğinin
araştırılmasıdır.

Gereç ve Yöntem: Ocak 2007 ile Mayıs 2008 tarihleri
arasında makroskopik veya mikroskopik hematürisi bulunan ve kliniğimizde BT
ürografi çekilen, yaşları 20 ile 90 ( ortalama 50,5) arasında değişen 59
olgunun (27 kadın, 32 erkek) görüntüleri retrospektif olarak tarandı. Olguların
tümünün incelenmesinde 16-dedektörlü çok kesitli BT cihazı ile aynı inceleme
protokolü (prekontrast, nefrografik faz, 
pyelografik faz ) kullanıldı. Alınan ham görüntülerden multiplanar reformat,
maksimum intensity projection ve volum rendering teknikleri kullanılarak iki ve
üç boyutlu görüntüler oluşturuldu.

Bulgular: Hematürisi bulunan toplam 59 olgunun
6’sında (%10,2) BT ürografi ile hematüriye neden olabilecek herhangi bir bulgu
saptanmamıştır. Geriye kalan 53 olguda BT ürografi ile saptanan hematüri
nedenleri; taş (n=25), renal hücreli karsinom (n=3), Bosniak kategori 4 renal
kist (n=1), renal papiller nekroz (n=1), üreteropelvik bileşke darlığı (n=2),
pelvikaliksiyel yapılarda basıya neden olan multiple renal kist (n=8),
pelvikaliksiyel yapılarda bası ve dilatasyona neden olan multiple intrarenal
lenfadenopati (n=1), üretelyal tümör (n=1) ve mesane anormallikleri (n=11)
şeklindeydi. Ayrıca 52 olgunun 41’inde (%79) ekstraüriner bulgu mevcuttu.

Sonuç: BT ürografi hematürili olguların tek
bir incelemede kapsamlı olarak değerlendirilebilmesine olanak tanımaktadır. Bu
nedenle hematürili olgularda BT ürografi daha kapsamlı bilgi vermesi açısından
giderek artan bir kullanım alanına sahip olup bu hastalarda herhangibir
kontrendikasyon yoksa ilk tetkik olarak kullanılabilir.

Keywords

Hematüri, bilgisayarlı tomografi, ürografi

References

• Sutton, J. M. Evaluation of haematuria in adults. JAMA 263, 2475–2480 (1990).
• Edwards, T. J., Dickinson, A. J., Natale, S., Gosling, J. & McGrath, J. S. A prospective analysis of the diagnostic yield resulting from the attendance of 4020 patients at a protocoldriven haematuria clinic. BJU Int. 97, 301–305 (2006)
• Grossfeld GD, Litwin MS, Wolf JS, et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy–part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology 2001; 57:604-610.
• Nigel C. Cowan. CT urography for hematuria. Nat. Rev. Urol. 2012. 9, 218–226.
• Van Der Molen, A. et al. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur. Radiol. 18, 4–17 (2008).
• Sandor A. Joffe, MD, Sabah Servaes, MD, Stephen Okon, MD and Mitchell Horowitz, MD. Multi–Detector Row CT Urography in the Evaluation of Hematuria. Radiographics 2003;23:1441-1455.
• Woolhandler S, Pels RJ, Bor DH, et al. Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders. I. Hematuria and proteinuria. JAMA. 1989;262:1214-1219.
• Roth CS, Bowyer BA, Bergquist TH. Utility of the plain abdominal radiograph for diagnosing ureteral calculi. Ann Emerg Med. 1985;14:311-315.
• Cronan JJ. Contemporary concepts in imaging urinary tract obstruction. Radiol Clin North Am 1991; 26:527-542.
• Khadra MH, Pickard RS, Charlton M, et al. A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. J Urol. 2000;163:524-527.
• Leyendecker, J. R., Barnes, C. E. & Zagoria, R. J. MR urography: techniques and clinical applications. RadioGraphics 28, 23–46 (2008).
• Takahashi, N. et al. Small (<2-cm) upper-tract urothelial carcinoma: evaluation with gadolinium-enhanced three-dimensional spoiled gradient-recalled echo MR urography. Radiology 247, 451–457 (2008).
• Israel GM, Hindman N, Bosniak MA. Evaluation of cystic renal masses; comparison of CT and MR imaging by using the Bosniak classification system. Radiology. 2004;231:365-371.
• Nolte-Ernsting, C. C., Staatz, G., Tacke, J. & Gunther, R. W. MR urography today. Abdom. Imaging 28, 191–209 (2003).
• Coursey, C. et al. Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging? RadioGraphics 30, 1037–1055 (2010).
• Dillman, J. R., Caoili, E. M. & Cohan, R. H. Multidetector CT urography: a one-stop renal and urinary tract imaging modality. Abdom. Imaging 32, 519–529 (2007).
• Bosniak MA. Diagnosis and management of patients with complicated cystic lesions of the kidney. Am J Roentgenol. 1997;169:819-821.
• Lang EK, Macchia RJ, Thomas R, et al. Computerized tomography tailored for the assessment of microscopic hematuria. J Urol 2002; 167:547-554.
• Fielding JR, Silverman SG, Rubin GD. Helical CT of the urinary tract. AJR Am J Roentgenol 1999; 172:1199-1206.
• Roupret, M. et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur. Urol. 59, 584–594 (2011).
• Cohan, R. H., Caoili, E. M., Cowan, N. C., Weizer, A. Z. & Ellis, J. H. MDCT urography: exploring a new paradigm for imaging of bladder cancer. AJR Am. J. Roentgenol. 192, 1501–1508 (2009).
• Gray Sears CL, Ward JF, Sears ST, et al. Prospective comparison of computerized tomography and excretory urography in the initial evaluation of asymptomatic microhematuria. J Urol. 2002;168:2457-2460.