Korean J Urol.  2011 Jan;52(1):13-18.

Accuracy and Factors Affecting the Outcome of Multi-Detector Computerized Tomography Urography for Bladder Tumors in the Clinical Setting

• Hwang EC
• Kim JS
• Kim SO
• Jung SI
• Kang TW
• Kwon DD
• Park K
• Ryu SB
• Kim JW
• Wan LJ

Abstract

PURPOSE
The objective of this study was to investigate the diagnostic accuracy of multi-detector computerized tomography urography (MDCTU) for the detection of bladder tumors.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 143 patients who were scanned by use of 64-channel MDCTU and who underwent cystoscopy due to painless hematuria or a clinical suspicion of bladder tumor. We examined the accuracy of MDCTU for the detection of bladder tumors by comparing the results obtained by MDCTU with those obtained by cystoscopy. The associations between tumor characteristics, frequency of transurethral resection (TUR), and bladder volume and detectability of bladder tumors on MDCTU were also analyzed.
RESULTS
Of 143 patients, 50 patients had a history of urothelial carcinomas. In these patients, the sensitivity and specificity of MDCTU were 60.0% and 80.0%, respectively. In 93 patients without previous urothelial carcinomas, the sensitivity and specificity of MDCTU were 86.7% and 96.8%, respectively. Falsely diagnosed cases had a smaller distended bladder volume (p=0.014) and a smaller tumor size (p=0.022) than did true diagnosed cases. The false-negative rate increased when the bladder tumor was located at the bladder neck. In the univariate analysis, the tumor location, size, frequency of TUR, bladder volume, and initial hematuria were associated with detectability by MDCTU (p<0.05).
CONCLUSIONS
To improve the accuracy of MDCTU for diagnosing bladder tumors, bladder filling is recommended. Thus, cystoscopy should be considered as a standard diagnostic tool for bladder tumors even in patients with normal MDCTU results, especially in the evaluation of recurrent, bladder neck-located, small, or sessile bladder tumors.

Keyword

Hematuria; Tomography, spiral computed; Urinary bladder neoplasms

MeSH Terms

Cystoscopy
Hematuria
Humans
Medical Records
Neck
Retrospective Studies
Sensitivity and Specificity
Tomography, Spiral Computed
Urinary Bladder
Urinary Bladder Neoplasms
Urography

Figure

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  FIG. 1 Urothelial carcinomas of the bladder and left distal ureter. (A) Axial 2D and (B) 3D volume rendering (VR) CT urograms obtained during the excretory phase show an 11 mm mass (arrow) near the left ureterovesical junction and a 5 mm mass (arrowhead) in the left distal ureter in a 51-year-old man evaluated for gross hematuria. The masses were also detected during the cystoscopy performed after CT urography.

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