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Comparison of post contrast CT urography phases in bladder cancer detection

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Abstract

Objectives

The aim of this study was to investigate which post-contrast phase(s) in a four-phase CT urography protocol is (are) most suitable for bladder cancer detection.

Methods

The medical records of 106 patients with visible haematuria who underwent a CT urography examination, including unenhanced, enhancement-triggered corticomedullary (CMP), nephrographic (NP) and excretory (EP) phases, were reviewed. The post-contrast phases (n = 318 different phases) were randomized into an evaluation order and blindly reviewed by two uroradiologists.

Results

Twenty-one patients were diagnosed with bladder cancer. Sensitivity for bladder cancer detection was 0.95 in CMP, 0.83 in NP and 0.81 in EP. Negative predictive value (NPV) was 0.99 in CMP, 0.96 in NP and 0.95 in EP. The sensitivity was higher in CMP than in both NP (p-value 0.016) and EP (p-value 0.0003). NPV was higher in CMP than in NP (p-value 0.024) and EP (p-value 0.002).

Conclusions

In the CT urography protocol with enhancement-triggered scan, sensitivity and NPV were highest in the corticomedullary phase, and this phase should be used for bladder assessment.

Key Points

• More bladder tumours are detected during the corticomedullary phase than during other phases.

• Sensitivity and NPV for bladder cancer detection were highest in corticomedullary phase.

• The corticomedullary phase in CT urography should be used for bladder assessment.

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Acknowledgments

The scientific guarantor of this publication is Prof. Anders Magnusson. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors, Lisa Wernroth, has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Twenty-one study subjects have been previously reported in “Contrast enhancement in bladder tumors examined with CT urography using traditional scan phases”, e-pub Dec 23 2013 Acta Radiologica, doi: 10.1177/0284185113513762. Thirty-five study objects were previously reported in “Comparison of four different preparation protocols to achieve bladder distension in patients with gross haematuria undergoing a CT urography”, Radiography 2012, Volume 18, Issue 3, p 206-211. All patients were reported in “Bladder cancer detection in patients with gross haematuria: Computed Tomogaphy urography with enhancement-triggered scan versus flexible cystoscopy”, published in Scandinavian Journal of Urology, posted online on March 20, doi:10.3109/21681805.2015.1026937. Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Surgical Sciences, Section of Radiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden

    Malin Helenius, Par Dahlman, Maria Lonnemark & Anders Magnusson

  2. Department of Surgical Sciences, Section of Urology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden

    Einar Brekkan

  3. Uppsala Clinical Research Center, Uppsala University Hospital, SE-751 85, Uppsala, Sweden

    Lisa Wernroth

Authors
  1. Malin Helenius
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  2. Par Dahlman
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  3. Maria Lonnemark
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  4. Einar Brekkan
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  5. Lisa Wernroth
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  6. Anders Magnusson
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Corresponding author

Correspondence to Malin Helenius.

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Helenius, M., Dahlman, P., Lonnemark, M. et al. Comparison of post contrast CT urography phases in bladder cancer detection. Eur Radiol 26, 585–591 (2016). https://doi.org/10.1007/s00330-015-3844-7

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  • DOI: https://doi.org/10.1007/s00330-015-3844-7

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