Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease

  • Osama AliEmail author
  • Elliot K. Fishman
  • Sheila Sheth
Special Section : Urothelial Disease


Urothelial carcinoma of the upper urinary tract (UUT) is a relatively uncommon genitourinary malignancy, accounting for about 5–7% of urothelial tumors. The significant features of this tumor are multifocality and high rate of recurrence. Computed tomography urography (CTU) has replaced excretory urography (EU) and retrograde pyelography (RP) for imaging of upper tract urothelial carcinoma. While many studies have confirmed high sensitivity (88–100%) and specificity (93–100%) of CTU, an optimized CT protocol is of critical importance in screening, staging, and post-operative follow-up of patients (Chlapoutakis, Eur J Radiol 73(2):334–338, 2010; Caoli and Cohan, Abdom Radiol (NY) 41(6):1100–1107, 2016). The key element of the CT protocol is to have adequate distension of the collecting system with excreted contrast, to detect subtle lesions at an early stage. In this article, we discuss the background of upper urinary tract TTC, pathogenesis, CT protocol and the role of imaging in evaluation of this malignancy, staging, as well as different imaging appearances.



  1. 1.
    Chlapoutakis K, et al. (2010) Performance of computed tomographic urography in diagnosis of upper urinary tract urothelial carcinoma, in patients presenting with hematuria: Systematic review and meta-analysis. Eur J Radiol 73(2):334–8CrossRefGoogle Scholar
  2. 2.
    Caoili EM, Cohan RH (2016) CT urography in evaluation of urothelial tumors of the kidney. Abdom Radiol (NY) 41(6):1100–7CrossRefGoogle Scholar
  3. 3.
    Kirkali Z, Tuzel E (2003) Transitional cell carcinoma of the ureter and renal pelvis. Crit Rev Oncol Hematol 47(2):155–69CrossRefGoogle Scholar
  4. 4.
    Vikram R, Sandler CM, Ng CS (2009) Imaging and staging of transitional cell carcinoma: part 2, upper urinary tract. AJR Am J Roentgenol 192(6):1488–93CrossRefGoogle Scholar
  5. 5.
    Browne RF, et al. (2005) Transitional cell carcinoma of the upper urinary tract: spectrum of imaging findings. Radiographics 25(6):1609–27CrossRefGoogle Scholar
  6. 6.
    Polenakovic M, Stefanovic V (2014) What do we know about the Balkan endemic nephropathy and the uroepithelial tumors?. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 35(1):11–15Google Scholar
  7. 7.
    Buckley JA, et al. (1996) Transitional cell carcinoma of the renal pelvis: a retrospective look at CT staging with pathologic correlation. Radiology 201(1):194–8CrossRefGoogle Scholar
  8. 8.
    Davis R, et al. (2012) Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 188(6 Suppl):2473–2481CrossRefGoogle Scholar
  9. 9.
    Jinzaki M, et al. (2011) Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract. AJR Am J Roentgenol 196(5):1102–9CrossRefGoogle Scholar
  10. 10.
    Sudakoff, G.S., et al., Multidetector computerized tomography urography as the primary imaging modality for detecting urinary tract neoplasms in patients with asymptomatic hematuria. J Urol, 2008. 179(3): p. 862-7; discussion 867.Google Scholar
  11. 11.
    Sadow CA, et al. (2010) Positive predictive value of CT urography in the evaluation of upper tract urothelial cancer. AJR Am J Roentgenol 195(5):W337–43CrossRefGoogle Scholar
  12. 12.
    Raman SP, Fishman EK (2018) Upper and Lower Tract Urothelial Imaging Using Computed Tomography Urography. Urol Clin North Am 45(3):389–405CrossRefGoogle Scholar
  13. 13.
    Takeuchi M, et al. (2012) Split-bolus CT-urography using dual-energy CT: feasibility, image quality and dose reduction. Eur J Radiol 81(11):3160–5CrossRefGoogle Scholar
  14. 14.
    Chen CY, et al. (2016) Diagnostic Performance of Split-Bolus Portal Venous Phase Dual-Energy CT Urography in Patients With Hematuria. AJR Am J Roentgenol 206(5):1013–22CrossRefGoogle Scholar
  15. 15.
    Kaza RK, Platt JF (2016) Renal applications of dual-energy CT. Abdom Radiol (NY) 41(6):1122–32CrossRefGoogle Scholar
  16. 16.
    Dillman JR, et al. (2007) Comparison of urinary tract distension and opacification using single-bolus 3-Phase vs split-bolus 2-phase multidetector row CT urography. J Comput Assist Tomogr 31(5):750–7CrossRefGoogle Scholar
  17. 17.
    Chow LC, et al. (2007) Split-bolus MDCT urography with synchronous nephrographic and excretory phase enhancement. AJR Am J Roentgenol 189(2):314–22CrossRefGoogle Scholar
  18. 18.
    McTavish JD, et al. (2002) Multi-detector row CT urography: comparison of strategies for depicting the normal urinary collecting system. Radiology 225(3):783–90CrossRefGoogle Scholar
  19. 19.
    Silverman SG, et al. (2006) Multi-detector row CT urography of normal urinary collecting system: furosemide versus saline as adjunct to contrast medium. Radiology 240(3):749–55CrossRefGoogle Scholar
  20. 20.
    Sanyal R, et al. (2007) CT urography: a comparison of strategies for upper urinary tract opacification. Eur Radiol 17(5):1262–6CrossRefGoogle Scholar
  21. 21.
    Caoili EM, et al. (2005) MDCT urography of upper tract urothelial neoplasms. AJR Am J Roentgenol 184(6):1873–81CrossRefGoogle Scholar
  22. 22.
    Raman SP, Fishman EK (2014) Bladder malignancies on CT: the underrated role of CT in diagnosis. AJR Am J Roentgenol 203(2):347–54CrossRefGoogle Scholar
  23. 23.
    Raman SP, Horton KM, Fishman EK (2013) MDCT evaluation of ureteral tumors: advantages of 3D reconstruction and volume visualization. AJR Am J Roentgenol 201(6):1239–47CrossRefGoogle Scholar
  24. 24.
    Raman SP, Horton KM, Fishman EK (2012) Transitional cell carcinoma of the upper urinary tract: optimizing image interpretation with 3D reconstructions. Abdom Imaging 37(6):1129–40CrossRefGoogle Scholar
  25. 25.
    Washburn ZW, et al. (2009) Computed tomographic urography update: an evolving urinary tract imaging modality. Semin Ultrasound CT MR 30(4):233–45CrossRefGoogle Scholar
  26. 26.
    Kawamoto S, Horton KM, Fishman EK (2008) Transitional cell neoplasm of the upper urinary tract: evaluation with MDCT. AJR Am J Roentgenol 191(2):416–22CrossRefGoogle Scholar
  27. 27.
    Hartman DS, et al. (1988) Infiltrative renal lesions: CT-sonographic-pathologic correlation. AJR Am J Roentgenol 150(5):1061–4CrossRefGoogle Scholar
  28. 28.
    Prando A, Prando P, Prando D (2010) Urothelial cancer of the renal pelvicaliceal system: unusual imaging manifestations. Radiographics 30(6):1553–66CrossRefGoogle Scholar
  29. 29.
    Fritz GA, et al. (2006) Multiphasic multidetector-row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract. Eur Radiol 16(6):1244–52CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  1. 1.Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of MedicineJohns Hopkins UniversityBaltimoreUSA

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