Split-Bolus MDCT Urography with Synchronous Nephrographic and Excretory Phase Enhancement
Lawrence C. Chow1,2,
Sharon W. Kwan1,
Eric W. Olcott1,3 and
Graham Sommer1
1 Department of Radiology, Stanford University School of Medicine, Stanford,
CA.
2 Present address: Department of Radiology, Oregon Health and Science
University, MC L340, 3181 SW Sam Jackson Park Rd., Portland, OR 97201.
3 Department of Radiology, VA Palo Alto Health Care System, Palo Alto, CA.
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Fig. 1A —CT urogram in 41-year-old man with microhematuria. No cause for
hematuria was identified in this patient. Maximum-intensity-projection (MIP)
images from normal CT urogram show areas of peristalsis within ureters
(arrows, B) resulting in undulating appearance of ureteral
contours. Abdominal data set (A) was acquired with abdominal
compression in place; pelvic data set (B) was acquired after release of
compression. Small amount of overlap between two acquisitions ensures that
there are no gaps in coverage resulting from slight differences in
breath-hold.
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Fig. 1B —CT urogram in 41-year-old man with microhematuria. No cause for
hematuria was identified in this patient. Maximum-intensity-projection (MIP)
images from normal CT urogram show areas of peristalsis within ureters
(arrows, B) resulting in undulating appearance of ureteral
contours. Abdominal data set (A) was acquired with abdominal
compression in place; pelvic data set (B) was acquired after release of
compression. Small amount of overlap between two acquisitions ensures that
there are no gaps in coverage resulting from slight differences in
breath-hold.
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Fig. 2A —79-year-old man with new onset of painless hematuria and
infundibular transitional cell carcinoma. Axial (A) and sagittal
(B) images of right kidney from CT urography show method of prescribing
double-oblique plane, coronal to kidney, from which sliding thin-slab
maximum-intensity-projection (MIP) images are generated.
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Fig. 2B —79-year-old man with new onset of painless hematuria and
infundibular transitional cell carcinoma. Axial (A) and sagittal
(B) images of right kidney from CT urography show method of prescribing
double-oblique plane, coronal to kidney, from which sliding thin-slab
maximum-intensity-projection (MIP) images are generated.
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Fig. 2C —79-year-old man with new onset of painless hematuria and
infundibular transitional cell carcinoma. Coronal thin-slab MIP images show
circumferential mass encasing upper pole infundibulum (arrows).
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Fig. 2D —79-year-old man with new onset of painless hematuria and
infundibular transitional cell carcinoma. Coronal thin-slab MIP images show
circumferential mass encasing upper pole infundibulum (arrows).
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Fig. 3A —75-year-old woman with intermittent gross painless hematuria.
Coronal maximum-intensity-projection (MIP) images of right kidney show
soft-tissue mass (open arrows) filling lower pole calyx and
infundibulum with extension into renal pelvis (black arrow,
A). Patient underwent right nephroureterectomy, which revealed invasive
transitional cell carcinoma.
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Fig. 3B —75-year-old woman with intermittent gross painless hematuria.
Coronal maximum-intensity-projection (MIP) images of right kidney show
soft-tissue mass (open arrows) filling lower pole calyx and
infundibulum with extension into renal pelvis (black arrow,
A). Patient underwent right nephroureterectomy, which revealed invasive
transitional cell carcinoma.
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Fig. 4A —Ureteral transitional cell carcinoma. Axial image from CT urography
shows irregular lobulated filling defect (arrows) within distal right
ureter in 85-year-old man with painless hematuria. Ureteroscopy confirmed
finding and patient underwent ureterectomy with reimplantation. Pathology
revealed high-grade transitional cell carcinoma with invasion into muscularis
propria.
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Fig. 4B —Ureteral transitional cell carcinoma. Oblique
maximum-intensity-projection (MIP) image from CT urography in 72-year-old man
with ureteral transitional cell carcinoma shows soft-tissue filling defect
within distal left ureter (solid arrows). Contracted segment of
ureter from peristalsis (open arrow) is also seen.
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Fig. 5 —48-year-old man with history of bladder transitional cell carcinoma.
Patient had undergone resection and bacille Calmette-Guérin (BCG)
treatment with negative cystoscopy. Axial image from CT urography shows
circumferential thickening of distal left ureter (open arrows) with
periureteric stranding, thought to represent recurrent tumor, and normal right
ureter (arrow). Ureteroscopy revealed stricture in this region with
no visible tumor. Ureteroscopic biopsy of this region, performed on two
separate occasions 2 years apart, revealed only inflammatory changes with no
carcinoma. Follow-up imaging over past 4 years has shown no significant change
in appearance of this stricture.
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Fig. 6 —70-year-old man with painless hematuria. Axial image from CT
urography shows pedunculated mass (white arrow) with narrow,
stalklike attachment (open arrow) arising from bladder trigone near
left ureteral orifice. Transurethral resection revealed high-grade papillary
transitional cell carcinoma. Small filling defect (black arrow)
medial to right ureteral orifice represents normal interureteric ridge and
should not be mistaken for tumor. Although bladder tumors can be seen with CT
urography, its sensitivity remains low and it should not be substituted for
cystoscopy.
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Fig. 7A —42-year-old man with one episode of gross, painless hematuria and
right renal cell carcinoma. Coronal thick-slab maximum-intensity-projection
(MIP) image from CT urography performed on 4-MDCT scanner, which simulates
conventional excretory urography, shows no abnormality because of small size
of mass, which does not deform lateral renal contour or renal collecting
system.
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Fig. 7B —42-year-old man with one episode of gross, painless hematuria and
right renal cell carcinoma. Sagittal image from CT urography clearly shows
mass (arrows) involving anterior upper pole.
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Fig. 8 —24-year-old man with flank pain. Curved planar reformation image
through left kidney and ureter from unenhanced scan shows medullary
nephrocalcinosis, multiple calculi, within distal left ureter (solid
arrow); ureteral thickening; and extensive periureteric stranding
(open arrows).
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Fig. 9A —62-year-old woman with microscopic hematuria. Coronal
maximum-intensity-projection (MIP) image of abdomen (A) and coronal
oblique MIP image of pelvis (B) from CT urography show complete
duplication of right renal collecting system with completely separate upper
pole (black arrows) and lower pole (white arrows) ureters
all way to level of bladder, both with orthotopic bladder insertion. Urologic
workup, including cystoscopy, was otherwise completely normal, and cause for
hematuria was not identified.
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Fig. 9B —62-year-old woman with microscopic hematuria. Coronal
maximum-intensity-projection (MIP) image of abdomen (A) and coronal
oblique MIP image of pelvis (B) from CT urography show complete
duplication of right renal collecting system with completely separate upper
pole (black arrows) and lower pole (white arrows) ureters
all way to level of bladder, both with orthotopic bladder insertion. Urologic
workup, including cystoscopy, was otherwise completely normal, and cause for
hematuria was not identified.
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Fig. 10A —23-year-old woman with intermittent gross hematuria for 5 days.
Maximum-intensity-projection (MIP) images from CT urography show pooling of
contrast material within multiple papillae bilaterally (open arrows)
consistent with papillary necrosis. Filling defect within left renal pelvis
(solid arrow, B) was shown to represent blood clot at
ureteroscopy. Patient was later found to have sickle cell trait.
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Fig. 10B —23-year-old woman with intermittent gross hematuria for 5 days.
Maximum-intensity-projection (MIP) images from CT urography show pooling of
contrast material within multiple papillae bilaterally (open arrows)
consistent with papillary necrosis. Filling defect within left renal pelvis
(solid arrow, B) was shown to represent blood clot at
ureteroscopy. Patient was later found to have sickle cell trait.
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Fig. 11 —Coronal maximum-intensity-projection (MIP) image from CT urography
of 51-year-old woman with microscopic hematuria and interstitial cystitis.
Medullary pyramids show striated, paint-brush appearance of renal tubular
ectasia.
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Copyright © 2007 by the American Roentgen Ray Society.
