MDCT Urography of Upper Tract Urothelial Neoplasms
Elaine M. Caoili1,
Richard H. Cohan1,
Prasuna Inampudi1,
James H. Ellis1,
Rajal B. Shah2,
Gary J. Faerber3 and
James E. Montie3
1 Department of Radiology, University of Michigan Health System, B1-132 Taubman
Center 0302, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0302.
2 Department of Pathology, University of Michigan Health System, Ann Arbor, MI
48109-0302.
3 Department of Urology, University of Michigan Health System, Ann Arbor, MI
48109-0302.
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Fig. 1. —59-year-old man with papillary transitional cell carcinoma of
right collecting system. Contrast-enhanced axial MDCT scan shows large (> 5
mm) mass (arrow) in right renal pelvis. Tumor stage is not available
on this patient, who was diagnosed only with endoscopic biopsy.
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Fig. 2A. —74-year-old man with unstaged papillary transitional cell
carcinoma of right collecting system. Contrast-enhanced axial MDCT scan shows
upper pole infundibular urothelial wall thickening (arrows) that
represents cancer.
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Fig. 2B. —74-year-old man with unstaged papillary transitional cell
carcinoma of right collecting system. Lesion (arrow) is less well
depicted on average-intensity-projection image.
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Fig. 3A. —65-year-old man after right nephrectomy for transitional cell
carcinoma with unstaged papillary carcinoma of left collecting system.
Excretory phase axial MDCT scan viewed with wide window setting shows two
small ( 5 mm) masses in left intrarenal collecting system
(arrows). Lesions were not seen when standard soft-tissue window
setting was used.
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Fig. 3B. —65-year-old man after right nephrectomy for transitional cell
carcinoma with unstaged papillary carcinoma of left collecting system.
Volume-rendered image is unremarkable and also does not show tumor.
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Fig. 4A. —67-year-old man with flat carcinoma in situ of left distal
ureter. Excretory phase axial MDCT scan (A) and volume-rendered image
(B) show poor opacification of left distal ureteral segment
(arrow). Urothelial cancer was missed on both prospective and
retrospective review. Banding artifact overlying renal parenchyma on
volume-rendered image is due to injection pump implant.
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Fig. 4B. —67-year-old man with flat carcinoma in situ of left distal
ureter. Excretory phase axial MDCT scan (A) and volume-rendered image
(B) show poor opacification of left distal ureteral segment
(arrow). Urothelial cancer was missed on both prospective and
retrospective review. Banding artifact overlying renal parenchyma on
volume-rendered image is due to injection pump implant.
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Fig. 5A. —76-year-old woman with noninvasive (stage Ta) papillary
transitional cell carcinomas of left collecting system. Excretory phase axial
MDCT image with wide window setting of left renal pelvis shows small ( 5
mm) masses (arrows).
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Fig. 5B. —76-year-old woman with noninvasive (stage Ta) papillary
transitional cell carcinomas of left collecting system. Lesions are much more
difficult to identify on same image using soft-tissue window setting.
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Fig. 6A. —56-year-old man with papillary transitional cell carcinoma of
left collecting system, which invades renal parenchyma (stage T3). Standard
excretory phase axial MDCT image (A) and maximum-intensity-projection
image (B) of left upper pole show large infundibular and caliceal mass
(arrows).
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Fig. 6B. —56-year-old man with papillary transitional cell carcinoma of
left collecting system, which invades renal parenchyma (stage T3). Standard
excretory phase axial MDCT image (A) and maximum-intensity-projection
image (B) of left upper pole show large infundibular and caliceal mass
(arrows).
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Fig. 7. —73-year-old man with high-grade papillary transitional cell
carcinoma of right collecting system and invasion of lamina propria (stage
T1). Excretory phase axial CT image of right renal pelvis shows urothelial
thickening (arrows). Thickening could not be identified on any 3D
image, each of which showed only normal-appearing renal pelvis.
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Fig. 8A. —76-year-old man after radical cystectomy for bladder
carcinoma. Patient has high-grade papillary transitional cell carcinoma of
left collecting system and invasion into renal parenchyma (stage T3).
Excretory phase axial MDCT image of left kidney shows large infiltrative mass
in upper pole (arrows).
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Fig. 8B. —76-year-old man after radical cystectomy for bladder
carcinoma. Patient has high-grade papillary transitional cell carcinoma of
left collecting system and invasion into renal parenchyma (stage T3). Although
maximum-intensity-projection image shows distortion of collecting system from
upper pole tumor (arrow), full extent of tumor is not determined and
renal parenchymal invasion cannot be identified.
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Copyright © 2005 by the American Roentgen Ray Society.
