Virtual Cystoscopy of the Contrast Material—Filled Bladder in Patients with Gross Hematuria
Jeong Kon Kim1,
Jae Hong Ahn1,
Taehan Park2,
Han Jong Ahn2,
Chung Soo Kim2 and
Kyoung-Sik Cho1
1 Department of Radiology, Asan Medical Center, University of Ulsan, 388-1
Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
2 Department of Urology, Asan Medical Center, University of Ulsan, Seoul,
138-736, South Korea.
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Fig. 1. —Virtual cystoscopy image of normal bladder in healthy
47-year-old man shows contrast material and urine are adequately mixed.
Projected inferior wall shows normal urethral orifice (arrow)
surrounded by smooth mucosal surface.
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Fig. 2. —Virtual cystoscopy image of bladder in 62-year-old man with
transitional cell carcinoma obtained in area toward left wall shows polypoid
lesion (arrows). Surrounding mucosal surface appears normal.
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Fig. 3A. —58-year-old woman with cystitis glandularis. Virtual
cystoscopy image obtained toward inferior wall of bladder shows sessile lesion
with irregular surface (arrows) anterior to urethral orifice
(arrowhead).
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Fig. 3B. —58-year-old woman with cystitis glandularis. Lesion is not
identified on contrast-enhanced single-detector helical abdominopelvic CT scan
of 5-mm intervals obtained at same level as A.
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Fig. 4A. —63-year-old man with 0.2-cm transitional cell carcinoma in
bladder. Virtual cystoscopy image obtained toward right wall shows tiny
polypoid lesion (arrows).
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Fig. 4B. —63-year-old man with 0.2-cm transitional cell carcinoma in
bladder. Lesion is not visible on single-detector helical abdominopelvic CT
scan (5-mm interval) obtained at same level as A.
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Fig. 5A. —False-positive finding of lesion was due to air bubble in
bladder of 46-year-old man who had undergone cystography 3 days before virtual
cystoscopy. We believe that air bubble entered bladder during bladder
catheterization. Virtual cystoscopy image projecting left wall of bladder
reveals 0.2-cm polypoid lesion (arrow) on anterior wall.
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Fig. 5B. —False-positive finding of lesion was due to air bubble in
bladder of 46-year-old man who had undergone cystography 3 days before virtual
cystoscopy. We believe that air bubble entered bladder during bladder
catheterization. At retrospective evaluation of this multidetector helical CT
source image, tiny air bubble (arrow) was identified.
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Fig. 6A. —Virtual images of 54-year-old woman who presented with gross
hematuria are of suboptimal quality because of inadequate mixing of contrast
material and urine. Fluid—fluid level (arrows) is visible on
multidetector helical CT source image.
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Fig. 6B. —Virtual images of 54-year-old woman who presented with gross
hematuria are of suboptimal quality because of inadequare mixing of contrast
material and urine. Virtual cystoscopy image obtained toward anterior wall
(attenuation coefficient range, 150-1400 H) shows multiple artifacts
(arrows) caused by lower attenuation of supernatant layer.
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Fig. 6C. —Virtual images of 54-year-old woman who presented with gross
hematuria are of suboptimal quality because of inadequate mixing of contrast
material and urine. In virtual cystoscopy image with same projection as
B (attenuation coefficient range, 100-1400 H), artifacts (black
arrows) fade and polypoid lesion (white arrows) is now visible.
Lesion was true-positive finding.
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Fig. 7A. —56-year-old man with two transitional cell carcinomas in
bladder. Virtual cystoscopy image projected from anterior wall toward
posterior wall shows large polypoid mass (arrows) in inferior wall
and small sessile lesion (arrowheads) in posterior wall.
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Fig. 7B. —56-year-old man with two transitional cell carcinomas in
bladder. Single-detector helical abdominopelvic CT scan (5-mm interval)
reveals lesion (arrows) in inferior wall. However, second lesion (not
shown) in posterior wall was not identified.
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Copyright © 2002 by the American Roentgen Ray Society.
