[Urotheliomas of the upper urinary tract. The role of computed tomography in integrated diagnostic imaging].
BACKGROUND
Transitional cell carcinomas are frequent in the bladder but rare in the renal pelvis. Most upper urinary tract cancers are suspected and detected with urography and retrograde pyelography; CT is important in the questionable cases at US, urography and retrograde pyelography, but it is also useful to detect locoregional disease. We report the findings of 35 patients, with ureteral lesions to assess the role of CT in the diagnosis and staging.


METHODS
Thirty-five patients were examined with US and CT; 27 underwent urography, 16 retrograde pyelography and 4 nephrostomic pyelography, CT staging was made with Hahn's criteria related to TNM (stages CT I, CT II, CT III). All patients underwent surgery and the histologic findings were compared with CT staging.


RESULTS
CT detected all lesions and characterized them from a morphological viewpoint (intraluminal minus, wall thickening). Using Hahn's CT staging we obtained agreement with histologic findings in 21 of 23 cases in CT stage I, six of 10 in CT stage II and 4 of 5 in CT stage III.


CONCLUSIONS
CT is an important tool for both diagnosis and therapy because it shows the renal cavities and parenchyma and permits accurate staging, differentiating the tumors localized in the wall from those with local spread or distant metastases. In our experience, CT is not useful to differentiate mucosal from pelvic-ureteral muscle invasion but peripelvic and periureteral fat invasion can be suspected when the infiltrated wall exhibits an irregular and spiculated profile.
Pieri
L
L
Cattedra di Radiologia, Clinica Urologica, Università di Pisa.
Tozzini
A
A
Orsitto
E
E
Bulleri
A
A
Morelli
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014567:Urography / Q000379:methods*; D014571:Urologic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology