Imaging protocols for CT urography: results of a consensus conference from the French Society of Genitourinary Imaging

An Editorial Comment to this article was published on 17 January 2020

Abstract

Objectives

To develop technical guidelines for computed tomography urography.

Methods

The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Consensus was strictly defined using a priori criteria.

Results

Forty-two expert uro-radiologists completed both survey rounds with no attrition between the rounds. Ninety-six (70%) of the initial 138 statements of the questionnaire achieved final consensus. An intravenous injection of 20 mg of furosemide before iodinated contrast medium injection was judged mandatory. Improving the quality of excretory phase imaging through oral or intravenous hydration of the patient or through the use of an abdominal compression device was not deemed necessary. The patient should be imaged in the supine position and placed in the prone position only at the radiologist’s request. The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. Repeated single-slice test acquisitions should not be performed to decide of the timing of excretory phase imaging; instead, excretory phase imaging should be performed 7 min after the injection of the contrast medium. The optimal combination of unenhanced, corticomedullary phase and nephrographic phase imaging depends on the context; suggestions of protocols are provided for eight different clinical situations.

Conclusion

This expert-based consensus conference provides recommendations to standardise the imaging protocol for computed tomography urography.

Key Points

To improve excretory phase imaging, an intravenous injection of furosemide should be performed before the injection of iodinated contrast medium.

Systematic oral or intravenous hydration is not necessary to improve excretory phase imaging.

The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation.

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Abbreviations

Cons:

Consensus

CT:

Computed tomography

CTU:

Computed tomography urography

PCNL:

Percutaneous nephro-lithotomy

Ph:

Imaging phase

SUR:

Society of Uro-Radiology

TCC:

Transitional cell carcinoma

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Acknowledgements

The authors thank Aurélie Aubert and Anna Rouvière for their help with data management, and Patrick Poutière for his technical help during the face-to-face meeting. This work was funded by the French Society of Genitourinary Imaging (Société d’imagerie Génito-urinaire, SIGU).

On behalf of the Collaborators of The French Society of Genitourinary Imaging (Société d’Imagerie Génito-Urinaire) Consensus group: Michel Abihanna, Alexandre Ben Cheikh, Flavie Bratan, Laurent Brunereau, Jean Champagnac, François Cornelis, Malek Ezziane, Paul-Hugo Jouve de Guibert, Eric de Kerviler, Yann Lebras, Pierre Leyendecker, Laurent Milot, Paul Moldovan, Sarah Montagne, Isabelle Mollard Garassus, Sébastien Novellas, Gaele Pagnoux, Sylvain Poirée, Philippe Puech, Anne Ravel, Jean-Romain Risson, Rémy Rosset, Athivada Soto Thammavong, Philippe Souteyrand.

Funding

This work was funded by the French Society of Genitourinary Imaging (Société d’imagerie Génito-urinaire, SIGU).

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Correspondence to Raphaële Renard-Penna.

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Renard-Penna, R., Rocher, L., Roy, C. et al. Imaging protocols for CT urography: results of a consensus conference from the French Society of Genitourinary Imaging. Eur Radiol 30, 1387–1396 (2020). https://doi.org/10.1007/s00330-019-06529-6

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Keywords

  • Tomography
  • Spiral computed
  • Urography
  • Guidelines
  • Haematuria