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What a difference a delay makes! CT urogram: a pictorial essay

  • Special Section : Urothelial Disease
  • Published:
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Abstract

Purpose

The aim of this pictorial essay is to demonstrate several cases where the diagnosis would have been difficult or impossible without the excretory phase image of CT urography.

Methods

A brief discussion of CT urography technique and dose reduction is followed by several cases illustrating the utility of CT urography.

Results

CT urography has become the primary imaging modality for evaluation of hematuria, as well as in the staging and surveillance of urinary tract malignancies. CT urography includes a non-contrast phase and contrast-enhanced nephrographic and excretory (delayed) phases. While the three phases add to the diagnostic ability of CT urography, it also adds potential patient radiation dose. Several techniques including automatic exposure control, iterative reconstruction algorithms, higher noise tolerance, and split-bolus have been successfully used to mitigate dose. The excretory phase is timed such that the excreted contrast opacifies the urinary collecting system and allows for greater detection of filling defects or other abnormalities. Sixteen cases illustrating the utility of excretory phase imaging are reviewed.

Conclusions

Excretory phase imaging of CT urography can be an essential tool for detecting and appropriately characterizing urinary tract malignancies, renal papillary and medullary abnormalities, CT radiolucent stones, congenital abnormalities, certain chronic inflammatory conditions, and perinephric collections.

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Authors and Affiliations

  1. Department of Radiology, University of California, San Diego Health, San Diego, USA

    Abraham Noorbakhsh, Lejla Aganovic, Noushin Vahdat, Soudabeh Fazeli, Romy Chung & Fiona Cassidy

  2. Department of Radiology, Veterans Affairs San Diego Healthcare, San Diego, CA, USA

    Lejla Aganovic, Noushin Vahdat & Fiona Cassidy

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  1. Abraham Noorbakhsh
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  2. Lejla Aganovic
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Correspondence to Fiona Cassidy.

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Noorbakhsh, A., Aganovic, L., Vahdat, N. et al. What a difference a delay makes! CT urogram: a pictorial essay. Abdom Radiol 44, 3919–3934 (2019). https://doi.org/10.1007/s00261-019-02086-0

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