American Journal of Roentgenology, Vol 171, 1349-1354, Copyright © 1998 by American Roentgen Ray Society
Urinary bladder pseudolesions on contrast-enhanced helical CT: frequency and clinical implications
EW Olcott, M Nino-Murcia and JS Rhee
Department of Radiology, Veterans Affairs Palo Alto Health Care System, CA 94304, USA.
OBJECTIVE: The goals of this study were to define the distinguishing
characteristics and frequency of urinary bladder pseudolesions that are
produced as opacified urine enters the bladder during contrast-enhanced
helical CT of the abdomen and to evaluate the usefulness of delayed imaging
in differentiating pseudolesions from true lesions. SUBJECTS AND METHODS:
Contrast-enhanced routine CT scans of 184 patients were obtained
prospectively. For each patient, we also obtained 5-min delayed images of
the bladder. The images were evaluated for apparent focal thickening or
polypoid lesions involving the bladder wall, findings that may represent
bladder neoplasia, without knowledge of the indications for the scan, the
patient's clinical history, or the patient's diagnosis. Apparent lesions
that were visible on routine images and entirely absent on delayed images
were considered to be pseudolesions. RESULTS: Apparent lesions were
identified on 20 (10.9%+/- 4.5% [limits of the 95% confidence interval]) of
the routine CT scans. Using delayed images, the 21 apparent lesions in
these 20 patients were resolved as 13 pseudolesions and eight true lesions.
Pseudolesions were present in 6.5%+/-3.6% of patients. CONCLUSION:
Pseudolesions of the bladder that are indistinguishable from true lesions
pose a significant clinical problem in routine contrast-enhanced helical CT
of the abdomen. Delayed imaging of the bladder is useful in distinguishing
pseudolesions from true lesions.
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